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Some elements of the DSM-5, released nearly 6 months ago now, follow a tricky path between giving the psychiatric community useful, new diagnostic tools and pathologizing what is part of the normal range of human behavior, but despite that, the manual seems to generally succeed in "better classifying the patients who come to psychiatrists," said Dr. Guy Goodwin, head of the psychiatry department at the University of Oxford (England).
Dr. Goodwin spoke in an unusual press conference during the annual Congress of the European College of Neuropsychopharmacology (ECNP) in Barcelona in October. The topic was the still somewhat new Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and the role of diagnosis in psychiatry, which did not link to any report or talk at the meeting. The press conference seemed mostly a way for Dr. Goodwin, who became president of the ECNP during the meeting, and two other participants to give their thoughts on the DSM-5 and shifting views on psychiatric diagnoses, especially in children.
Dr. Goodwin ultimately called himself "sort of pro-DSM-5" and said that the key test of whether the diagnostic changes made by the DSM-5 were a step forward or not will come with time, as psychiatrists determine whether following the DSM-5 results in better diagnosis and patient care.
He offered an example of what he said some have characterized as a disorder "invented" by the DSM-5, disruptive mood dysregulation disorder (DMDD). It was an interesting choice for Dr. Goodwin to highlight, as he is not a pediatric specialist, although he noted it ties to his practice of treating patients with bipolar disorder because DMDD was designed as a replacement diagnosis for many children previously diagnosed with bipolar disorder. DMDD also has a history of controversy going back several years to when the DSM-5 writing group struggled with how to deal with what many saw as overdiagnosis of bipolar disease in children.
The DSM-5 "is trying to stop" the diagnosis of bipolar disease by U.S. psychiatrists in children as young as 3 years old "by inventing a disorder that describes these problematic children." DMDD is "a diagnosis that takes you into areas of judgment that many people are uncomfortable with," such as deciding whether outbursts by children are "grossly out of proportion" to the situation, Dr. Goodwin said. "It’s specific to the United States, and I think the rest of the world has difficulty with this. You’ve added another diagnosis that’s carved out of normal childhood experience. This is the difficulty for people with the perspective that all diagnoses are bad labels."
But Dr. Goodwin also noted that the DSM-5 "set the bar high" when designing the diagnosis. "U.S. psychiatrists see this as a way to stop the pathologizing of normal life" by creating a high threshold for diagnosis that is rarely met.
Dr. Goodwin also stressed that psychiatric diagnoses are not inherently bad for patients. Research findings, including work he collaborated on, showed that patients generally welcome a diagnosis and don’t feel stigmatized by it.
"Diagnoses are useful, because they give patients a starting point for understanding their problems and give clinicians a starting point for understanding" the best way to manage each patient, he said. "What patients want is an explanation of their situation."
A second speaker at the press conference, Dr. Celso Arango, head of child and adolescent psychiatry at a university hospital in Madrid and president-elect of ECNP, offered his own take on diagnosing psychiatric disorders in children that indirectly added another dimension to questions about DMDD’s validity and role.
Although psychiatric disorders are usually first diagnosed in adults, "they start much earlier. More than 70% of mental illnesses present first symptoms during childhood," said Dr. Arango. "The earlier we intervene, the lower the risk of a more severe disorder." He cited recent study results documenting the cost effectiveness of early intervention in children diagnosed with psychosis.
The DMDD diagnosis "may or may not be useful. If you count kids with this new diagnosis and find that it’s useful, that it’s a precursor for later problems, and is something we need to take seriously and treat, then it may be a prelude to successful intervention," Dr. Goodwin said.
On Twitter @mitchelzoler
Some elements of the DSM-5, released nearly 6 months ago now, follow a tricky path between giving the psychiatric community useful, new diagnostic tools and pathologizing what is part of the normal range of human behavior, but despite that, the manual seems to generally succeed in "better classifying the patients who come to psychiatrists," said Dr. Guy Goodwin, head of the psychiatry department at the University of Oxford (England).
Dr. Goodwin spoke in an unusual press conference during the annual Congress of the European College of Neuropsychopharmacology (ECNP) in Barcelona in October. The topic was the still somewhat new Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and the role of diagnosis in psychiatry, which did not link to any report or talk at the meeting. The press conference seemed mostly a way for Dr. Goodwin, who became president of the ECNP during the meeting, and two other participants to give their thoughts on the DSM-5 and shifting views on psychiatric diagnoses, especially in children.
Dr. Goodwin ultimately called himself "sort of pro-DSM-5" and said that the key test of whether the diagnostic changes made by the DSM-5 were a step forward or not will come with time, as psychiatrists determine whether following the DSM-5 results in better diagnosis and patient care.
He offered an example of what he said some have characterized as a disorder "invented" by the DSM-5, disruptive mood dysregulation disorder (DMDD). It was an interesting choice for Dr. Goodwin to highlight, as he is not a pediatric specialist, although he noted it ties to his practice of treating patients with bipolar disorder because DMDD was designed as a replacement diagnosis for many children previously diagnosed with bipolar disorder. DMDD also has a history of controversy going back several years to when the DSM-5 writing group struggled with how to deal with what many saw as overdiagnosis of bipolar disease in children.
