New Childhood Mental Illness In The Upcoming DSM-V

One of the more disturbing aspects of the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), scheduled for publication in 2013, is that it will undoubtedly contain yet a further diagnostic category for permitting the abuse of children by the psychiatric system in collusion with inept parents.

This brand spanking new childhood behavioral disorder the psychiatrists drafting the DSM have come up with is called temper dysregulation with dysphoria, or TDD for short. This label, according to an ABC newstory, Big Changes for DSM-V, the Psychiatrist’s “Bible” , will be applied to those children who display “persistent negative mood with bursts of rage”.

“About 40 percent to 60 percent of the cases [seen by child psychiatrists] will be children who are doing things that other people don’t want them to do,” he said. Many of these are children who are “stubborn and resistant and disobedient and moody.”

There is currently a recognized syndrome known as oppositional defiant disorder, but some children also display severe aggression and negative moods that go beyond mere stubbornness, according to [Dr. David] Shaffer.

Such children are often tagged as having juvenile bipolar disorder, but research has shown that the label is often inappropriate, since they usually do not qualify for a bipolar disorder diagnosis when they reach adulthood, though they remain dysfunctional. More often, these children are diagnosed as depressed when they become adults.

If the idea is to reverse some of the damage done by the reassigning of some children labeled ADHD as early onset bipolar disorder sufferers, the extension is still an extension, and it is apt to mean more children labeled mentally ill and maintained on powerful psycho-active drugs.

Certainly anybody who will be diagnosed depressed as an adult, after having been diagnosed bipolar, ADHD, TDD, or any combination of those mental disorder labels, as a child, could be said to have gotten off on the wrong career path.

UPDATE

The New York Times is running an article on this future edition of the DSM today, Revising Book on Disorders of the Mind.

“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,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.

“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”

One significant change would be adding a childhood disorder called temper dysregulation disorder with dysphoria, a recommendation that grew out of recent findings that many wildly aggressive, irritable children who have been given a diagnosis of bipolar disorder do not have it.

The misdiagnosis led many children to be given powerful antipsychotic drugs, which have serious side effects, including metabolic changes.

Apparently this new mental disorder is an attempt to lessen the destruction wreaked in large measure by Dr. Joseph Biederman, who was almost single handedly responsible, together with his associates, for a recent 40-fold increase in the incidense of bipolar disorder.

It’s not this disease. It must be that disease. Oh, no! It’s something entirely different. Or is it? Once we have TDD, I guess we will have to fabricate a history for it the way people have fabricated a history for ADHD.

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24 Responses

  1. The new DMS-5 is making waves here in town among those who use such books to work with people of all kinds. I hope it helps more than hurts. One never knows for sure, but I also hope they will be willing to rework it if many more misdiagnoses show up due to this shifting mental aliments around, I mean when is a rose not a rose by any other name. But if one chooses to prune differently because of what name the rose goes by then maybe one should do so very carefully and ready to return to what works from what doesn’t.

    • Maybe, but roses are a species of flowering shrub. Rose blights are another matter. All human beings are members of the species homo sapiens. It isn’t the same thing as labeling human beings sick. Call it sickness A, sickness B, or sickness C, or sickness what have you, psychiatrists admit they don’t know the source of mental illness. Many many issues are at play here. Depression at its most basic is plain unhappiness. The difference between clinical depression and ordinary depression might be a thinner one than most people think it is. Should, one might ask, sadness equal sickness? Sometimes it’s a matter of not seeing the people for the diagnostic labels.

      • (My words. The second after I’d clicked the “Submit Comment” button I thought, I should have written “a psych label instead of a name”… )

  2. I haven’t yet made up my mind what I think of this disorder. It sounds somewhat valid, but then again a number of children who could be diagnosed with this, and who are actually mentally ill, should really be diagnosed with something else (eg. I could have been diagnosed with this if it was in DSM-IV, but I am autistic). That leaves the can of worms of children who *aren’t* mentally ill and will now be diagnosed.

