Tuesday, February 19, 2013

DSM-5 promoting "sick society" by labelling legitimate worry as mental illness

...observers fear the expanded definition will lead to widespread over-diagnosis and inappropriate treatment of people with medical illnesses, including the “worried well.”

“This DSM-5 overreach touches the lives of everyone who is medically ill,” says Dr. Allen Frances, a professor emeritus at Duke University who chaired the task force that wrote the previous edition of the manual, known as DSM-IV.
"The fundamental change is that they’re allowing the diagnosis if a person has just one physical symptom that they worry about (for at least six months), and they’ve eliminated the hierarchies that previously protected against over-diagnosis,” he said. (from "‘The sickening of society’: New psychiatric disorder could label people who worry about their physical health as mentally ill" by Sharon Kirkey, National Post, February 18, 2013, excerpted below)
Under George W. Bush, it was known as "shock and awe" in the then administration's bravado about the manner in which the U.S. would attack Saddam Hussein in Iraq. In Mali, the world again uses the phrase "mission creep" to describe a phenomenon known as snailing into another conflict with non-state terrorists.
In psychiatry, we also are witnessing what can only be described as "mission creep" or better yet, mission gallop, as more and more people, people who should be legitimately worried about a potentially terminal illness, are double-diagnosed as mentally ill to boot.
Somatic Symptom Disorder is the new label included in the soon-to-be-published DSM-5, and some seven million people could fall under both its diagnosis, as well as additional "treatment".
If Coke expanded its reach, we would call it marketing. If the New York Yankees won another World Series, we would call it "buying the pennant". In psychiatry, are we expected to lie down in our angst and "take more pills" prescribed under the rubric of the Diagnostic Statistical Manual, the bible for growing the practice of psychiatry, and thereby covered by most insurance plans?
This is really a time for the public to barricade ourselves in our homes, pour a glass of Volpolicello, put our feet up and talk intimately with our partner, and let the ravages of such professional and intellectual pomposity flow out to sea with the rest of the flotsam and jetsam. I am reminded of the mother who barricaded herself behind the door of her son's hospital room, after he had suffered a serious accident in which both legs were broken and the diagnosis and prescription from the medical staff was to amputate both legs. She screemed that she would not let any doctor near her bed-ridden son, until her country-doctor friend arrived. Upon his arrival, he saved both legs and the young man went on to a successful athletic career on both legs.
If and when we hear a serious, even terminal diagnosis, we can all be reminded that somewhere there is an army of doctors, trained psychiatrists, who will be ready, willing and eager to listen to our legitimate anxiety and treat what has to be one of the most normal, natural and predictable conditions of worry about our mortality...
Isn't there a clause in the Hippocratic Oath that requires doctors to "do no harm"?
What happened to that clause in the deliberations of the DSM-5 committee?

‘The sickening of society’: New psychiatric disorder could label people who worry about their physical health as mentally ill

By Sharon Kirkey, Postmedia News, in National Post, February 18, 2013
A controversial new mental diagnosis could label thousands of people with legitimate medical illnesses as psychiatrically sick and in need of treatment if they worry “excessively” about their symptoms, observers say.

The newest version of psychiatry’s official catalogue of mental disorders, due to be published in May, will contain a newly expanded definition of “somatic symptom disorder,” or SSD.
Under the previous edition of the Diagnostic and Statistical Manual of Mental Disorders — an influential guidebook used by doctors around the globe — somatoform disorders applied to people with medically unexplained health complaints. The diagnosis required that physical, bodily symptoms couldn’t be traced to any identifiable, underlying medical cause.
In the fifth and latest edition of the manual, known as DSM-5, that proviso has been removed.
The new diagnosis doesn’t distinguish between “medically unexplained” symptoms or symptoms related to an actual underlying medical problem.

According to the American Psychiatric Association, publishers of the DSM, “some patients with illnesses like heart disease or cancer will indeed experience thoughts, feelings or behaviours related to their illness that will be extreme or overwhelming” and that these individuals “may qualify for an SSD diagnosis.”
But observers fear the expanded definition will lead to widespread over-diagnosis and inappropriate treatment of people with medical illnesses, including the “worried well.”
“This DSM-5 overreach touches the lives of everyone who is medically ill,” says Dr. Allen Frances, a professor emeritus at Duke University who chaired the task force that wrote the previous edition of the manual, known as DSM-IV.
"The fundamental change is that they’re allowing the diagnosis if a person has just one physical symptom that they worry about (for at least six months), and they’ve eliminated the hierarchies that previously protected against over-diagnosis,” he said.

“In DSM-IV you wouldn’t pin a mental disorder label on someone with a medical illness until you had first ruled out several different important possibilities,” he said — including that the person is worried about something real.
“If a person has a medical illness that’s worrisome, they should be worried about it,” Frances said.
The American Psychiatric Association says that the new criteria will help doctors better identify people who need treatment.








No comments:

Post a Comment