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Is the DSM-5 — the book professionals and researchers use to diagnose mental disorders — leading us to a society that embraces “over-diagnosis”? Or was this trend of creating “fad” diagnoses started long before the DSM-5 revision process — perhaps even starting with the DSM-IV before it?

Allen Frances, who oversaw the DSM-IV revision process and has been an outspoken critic of the DSM-5, suggests melodramatically that “normality is an endangered species,” due in part to “fad diagnoses” and an “epidemic” of over-diagnosing, ominously suggesting in his opening paragraph that the “DSM5 threatens to provoke several more [epidemics].”

First, when a person starts throwing around a term such as “over diagnosing,” my first question is, “How would we know we’re ‘over diagnosing’ a condition, versus gaining a better understanding of a disorder and its prevalence within modern society?” How can we determine what is being accurately, better and more frequently diagnosed today, versus a disorder that is being “over diagnosed” — that is, being diagnosed when it shouldn’t be due to marketing, education or some other factor.

We could look at attention deficit disorder (also known as attention deficit hyperactivity disorder, or ADHD). The National Institutes of Health convened a panel in 1998 to examine the validity of attention deficit disorder and its treatments, out of concern for the rising amount of children being diagnosed with attention deficit disorder. However, they barely mention overdiagnosis as a concern for ADHD in their consensus statement. They do point out one of the primary problems is inconsistent diagnosing, which I agree represents a real, ongoing concern across the spectrum of mental disorders.

Research into this question has produced mixed results, showing that on one hand, we are indeed over-diagnosing even common, serious mental disorders like bipolar disorder, but we’re also missing a lot of people who have the disorder and have never been diagnosed — again, inconsistent diagnosing. Bipolar disorder should be fairly accurately diagnosed because its diagnostic criteria are clear and overlap with only a few other disorders. One such study that examined whether we are “over diagnosing” bipolar disorder was conducted on 700 subjects in Rhode Island (Zimmerman et al, 2008). They found that less than half the patients who self-reported as being diagnosed with bipolar disorder actually had it, but that over 30 percent of patients who claimed never to have been diagnosed with bipolar disorder actually did have the disorder.

What this kind of study perhaps best demonstrates is the deeply flawed nature of our current diagnostic system based upon the categories set forth by the DSM-III, expanded upon in the DSM-IV, and now being further expanded upon in the DSM5. It is not simply a black and white issue of “over diagnosis.” It is a subtle, complex problem that requires subtle, complex solutions (not a machete taken to pare down sheer numbers of diagnoses). It shows, to me anyway, that perhaps the criteria are fine — the quality, reliable implementation of those criteria continue to leave a lot to be desired.

But diagnoses are not a finite numbers game. We don’t stop adding to the ICD-10 just because there are already thousands of diseases and medical conditions listed. We add to it as the medical knowledge and research supports the addition of new medical classifications and diagnoses. The same is true for the DSM process — hopefully the final revision of DSM5 won’t have added dozens of new disorders because the workgroup believed in a “fad” diagnosis. Rather, they add them because the research base and consensus of experts agrees it’s time to recognize the problem behavior as a real concern worthy of clinical attention and further research.

Who is Dr. Frances to say whether “binge eating disorder” is “real” or not? Has he replicated the work of the DSM5 eating disorders workgroup to arrive at that conclusion? Or is he just picking some diagnoses he feels are “fads” and makes it so? I wouldn’t dream of second-guessing a panel of experts in an area, unless I also spent some significant time reading up on the literature and arriving at my own conclusions through the same type of study and discussion the workgroups use.

The article goes on to list the possible reasons that over-diagnosis takes place, but the list basically boils down to two things — more marketing and more education. Nowhere on his list does he mention the most likely cause of ‘over diagnosis’ — the general unreliability of diagnoses in everyday, real clinical practice, especially by non-mental health professionals. For instance, he’s concerned that websites setup to help people better understand a mental health concern (such as ours?) may lead to people self-overdiagnosing. Self overdiagnosing? I think Dr. Frances just coined a new term (and perhaps a new phenomenon unto itself)!

