DSM-IV-TR

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April 14, 2010

Only a Few More Days to Weigh in on Changes to the DSM

Posted by Nathen under diagnostic criteria, DSM-IV-TR, DSM-V, eating disorders, Gender Identity Disorder, headlines, healthcare, insurance companies, mental disorders, mental illness, normalcy, pharmaceutical companies, politics, psychopathology, psychosis, psychotropic medication, schizophrenia, transparency
[8] Comments

I posted in February about how the committee that is redesigning the DSM is accepting feedback on their proposed changes. The Diagnostic and Statistical Manual of Mental Disorders is the book used around the world by clinicians to determine what kinds of human suffering count as mental disorders, what symptoms one has to show to qualify as having one of those disorders, and what what can get covered by insurance. The content of this book will shape the lives of those who will interact with the mental health system for the next generation. Being labeled with a mental disorder is a big deal, and which one you get can mean the difference between decent and indecent treatment. Personality Disorder? You’re pretty much screwed. Very few people think they can help you and no insurance will cover you. Adjustment Disorder? PTSD? You’re in luck, most likely. We’re all very hopeful for, and will pay for, your recovery.

If you’re life has in any way been affected by anything labeled a mental disorder, I encourage you to look at the appropriate proposed changes to your future and the future of your loved ones, and write them an email about what you think. You have until April 20, 2010.

Structural, Cross-Cutting, and General Classification Issues for DSM-5

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Delirium, Dementia, Amnestic, and Other Cognitive Disorders

Mental Disorders Due to a General Medical Condition Not Elsewhere Classified

Substance-Related Disorders

Schizophrenia and Other Psychotic Disorders

Dissociative Disorders

Sexual and Gender Identity Disorders

Eating Disorders

Sleep Disorders

Impulse-Control Disorders Not Elsewhere Classified

Adjustment Disorders

Personality Disorders

Other Conditions that May Be the Focus of Clinical Attention

March 17, 2010

DSM-IV-TR Diagnostic Criteria for Eating Disorders

Posted by Nathen under abstinence, bodies, bulemia, death, diagnostic criteria, DSM-IV-TR, eating disorders, exercise, food, mental disorders, psychopathology
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There are two official DSM diagnoses for eating disorders, with two variations each. This gives us four options: Anorexia Nervosa, Restricting Type; Anorexia Nervosa, Binge Eating/Purging Type; Bulimia Nervosa, Purging Type; Bulimia Nervosa, Nonpurging Type.

This is are direct direct quotes from the DSM-IV-TR. “Postmenarcheal” means after the onset of the menstrual cycle. In addition to Anorexia Nervosa and Bulimia Nervosa, there is a category with no diagnostic criteria called Eating Disorder Not Otherwise Specified that clinician can give to someone “for disorders of eating that do not meet the criteria for any specific Eating Disorder.” People diagnosed with EDNOS are even more likely to die from their conditions than those in AN or BN.

Diagnostic criteria for 307.1 Anorexia Nervosa

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during a period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Specify type:

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Diagnostic criteria for 307.51 Bulimia Nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxative, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

March 16, 2010

10 Things Parents Can Do to Help Prevent Eating Disorders

Posted by Nathen under advice, bodies, children, DSM-IV-TR, eating disorders, exercise, food, lists, parenting, sexism, weightism
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This is a handout I got in my Medical Family Therapy class. The copyright at the bottom says “(c) 2005 National Eating Disorders Association. Permission is granted to copy and reprint materials for educational purposes only. National Eating Disorders Association must be cited and web address listed. www.NationalEatingDisorders.org Information and Referral Helpline: 800.931.2237.” I think that covers me. I’m willing to take the risk, anyway, because eating disorders are a huge problem. The most conservative estimates, using the most strict definitions, are that six million people in the US struggle with disordered eating. Estimates using less strict definitions (including Eating Disorder Not Otherwise Specified in the DSM-IV-TR), but still very realistic, are at about 20 million. And eating disorders are the most deadly mental disorder. If not treated, 20-25% of those with serious eating disorders die from them. You won’t find that statistic in many official sources, though, because for some very strange reason, coroners will not list Anorexia or Bulimia Nervosa as a cause of death. They prefer “Cause of death unknown” in those cases. Plus, eating disorders are learned behavior. Don’t let your kids learn the values that encourage disordered eating from you!

OK, here it is. It’s by Michael Levine, PhD:

1. Consider your thoughts, attitudes, and behaviors toward your own body and the way that these beliefs have been shaped by the forces of weightism and sexism. Then educate your children about (a) the genetic basis for the natural diversity of human body shapes and sizes and (b) the nature and ugliness of prejudice.

