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That's what DSM-5 needs: One more diagnosis

Nassir Ghaemi, MD, Psychiatry/Mental Health, 09:29PM Sep 19, 2012

Maybe I just don't understand, but suppose you agree with all the world that hates the diagnosis of bipolar disorder in children. Exactly how does it make sense for DSM-5 to specificially try to discourage the diagnosis of bipolar disorder in children by adding another diagnosis - Temper Dysregulation Disorder (TDD), something in between oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD) - so that if a child is aggressive and hyperactive you can give him one, or all of these other diagnoses - and not bipolar disorder?

People complain about DSM: they say it has about 400 diagnoses - that's too much. People complain about the pharmaceutical industry: they say they create diagnoses for their drugs. So how is it a solution to make up one more diagnosis, thinking we can outsmart the pharmaceutical industry so that we don't use their drugs anymore for bipolar disorder? I have a hunch the pharmaceutical industry will just turn to doing clinical trials in TDD, and they'll get FDA indications, and we'll be right back where we were.

There are some data to support TDD, some will say. But all those data come from one researcher's group, who happened to be on the DSM-5 committee and strongly pushed for the new diagnosis. Isn't that a conflict of interest, especially for a totally new disorder?

These thoughts came to mind when I read a NIMH-sponsored conference at the Hastings Center in New York on childhood bipolar disorder. Most of those involved with child psychiatry in relation to this condition agreed with the idea of TDD. I wasn't convinced, which I'll explain in future blog posts. And I won't be surprised if many who will comment here will agree with the TDDites.

Truth is not a matter of majority vote, however, and I have a hunch that in the future we will look back on this TDD mania with incomprehension.

That's the whole problem with DSM, as I've said before.

Why don't we just allow the diagnosis of bipolar disorder in children (there are good data that it happens, even going back to 1845 France in Esquirol's textbook), and then educate clinicians about how to diagnose it, avoiding overdiagnosis, and how to treat it, avoiding overuse of drugs with the most risks, such as antidepressants and antipsychotics?

Instead of being scientifically honest in our nosology and taking upon ourselves the professional responsibility of adequate education, we use the next revision of DSM to make up an entirely new diagnosis so that we can, more or less, force clinicians to do what we want. Don't diagnose that condition (and use drug X); you must diagnose this condition (and use drug Y).

That's how we revise DSM; no wonder we make so little progress with DSM "disorders" in scientific research on biology, causes, and treatments.


About This Blog

A view of psychiatry from the inside. Nassir Ghaemi, MD, MPH, provides insights and current updates on events and studies in psychiatry.

Nassir Ghaemi, MD, has disclosed the following relevant financial relationships:
Received research grants from: National Institute of Mental Health; Takeda Pharmaceuticals North America, Inc.
Provided research consultation to: Sunovion Pharmaceuticals Inc.

Poll: Do you agree with the proposed DSM 5 changes for personality disorders? Yes|No|Unsure|

  • Nassir Ghaemi

    Nassir Ghaemi, MD, MPH, is Professor of Psychiatry at Tufts University School of Medicine and Director of the Mood Disorders Program at Tufts Medical Center. His most recent book is On Depression: Diagnosis, Drugs and Despair in the Modern World (2013). Previously he published A First-Rate Madness: Uncovering the links between mental illness and leadership (Penguin Press, 2011). He also has written The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry (2009); A Clinician's Guide to Statistics and Epidemiology in Mental Health (2009); The Concepts of Psychiatry (2007); and Mood Disorders: A Practical Guide (2007).

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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