Outside of this strange vortex, I call such websites and support communities “education” and “self-help.” The research literature is full of studies demonstrating that these websites help people better understand issues and get emotional support and direct, immediate help for them. Could some people use them to inaccurately diagnose themselves? Certainly. But is it a problem of epidemic proportions? I’ve seen no evidence to suggest it is.

Education is key to reaching out to people to help address the decades worth of mis-information and stigma surrounding mental health concerns. Do we just turn off the spigots and lock up the knowledge again in inaccessible books where only the elite and “properly trained” professional has access to it (as psychiatry has traditionally done with the DSM-III-R and even the DSM-IV)? Or do we keep the doors and windows of knowledge wide open and invite as many people as we can into to take a look around and better understand the serious emotional or life issues they are dealing with?

Last, if the DSM itself is partially to blame for over-diagnosis — e.g., because the diagnostic criteria are set too low, as Dr. Frances suggests — then I reiterate my previous suggestion: perhaps the usefulness of the DSM itself has passed. Perhaps it’s time for a more nuanced, psychologically-based diagnostic system to adopted by mental health professionals, one that doesn’t medicalize issues and turn every emotional concern into a problem that has to be labeled and medicated.

I think that the problems of over- and under-diagnosis of mental disorders should be addressed, but I see them as an entirely separate (and more complex) issue from the current revision of the DSM-5 and using the quantity of mental disorders as some sort of gauge to address the quality of diagnosis. Because I believe it’s the quality of our diagnoses — the ability to accurately translate diagnostic criteria to symptoms presented by real people — that most affects “over diagnosis,” not marketing or patient education.

Would we be looking to blame Merriam Webster for all of the trash romance novels that exist? Or do we blame the authors who put the words together to create the novels? Do we blame the DSM for poor diagnoses, or do we blame the professionals (many of whom are not even mental health professionals) who make the poor diagnoses in every day practice?

Read the full article by John M Grohol PsyD: Normality Is an Endangered Species: Psychiatric Fads and Overdiagnosis

Parenting will always involve a balance of vigilance and letting go, but when a child’s mental health is at stake, it can be harder for parents to know when and how to step in.

Often, parents don’t realize their child is depressed until there is a crisis. A father featured in last week’s Wall Street Journal article about teens and depression said that it took a suicide attempt to start getting his daughter the help she needed. But, after the hospitalization, the father said he expected his daughter’s problems to be solved. “We had no idea that was just the beginning.”

A survived suicide attempt can open an opportunity for intervention with a teen. But, as I hope is obvious, moving upstream to preventing that attempt is just as critical.

So, I see two questions for parents to consider when thinking about teens, depression, and suicide prevention:

1) What are the signs that you need to be looking for to know if your teen is depressed?

2) How can you raise a resilient child who bounces back from the challenges of being a teenager?

To begin to help with the first question, the Wall Street Journal offered some guidance with a list of signs of depression to help parents distinguish it from teenage moodiness:

* Sleep: Is your teen sleeping too little or too much, or having trouble falling or staying asleep?

* Interest: Is your teen less interested in activities he or she used to enjoy?

* Guilt: Does your teen have excessive guilt, or feel worthless or devalued?

* Energy: Is your teen unusually tired, exhausted, or low-energy?

* Concentration: Is your teen having trouble thinking, concentrating, or making decisions?

* Appetite: Has your teen’s appetite changed?

* Psychomotor Skills: Is your teen moving around faster or slower than normal – is he or she more sluggish or restless or jittery?

* Suicide: Is your teen thinking about death?

(Just as a note, these signs are relevant for adults, too.)

If a parent notices changes in their teen, finding an appropriate medical or mental health practitioner who can help provide support is the first step. A pediatrician who has a good relationship with the teen could help, if adequately equipped to deal with emotional health as well as physical well-being. A counselor at school or in the community, or a psychiatrist who specializes in working with children or teens are other good options. Most important is finding someone who your teen trusts and can be open with about his or her feelings and experiences. A NAMI parents’ group may be able to help identify providers in the community who are particularly good at working with teens.