The DSM-5 "is trying to stop" the diagnosis of bipolar disease by U.S. psychiatrists in children as young as 3 years old "by inventing a disorder that describes these problematic children." DMDD is "a diagnosis that takes you into areas of judgment that many people are uncomfortable with," such as deciding whether outbursts by children are "grossly out of proportion" to the situation, Dr. Goodwin said. "It’s specific to the United States, and I think the rest of the world has difficulty with this. You’ve added another diagnosis that’s carved out of normal childhood experience. This is the difficulty for people with the perspective that all diagnoses are bad labels."
But Dr. Goodwin also noted that the DSM-5 "set the bar high" when designing the diagnosis. "U.S. psychiatrists see this as a way to stop the pathologizing of normal life" by creating a high threshold for diagnosis that is rarely met.
Dr. Goodwin also stressed that psychiatric diagnoses are not inherently bad for patients. Research findings, including work he collaborated on, showed that patients generally welcome a diagnosis and don’t feel stigmatized by it.
"Diagnoses are useful, because they give patients a starting point for understanding their problems and give clinicians a starting point for understanding" the best way to manage each patient, he said. "What patients want is an explanation of their situation."
A second speaker at the press conference, Dr. Celso Arango, head of child and adolescent psychiatry at a university hospital in Madrid and president-elect of ECNP, offered his own take on diagnosing psychiatric disorders in children that indirectly added another dimension to questions about DMDD’s validity and role.
Although psychiatric disorders are usually first diagnosed in adults, "they start much earlier. More than 70% of mental illnesses present first symptoms during childhood," said Dr. Arango. "The earlier we intervene, the lower the risk of a more severe disorder." He cited recent study results documenting the cost effectiveness of early intervention in children diagnosed with psychosis.
The DMDD diagnosis "may or may not be useful. If you count kids with this new diagnosis and find that it’s useful, that it’s a precursor for later problems, and is something we need to take seriously and treat, then it may be a prelude to successful intervention," Dr. Goodwin said.
On Twitter @mitchelzoler
Some elements of the DSM-5, released nearly 6 months ago now, follow a tricky path between giving the psychiatric community useful, new diagnostic tools and pathologizing what is part of the normal range of human behavior, but despite that, the manual seems to generally succeed in "better classifying the patients who come to psychiatrists," said Dr. Guy Goodwin, head of the psychiatry department at the University of Oxford (England).
Dr. Goodwin spoke in an unusual press conference during the annual Congress of the European College of Neuropsychopharmacology (ECNP) in Barcelona in October. The topic was the still somewhat new Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and the role of diagnosis in psychiatry, which did not link to any report or talk at the meeting. The press conference seemed mostly a way for Dr. Goodwin, who became president of the ECNP during the meeting, and two other participants to give their thoughts on the DSM-5 and shifting views on psychiatric diagnoses, especially in children.
Dr. Goodwin ultimately called himself "sort of pro-DSM-5" and said that the key test of whether the diagnostic changes made by the DSM-5 were a step forward or not will come with time, as psychiatrists determine whether following the DSM-5 results in better diagnosis and patient care.
He offered an example of what he said some have characterized as a disorder "invented" by the DSM-5, disruptive mood dysregulation disorder (DMDD). It was an interesting choice for Dr. Goodwin to highlight, as he is not a pediatric specialist, although he noted it ties to his practice of treating patients with bipolar disorder because DMDD was designed as a replacement diagnosis for many children previously diagnosed with bipolar disorder. DMDD also has a history of controversy going back several years to when the DSM-5 writing group struggled with how to deal with what many saw as overdiagnosis of bipolar disease in children.
The DSM-5 "is trying to stop" the diagnosis of bipolar disease by U.S. psychiatrists in children as young as 3 years old "by inventing a disorder that describes these problematic children." DMDD is "a diagnosis that takes you into areas of judgment that many people are uncomfortable with," such as deciding whether outbursts by children are "grossly out of proportion" to the situation, Dr. Goodwin said. "It’s specific to the United States, and I think the rest of the world has difficulty with this. You’ve added another diagnosis that’s carved out of normal childhood experience. This is the difficulty for people with the perspective that all diagnoses are bad labels."
But Dr. Goodwin also noted that the DSM-5 "set the bar high" when designing the diagnosis. "U.S. psychiatrists see this as a way to stop the pathologizing of normal life" by creating a high threshold for diagnosis that is rarely met.
Dr. Goodwin also stressed that psychiatric diagnoses are not inherently bad for patients. Research findings, including work he collaborated on, showed that patients generally welcome a diagnosis and don’t feel stigmatized by it.
"Diagnoses are useful, because they give patients a starting point for understanding their problems and give clinicians a starting point for understanding" the best way to manage each patient, he said. "What patients want is an explanation of their situation."
A second speaker at the press conference, Dr. Celso Arango, head of child and adolescent psychiatry at a university hospital in Madrid and president-elect of ECNP, offered his own take on diagnosing psychiatric disorders in children that indirectly added another dimension to questions about DMDD’s validity and role.
Although psychiatric disorders are usually first diagnosed in adults, "they start much earlier. More than 70% of mental illnesses present first symptoms during childhood," said Dr. Arango. "The earlier we intervene, the lower the risk of a more severe disorder." He cited recent study results documenting the cost effectiveness of early intervention in children diagnosed with psychosis.
The DMDD diagnosis "may or may not be useful. If you count kids with this new diagnosis and find that it’s useful, that it’s a precursor for later problems, and is something we need to take seriously and treat, then it may be a prelude to successful intervention," Dr. Goodwin said.
On Twitter @mitchelzoler
