Michelle Sicignano, LMSW

Michelle Sicignano, LMSW

Social Justice Solutions | Staff Writer
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DSM 5, Why?

So, by now many have heard the American Psychological Association has finished it’s current revisions to the Diagnostic and Statistical Manual of Mental Disorders, the DSM. The DSM, in the US, is the standard by which conditions are coded, and therefor recognized, and approved as reimbursable.

Granted, you cannot make everyone happy, but I am not a fan of many of these changes and am left to wonder what the real point of  this revision is.

A proposed change I did like, which seems to have made  it into the final approved draft, was the scaled coding of personality disorders such as narcissism, but I don’t know if the final version was as comprehensive as  the draft.  However, the old PD diagnostic criteria were left as is despite the need for changes.

A proposed change I wanted to see was for a better diagnostic criteria relating to childhood trauma, especially that of an ongoing nature, and the resultant stress. PTSD does not begin to cover this effectively.  I hope the newer model is more accurate, yet I know it falls short of what child trauma experts report as neeeded.

Getting rid of the grief bereavement exclusion seems very likely to lead to greater depression diagnoses and therefore medication instead of allowing for normal healing after loss.   Similarly, medicalizing child tantrums  also seems to lead down a path of greater diagnoses and more therefor more treatment,  likely with medication. How does medicalizing a tantrum, a normal child behavior,  help a child or a family? Perhaps what’s needed is simply more focused parenting with structure and consistent rules, something sorely lacking in my community, and in our society.

I am concerned about the elimination of Asperger’s and Dyslexia, and grouping these within Autistic Disorders   and Learning Disorders, respectively.  There is a real potential to increased difficulty in diagnosing  and therefore acquiring services through schools, and this is all ready a difficult task in too many districts.

One of my biggest questions is why are we not just using the International Statistical Classification of Diseases and Related Health Problems (IDC)?   If it is the official system for the US, and recognized by Medicare and Medicaid, why do we need a distinct DSM when the IDC covers mental and behavioral disorders, and that version is international in scope, and therefore in research and knowledge base?

For further reading on the changes to the DSM,  the link on the title will take you to an interesting article in Psychology Today, The DSM 5 Is a Guide Not a Bible-Ignore Its Ten Worst Changes.

And for a nice info-graphic, use this link.

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