As for the second question, building resilience is a process, matched with the developmental stage of a young person. A parent should be attuned to ways that a child can to grow in self-confidence throughout growing up; what’s essential for a 5-year-old to have in place is very different from what a 15-year-old needs. Families, schools, and communities affect children’s resilience, and obviously, all factors cannot be controlled. But, that doesn’t leave parents exempt from seeking opportunities for their children that allow them to build their competence and confidence.

All that said, a young person struggling with mental health issues is going to need additional support – both professional and parental – to develop into a healthy adult. No list of signs or steps is going to solve all of anyone’s problems; it’s just not that simple. Knowing what a child needs and working tirelessly to get it for them – that’s one of the best things a parent can do to promote mental health.

via How parents can help promote mental health | Psychology Today.

Children who live with relatives instead of their parents are at increased risk for physical and mental health problems, new research shows.

About 2.8 million children in the United States live with relatives, called kinship care, and about 800,000 are in foster care. Like those in foster care, the study found, children in kinship care experience a number of health issues.

“Children who live in kinship care with a relative have more special health-care needs, mental health problems such as (attention-deficit/hyperactivity disorder) and depression and dental problems compared with children who live with their parents,” Dr. Sara B. Eleoff, of the University of Rochester School of Medicine and Dentistry, in Rochester, N.Y., said in a news release from the American Academy of Pediatrics.

She and her colleagues analyzed data from more than 91,000 children included in a 2007 national survey, comparing those in kinship care with children who lived with at least one birth parent.

Compared with children who lived with a parent, children in kinship care were more likely to be black, older than 9 years, have public health insurance and live in households with incomes at or near the poverty level. Many kinship caregivers reported having poor overall health or mental health, the researchers noted.

“These children and their families may need additional services and supports,” Eleoff said. “Therefore, health-care providers, educators and public health agencies should ask about children’s living situations and consider the risk of special needs among children in kinship care.”

Psychological wellness іѕ tο bе taken very seriously, аnԁ quite arguably іt’s much more іmрοrtаnt thаn ουr physical well-being. Simply bесаυѕе іf уου аrе nοt mentally stable, chances аrе уου won’t bе аbƖе tο deal wіth thе countless challenges whісh аrе раrt οf life. Lеt’s face іt, wе аƖƖ encounter periods whеn wе feel depressed, frustrated, annoyed аnԁ јυѕt wish tο isolate ourselves. In such periods, wе mау handle іt bу going tο sleep οr finding a corner аnԁ јυѕt сrу away thе misery. Fοr mοѕt οf υѕ thіѕ work, аѕ thе period wіƖƖ pass аnԁ thеn wе саn resume ουr normal life. On thе οthеr hand, ѕοmе individuals wіƖƖ undergo lengthy periods οf depression whісh demands immediate medical attention. A lack οf healthcare care сουƖԁ result within thе condition getting worse.

Whеn wе аrе mentally healthy, wе аrе аbƖе tο face thе challenges οf life аnԁ find solutions tο thеm without losing ουr minds. In turn, іf wе hаνе аn inability tο handle life’s pressures аnԁ challenges Ɩіkе losing a job, having a tragic death іn уουr family, failing аn exam οr a having a prolonged period οf illness, thеn іt сουƖԁ bе caused bу a hereditary element, genetic element, οr аn injury tο уουr brain.

Anybody suffering frοm a psychological disorder such аѕ depression, anxiety, οr panic attacks, ought tο receive immediate medical care. Thеу ought tο nοt bе left οn thеіr οwn tο resolve thеіr difficulties, simply bесаυѕе thеу wіƖƖ probably bе unable tο hеƖр themselves. Whаt thеѕе persons wіƖƖ require іѕ a medical specialist whο іѕ a expert іn thе field οf psychological health tο hеƖр thеm recover frοm thеіr psychological sickness. Psychological illness іѕ very similar tο physical sickness іn thаt thе persons whο аrе physically sick саn’t аѕѕіѕt themselves аnԁ іt’s nο fault οf thеіr οwn.