    I will note here that the official proposed DSM-V criteria for TDD say the following: “The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) […].” In other words, the possibility of “pediatric bipolar” is kept quite explicitly, and it will even have to be assessed before a diagnosis of TDD can be made (if the TDD symptoms exceed those expected for bipolar).

    • Dr. Joseph Biederman of Harvard University got this idea of saying these children labeled with attention deficit hyperactivity disorder weren’t actually suffering from ADHD, no, they actually had early onset bipolar disorder. After he did this the childhood bipolar rate shot up like you wouldn’t believe. Given this situation, temper dysregulation with dysphoria (TDD) represents damage controll. Somebody recognizes somebody went a little too far. What are we (the American Psychiatric Association) going to do about it? The APA creates then another disorder somewhere between oppositional defiant disorder and bipolar disorder. Okay. That might work, but now where you had 2 disorders you have 3, and 3 isn’t going to bring down the childhood mental illness rate at all. No, it’s going to give psychiatrists and mental health workers the opportunity to label even more children. I wouldn’t say it even works as damage controll. I think we are far from the last plague to be released from this Pandora’s Box (i.e. the DSM).

  3. In the description of TDD it says:

    “The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.”

    What about the direct physiological effects of a (psych) drug of use?? And: not a word about trauma. Of course not.

  4. It’s absolutely mind-boggling to me to what extent it has become a matter of course that kids can be “mentally ill”. Not so many decades ago, “mental illness” was regarded a rare thing, if not an impossibility, when it comes to the still very much developing minds of kids. But, oh, look what progress we’ve made since then! All those poor undiagnozed and untreated kids back then! How did they ever survive without having their Adderall-Risperdal-Zoloft-Lamictal-deficits properly treated?? I can’t wait to see the day when a new-born gets a psych label together with a name.

    • I’m with you on this one, Marian. Not long ago “mental illness” was virtually non-existent in children. Now children are receiving psychiatric labels as young as 2 years old. Although perhaps a small percentage overall, any number is bigger than zero. At age 2 most children are holy terrors. Applying a psychiatric label to them, one is in danger of extending a temporary phase of life into a lifelong condition.

      To my way of thinking, calling children ‘mentally ill’ and giving them psychiatric drugs constitutes child abuse.

      Also the idea of saying nobody is to blame seems ludicrist to me. It’s a complete evasion of responsibility and accountability. “Bad genes” don’t act up, people act up. People generally have some degree of controll over their actions. Children may be innocent, but their parents are by no means innocent. I’m simply not going to let them off the hook for being bad parents when they are being bad parents.

    • @ Marian: please be aware that society *is* different now than it was say 50 or 100 years ago. That means people with the same brain wiring are treated differently. I don’t think all brain diviations speculated in all childhood mental illnesses of the day, are fabricated, but I do think that these children would possibly not have gotten stuck and been labeled as mentally ill if our society were more friendly towards them. You know, this is one possible explanation for the rise in autism diagnoses: my father claism that he has the exact same symptoms I have, but he neve rneeded a diagnosis of autism. One possible reason is that he lived in a different time, and I can think of ways in which that situation could’ve made it easier to live without psych services. The solution is not to strip all “mentally ill” kids off their labels and make them swim or drown in today’s society. The solution is to change that society so that it is more friendly towards people with “mental illness”.

      • Astrid: I wholeheartedly agree that it is society that has to change, not the people who are maladjusted to it. I also agree that there are situations where it can become (for instance financially) very, very difficult to cope without a label. Nevertheless, what I see is happening today is that people crowd round and beg for psych labels to be given to themselves and/or their kids, not because they really can’t figure any way to survive without, but because they mistake these labels for the meaning with life, their true identity (if I can’t be anything else, I can always be “bipolar”), and because these labels take the heavy burden of freedom and the responsibility that inevitably comes along with the freedom from their shoulders: if it’s “TDD”, it’s no one’s fault. Not the person’s who becomes a parent without being neither willing nor able to take the responsibility, everybody who becomes a parent simply has to be willing and able to take, nor the society’s that covers the asses of these irresponsible parents by accepting kids to get labelled wholesale.