*Make an effort to maintain positive attitudes and health behaviors. Children learn from the things you say and do!

2. Examine closely your dreams and goals for your children and other loved ones. Are you overemphasizing beauty and body shape, particularly for girls?

*Avoid conveying an attitude which says in effect, “I will like you more if you lose weight, don’t eat so much, look more like the slender models in ads, fit into smaller clothes, etc.”

*Decide what you can do and what you can stop doing to reduce the teasing, criticism, blaming, staring, etc. that reinforce the idea that larger or fatter is “bad” and smaller or thinner is “good.”

3. Learn about and discuss with your sons and daughters (a) the dangers of trying to alter one’s body shape through dieting, (b) the value of moderate exercise for health, and (c) the importance of eating a variety of foods in well-balanced meals consumed at least three times a day.

*Avoid categorizing and labeling foods (e.g. good/bad or safe/dangerous). All foods can be eaten in moderation.

*Be a good role model in regard to sensible eating, exercise, and self-acceptance.

4. Make a commitment not to avoid activities (such as swimming, sunbathing, dancing, etc.) simply because they call attention to your weight and shape. Refuse to wear clothes that are uncomfortable or that you don’t like but wear simply because they divert attention from your weight or shape.

5. Make a commitment to exercise for the joy of feeling your body move and grow stronger, not to purge fat from you body or to compensate for calories, power, excitement, popularity, or perfection.

6. Practice taking people seriously for what they say, feel, and do, not for how slender or “well put together” they appear.

7. Help children appreciate and resist the ways in which television, magazines, and other media distort the true diversity of human body types and imply that a slender body means power, excitement, popularity, or perfection.

8. Educate boys and girls about various forms of prejudice, including weightism, and help them understand their responsibilities for preventing them.

9. Encourage your children to be active and to enjoy what their bodies can do and feel like. Do not limit their caloric intake unless a physician requests that you do this because of a medical problem.

10. Do whatever you can to promote the self-esteem and self- respect of all of your children in intellectual, athletic , and social endeavors. Give boys and girls the same opportunities and encouragement. Be careful not to suggest that females are less important than males, e.g., by exempting males form housework or childcare. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to dieting and disordered eating.

February 23, 2010

Weigh In On the DSM-V

Posted by Nathen under DSM-III, DSM-IV-TR, DSM-V, Gender Identity Disorder, homosexuality, mental illness, power, prefrontal lobotomy, psychopathology
[6] Comments

The Diagnostic and Statistical Manual of Mental Disorders is revised every decade or so, and a revision is under way right now. Up until recently, there has been criticism that the proceedings were taking place in secret. This is not unusual, as I understand it, but it is significant for many people. Mental-health clinicians, for example, have to use the diagnostic categories in the DSM to label their clients, and if the categories and descriptions listed don’t coincide with their experiences or beliefs, this can be quite difficult. It is significant for mental-health clients, too, for complementary and even more personal reasons. What will happen to your diagnosis? In? Out? Changed? These decisions have a big impact on social issues, like stigma, and economic issues, like what insurance companies will pay for.

The DSM committee is proposing, for example, to subsume the diagnosis of Asperger’s Disorder into Autism Disorder. This seems to make a lot of sense, unless you or your child is benefiting from the existence of Asperger’s because of insurance company rules, state regulations, or other regulatory factors.

The content of the DSM is important to people for political reasons, too. For example, the third revision of the DSM eliminated homosexuality as a mental disorder. That was in 1973, for the DSM-III. (We’ve since had the DSM-III-R, DSM-IV, and DSM-IV-TR. They are currently working on the DSM-V.) It may be hard to believe that being gay was an official Mental Disorder, but it was. People were even lobotomized for it: Here, let me “help” you with that unnatural sexual attraction by forcing an icepick in over one of your eyes, through your skull, to twist it in your brain. The removal of homosexuality from the DSM was very controversial in its day, but no one credible is fighting for it to go back in.

That is to say, the DSM can reflect the changing mores of society, which in turn influences the way society sees mental health and illness. This process can effect the quality of a lot of our lives. And now the DSM committee has revealed the changes they are contemplating and is asking for feedback. This is from their website:

“Your input, whether you are a clinician, a researcher, an administrator, or a person/family member affected by a mental disorder, is important to us. We thank you for taking part in this historic process and look forward to receiving your feedback.”

You almost certainly fall into one of those categories. Take part in this opportunity! Of course, our input being “important” to them does not mean they will pay attention to it, but it can’t hurt to try. The worst that can happen is that you will be better informed about your mental-health system. Here are the categories that they are considering changes in. Click on them to read the proposed changes. To submit feedback, you have to register with them, but it only takes a minute: