Diagnostic and Statisical Manual of Mental Disorders

[TDurden1937]

This thread has been split from [DLMURL]http://www.ptsdforum.org/thread6899.html[/DLMURL].

See I'm not putting any one's opinion down here okay. No one.

I'm just sayin' 1) there are multiple ways the term "crazy" is used from sayin' to a friend, "Aw don't act so crazy." to calling the fella walking around in the park talking to him/herself crazy. 2) in my opinion the DSM is a pile of useless crap. No doctor ever developed a treatment plan using the dsm. It's used mainly to fill out forms for insurance companies, hospitals, etc. When I rx'ed meds I did it by symptom, not diagnosis. 3) getting a diagnosis in itself can be extremely stigmatizing. Get a label of Bipolar Mood Disorder well controlled with say Li, and put that on a job app. and see what happens as apposed to a type I diabetic who controls the diabetes with oral meds, food and exercise. You can kiss your career goodbye.

 

[anthony]

in my opinion the DSM is a pile of useless crap. No doctor ever developed a treatment plan using the dsm. It's used mainly to fill out forms for insurance companies, hospitals, etc. When I rx'ed meds I did it by symptom, not diagnosis.

I think your opinion is very wrong then Doug (valid as an opinion, but wrong)... because what you're stating is not what the DSM is even remotely about. The DSM is to help standardize physicians across the board to agreed diagnostic criteria to help aid correct diagnosis. That doesn't mean a physician will get it right, but I guarantee since its inception that those getting it right has increased significantly than without such a standardization mechanism. I think maybe you need to rethink your place on such a valuable tool that is utilised globally.

 

[upstream]

The DSM is to help standardize physicians across the board to agreed diagnostic criteria to help aid correct diagnosis. That doesn't mean a physician will get it right, but I guarantee since its inception that those getting it right has increased significantly than without such a standardization mechanism.

I'm informed that when Vietnam Vets started coming home, a large number of them were diagnosed as bipolar. Not surprisingly it turned out to be misdiagnosed PTSD.

Mentally retarded adults are often misdiagnosed as bipolar, because their limitations and struggles can cause their lives to be emotional roller coasters.

I was given a list of symptoms from my Aunt. I responded that those symptoms were textbook anti-social personality disorder. Then she mentioned he was a minority in a gang and described the context surrounding those symptoms. So turned out he doesn't necessarily have the disorder, he's just adapting to his environment in an effort to survive.

My point is the DSM is an excellent educational tool, but in many cases it is nothing more than statistical analysis and probability. Unless you have something cut and dry like the person hears voices and believes they are god (schizophrenia)... I would have to agree with TDurden. It is more important to look at the symptoms than to try to categorize a person into this or that.

Can we move the DSM conversation into a new thread?

 

[anthony]

Upstream, I do agree with the medication aspect, being it is diagnosed on a symptom basis, not a disorder basis "typically", though not always. You refer to Vietnam era... which is where I believe this is becoming confusing or your basis of data extends. That era from 1959 - 1975 only seen the DSM I & DSM II, both of which only distinguished between psychosis and a neurosis, nothing more or less. That means, all those diagnosed up until 1980 when the DSM III was released where likely diagnosed incorrectly, which the psychiatric community realised and accepted, hence the standard formation and change to the DSM where the psychodynamic view was abandoned and the medical model became the primary approach, introducing a clear distinction between normal and abnormal. The DSM became "atheoretical", since it had no preferred etiology for mental disorders.

I agree that the book is not the first place to go, but that is training you undertake as a psychology student. Within the field you understand that a history is what your basis is taken from, not just listen to a few issues and pull-out the DSM for a diagnosis. I have no issues agreeing that some physicians nowadays do exactly this, but that is due to money and ignorance... being the more labels they can slap you with, then the more pharmaceuticals they can diagnose you with based on the symptoms. A physician cannot prescribe a medication that does not directly correlate to a symptom, yes agreed.

If it where not for the DSM, you would still have the majority of physicians diagnoses PTSD sufferers with Bi-Polar, instead now you only get a minority do that and make the stuff-up.

My absolute disagreement is with the statement Doug made, "DSM is a pile of useless crap" which is a crap statement. Without the DSM in today's evolving state, we would still be diagnosing troops with Bi-Polar disorder or the like.... many would still be dieing instead of receiving atleast the semi-correct treatment the majority of the time. A significant portion of Vietnam veterans killed themselves because they where not treated for PTSD. Physicians started the DSM in that era, they didn't have it close to right though. They got it near correct by DSM III, though again, the book and its diagnoses evolve the more they learn through science, studies and the like. It was never designed to be used to replace a shrink, never... it was designed to help shrinks provide a standardized level of diagnostic ability across the globe and where regardless a person went, the criteria is the same from country to country. That is what the book achieved... which in itself is quite a milestone to say the least IMO that is.

 

[upstream]

My absolute disagreement is with the statement Doug made, "DSM is a pile of useless crap" which is a crap statement.

Yeah I didn't agree with that aspect of his argument either. I just didn't believe the DSM should be the end-all-be-all concrete bible of mental health science. It's still evolving as we learn and the diagnostic methods are far too dependent on human judgment rather than scientific evidence.

Without the DSM in today's evolving state, we would still be diagnosing troops with Bi-Polar disorder or the like.... many would still be dieing instead of receiving atleast the semi-correct treatment the majority of the time. A significant portion of Vietnam veterans killed themselves because they where not treated for PTSD. Physicians started the DSM in that era, they didn't have it close to right though. They got it near correct by DSM III, though again, the book and its diagnoses evolve the more they learn through science, studies and the like. It was never designed to be used to replace a shrink, never... it was designed to help shrinks provide a standardized level of diagnostic ability across the globe and where regardless a person went, the criteria is the same from country to country. That is what the book achieved... which in itself is quite a milestone to say the least IMO that is.

Did not know this about DSM I and II, excellent point Anthony. Also that certainly sounds like a milestone to me.

 

[anthony]

Yep, you and I could change countries mate and we would be assessed on the exact same criteria... and both end up with the same diagnosis, even being in different countries. I think that is amazing that the psychiatric community came together worldwide to agree in a "majority" viewpoint on specific aspects to provide a global balance to mental health. Someone said something similar to me face to face about the DSM, and when I said something similar to them in return, they thought about it and changed their mind on the DSM. They thought it was the end all of diagnosis, when in fact it has nothing really to do with that, it was about a minimum standard to meet a global standardization, so regardless where you go in the world for mental health treatment you will be assessed based on the same minimum standards.

Obviously the physicians individual knowledge, experience and personality then comes into play on any actual diagnosis. To me, not even physicians are created equal... as they often specialise in certain streams just as therapists do. Finding the right one for trauma is often just as much a case as is finding a trauma therapist.

 

[lrs]

I have seen first hand how it used to be.
I started seeing counselors in high school, then in college, then in professional life b/c I knew something was wrong. None of these people, ever snapped to what I had. :dontknow:
I am guessing that none of these people had the tools to piece together what would today be a simple diagnosis. :poke:
If you can not make an accurate diagnosis, of any type of illness, you certainly are not going to have much luck treating it.:think:
Today, it is a different story. They can make a diagnosis so accurate and descriptive, it'd scare you. :clap:

 

[upstream]

it was about a minimum standard to meet a global standardization, so regardless where you go in the world for mental health treatment you will be assessed based on the same minimum standards.

Does anyone know of any competing ideas out there that are not entirely in line with the DSM?

 

[anthony]

What do you mean upstream? There are no other manuals of type if that is what your referring, not like the DSM anyway.

 

[upstream]

I'm asking if there are prevailing theories about mental health and mental illness that come into conflict with material in the DSM-IV TR, or if the manual is widely accepted by the mental health community.

In my opinion, our understanding of mental health is still in its infancy... much like the days when we were debating whether or not micro organisms were created from reproduction or spontaneous generation.

 

[Deleted member 487]

DSM-IV has a great deal of potential in assisting the diagnosis of a client, but it's not the "crystal ball" some counselors have believed. There is too much detail one can get from a client that the book just doesn't cover.

A good example is a Chilton's book. For those of you that don't know what that is, it's a manual published that mechanics use to fix cars. Most generally backyard mechies that do it themselves.

Your engine is knocking. Ok, read up on it, and you'll find a dozen possible causes. But then you add the details- it also has black smoke for the first 5 minutes after start up. That just narrowed it down.

With a mechanical item, it's not that hard to narrow down the problem. But the human psyche is so dynamic, so diverse, it's not possible to have the same assurance of accuracy.

Like when I was in Utah some years back. Doctors diagnosed me with Bi-Polar Disorder. As I found out yesterday, there are even counselors here in Colorado that have diagnosed me with it. But...but....but how can they? They never did an evaluation on me! The doctors I went to in Wyoming were baffled. I had ZERO symptoms showing BPD. NOTHING. And that's counting the Utah doctor's notes! So just like here, they don't spend the time to find what the problem is. They pump you full of drugs and send you on your merry way.

THAT is why the DSM-IV is important. If you have nothing to base a diagnosis upon, what good is the diagnosis? "Oh, I just think he has BPD, so I put him on the meds"? Nah, not right in any way I can imagine.

The DSM-IV gives a foundation. The details the counselor gets then fills in the holes left by the DSM-IV.

Here's a tidbit I never shared about my meds, but worth mentioning-
When I was on those meds, paxil, depakote & risperidal, I was borderline on spending money on a sex change. I was so intent on this. I honestly felt I was a woman inside. I was not suicidal as in trying to kill myself, but I had a lot of suicidal thoughts. I had the stuff there that I could have done it without a problem and succeed. But I didn't. I had a great deal of difficulty with my temper. Because as I found out, I was on the wrong meds and the doctors wouldn't believe me.

Now, being on nutiritional suppliments, I no longer have any temper issues. I get mad, but hey, I'm human. I have emotions. I am no longer in any way suicidal. Not the thoughts and certainly not the actions. And I no longer think I'm a woman inside. I am truly comfortable with my sexuality.

So now reflecting on the issue of the DSM-IV, HAD the counselors actually paid any attention to the definitions and suspect causes in the DSM-IV, I would never have been placed on those medications. THAT is why a foundation is needed.
HTH

 

[upstream]

What do you mean upstream? There are no other manuals of type if that is what your referring, not like the DSM anyway.

There is The International Statistical Classification of Diseases and Related Health Problems (ICD) and more recently The Psychodynamic Diagnostic Manual (PDM)