When my son was diagnosed with schizophrenia at the age of 18 we had a difficult time accepting it. Once a person is labeled with a serious mental illness it can change their lives forever. I do not take this subject lightly. Mental illness is serious, but with proper treatment people do recover and live productive, happy lives and the earlier the intervention, the better.
Diagnosing mental illness is not something most physicians take lightly either. Because of the stigma sometimes the diagnosis can be delayed for decades. Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives. The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.
According to some estimates, the diagnosis of bi-polar in children under 18 has risen by 4000% since the 1990’s. Obviously that has caused a lot of controversy. Other disorders like autism, anorexia, binge eating, and ADHD have also skyrocketed. There are hundreds of reasons why people believe this is happening and I don’t have the space here to go over all of them, but the fact remains that many people do suffer needlessly for decades before seeking or receiving proper treatment for their disorder.
It’s a very complicated issue and one the new DSM-V is attempting to address. In the draft version of the manual which is a psychiatrists diagnostic bible, instead of bi-polar, clinicians will be able to use a new diagnosis called “temper dysregulation disorder” for a child over six years old. (the mania of bi-polar can manifest as uncontrolled temper or irritability in children.) Unlike bi-polar, it would not be classified as a life-long illness.
Local Tucson childhood psychiatrist, Dr. Ann Lettes addresses some of the issues in her statement to me by saying, “Whether the official label is Mood Disorder NOS, Bipolar Disorder NOS, or “Childhood Temper Dysregulation Disorder with Dysphoria” is unlikely to affect how we treat it. If the new diagnosis is reimbursible by insurance then I would likely use it because of the stigma around “Bipolar Disorder” and the impact that diagnosis can have on future employability, insurablility, and eligibility for military service. My concern is that clinicians who are not Psychiatrists will be diagnosing misbehaving children whose parents need parenting training more than the children need medication with a dysregulation disorder. This would also dilute the power of the diagnosis for the children who truly have severe physiologically based mood regulation problems.”
Dr. Michael First, a professor of psychiatry at Columbia University who edited the 4th addition of the manual is quoted in the New York Times as saying “Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled”
The bottom-line is that psychiatric illnesses are not only difficult to live with, they can be difficult to diagnose and treat. Stigma and mis-information cause people living with and families dealing with these disorders to not seek treatment. Insurance companies complicate the issue even further by requiring answers that fit nicely into a little box in order to provide coverage. Sometimes there are no clear cut answers.
Before the new DSM-V is published field trials and a risk/benefit analysis on the changes are being researched. To see a draft of the manual you can visit the website at www.DSM5.org
Viewers to the website will be able to submit comments until April 20, 2010.