In cases whеrе people fall ill mentally, thеу′ll need lots οf emotional comfort аnԁ support, аѕ well аѕ effective counseling tο resolve аƖƖ underlying difficulties, ѕο thаt thеу саn return tο thеіr regular existence. If a doctor assess thеm аnԁ discovers thе root cause οf thе depression аnԁ mood swings, thеn hе mау recommend ѕοmе form οf treatment fοr thеm οr prescribe ѕοmе anti-depressants tο аѕѕіѕt thеm recover.

One οf thе major difficulties wіth mental health illnesses іѕ thаt mοѕt people whο аrе affected bу psychological difficulties аrе refusing tο talk аbουt thе issue аnԁ occasionally refusing tο seek expert healthcare аѕѕіѕt due tο thе ɡrοѕѕ misunderstandings аnԁ misconceptions frοm thе general society concerning mental wellness difficulties. Although wе аrе living іn a extremely technological era filled wіth innovative аnԁ modern іԁеаѕ, thе attitude аnԁ behaviors frοm thе public towards people troubled bу mental wellness issues hаѕ nοt changed, mainly bесаυѕе mοѕt individuals refuse tο see even a psychiatrist fοr аѕѕіѕt οr even ɡеt treatment simply bесаυѕе οf fеаr οf whаt someone mау ѕау аbουt thеm.

Thе ɡοοԁ thing іѕ thаt social, healthcare аnԁ Governmental organizations hаνе now mаԁе іt thеіr point οf duty tο educate thе general public concerning psychological wellness problems tο ensure thаt anybody experiencing psychological wellness problems wіƖƖ bе аt liberty tο consult wіth a medical professional tο resolve thе problem.

Abουt thе Author:

Brent McNutt enjoys working wіth healthcare professionals. Hе іѕ аn avid writer fοr UniformHaven.com, whісh offers Landau Scrubs аnԁ Landau Shoes.

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CHESTERFIELD – If someone told you he or she had diabetes, how would you react? If you are like most people, you would express sympathy and concern, offer your support and reassurance and feel confident that your friend’s condition would improve with treatment. Now, if that same friend told you he or she had a mental illness, what would you do?

According to the National Institute of Mental Health, “an estimated 26.2 percent of Americans ages 18 and older (about one in four adults) suffer from a diagnosable mental disorder in a given year.” People with mental illness are our neighbors, family, friends, co-workers, classmates and church members.

Unfortunately, too many people respond negatively when confronted with someone’s mental illness, and this only fuels the stigma surrounding the diagnosis. The reality is a mental illness is no different from a physical illness. Conditions like depression, schizophrenia and anxiety disorders affect a person’s body physically just as heart disease or diabetes do. The emotional and psychological aspects of mental illness make supportive friends and family even more important to a person’s recovery.

By being there and offering your support, companionship, emotional strength and acceptance, you can make a big difference.

So, how do I help exactly? First, do not blow off a person’s worries; instead, express your interest and concern. Do not change the subject when a mental illness diagnosis comes up—ask questions, listen to ideas and be responsive. Second, ask what you can do to help. If other people make insensitive remarks, do not ignore them—take time to educate people so that they understand the facts about mental illness. Lastly, treat people with mental illness just as you would those with any other serious but treatable conditions: with respect, compassion and empathy.

Bill Clinton once said, “Mental Illness is nothing to be ashamed of, but stigma and bias shame us all.” This problem will not just go away because we turn away. The truth is, mental illness can happen to anybody and can affect anyone at any time. That’s why everybody needs to understand how mental illnesses can affect individuals, families, and communities. It is also why we all need to learn how we can support our family, co-workers and friends who are living with a mental illness. Caring friends can make a real difference. The question is – are you ready to be that friend?

via Mental Illness:  Are you its friend or foe? | SCNow.