        If we accept this to continue, and don’t question the validity of these labels, it’ll never end, and it’s the kids who pay the price. Both physically, having their health destroyed by psych drugs, and emotionally, being discriminated against, and ending up stuck, more often than not for life, in a false ego-identification that efficiently prevents them from ever becoming free, responsible human beings themselves.

        On another note, variations in brain wiring and also in genes are, just as a person’s thoughts, feelings and behavior, always a response to environmental influences (and it doesn’t need to be “the schizophrenogenic mother”, it can be, but it can also be something like a chemically contaminated environment). Thus childhood trauma has been shown to change brain wiring and even genes. And there are numerous studies that have shown a high correlation between child abuse/neglect and the occurrence of “mental illness” (be it “depression”, “bipolar”, “schizophrenia”, “ADHD”, or whatever else of that kind). Looking at the “symptoms” of “TDD”, I can only say that if I experienced a kid acting that way, I’d immediately conclude that something in this kid’s environment has severely traumatized him/her. No living organism, if its a single gene or a human being, just acts. They all react, to their environment. Thus, basically all DSM-labels are nothing but attempts to explain away and cover up abuse and neglect that are a fact in our modern western civilization, because, with a very few exceptions like PTSD, these labels do not say anything about the causality of “mental illness”. Covering up abuse, and blaming the victim (‘s allegedly faulty biology) is an abuse in itself. Thus, condoning the labels will not change society to the less abusive. On the contrary. It weren’t those who condoned being slaves who abolished slavery. It were those who resisted the identification with the label, who knew they were free and equal human beings underneath the label of slave that was thrown at them.

      • The DSM-V will be expurging Ausberger’s Syndrome as a category of autism, and instead will use the term Autism Spectrum Disorder. Some people have serious issues with this revision of the DSM on this very point.

        I make exception to what I said about mental illness when it comes to autism. We can’t blame the parents for autism. I do stick to what I said when it comes to childhood schizophrenia and bipolar disorder. You’re dealing with what amounts to mostly hokum. I do think that some of the higher functioning autistic individuals though might be said not to have autism at all.

        Our society has changed a lot in 50 years….

        Yes, 50 years ago neuroleptic drugs had not been developed for the purpose of maintaining the ‘mentally ill’, and therefor people in mental health treatment were not at risk for neurological disorders and metabolic problems on the scale that they are today. The average age at death for a person in mental health treatment was not 25 years younger than the rest of the humanity.

        100 years ago…

        According to the research of Robert Whitaker, author of Mad in America and the upcoming Anatomy of an Epidemic, the numbers of people in mental health treatment has drastically climbed since the last century.

        There were:

        1903 1 in 500 people in the USA treated for mental health issues
        1955 1 in 300
        1987 1 in 75
        2005 1 in 50

        If you get the impression that maybe our country is heading in the wrong direction when it comes to how it deals with certain matters, well, so do I.

  5. MF Virginia: Thanks for mentioning autism. I forgot to say, I don’t know enough about autism to be able to say anything about causality. Anyhow, it remains a fact that both genes and more complex organisms do react to the environment. So I don’t think, autism is something that just happens, accidentally. That said, and as mentioned above, it doesn’t need to be “bad parenting”. There are many other reasons why genes mutate, or why brains are wired the way they are, and especially when it comes to autism it seems it’s these other reasons (whatever they are) that are more likely to be the cause.

  6. I see your points about creating this diagnosis to cover tracks in psychiatry, but as a parent (with no formal training in psychiatry what so ever), this description was my kid exactly. It was a relief to read it when people often say to my face I can’t control my kid (even pediatrician). They just don’t get it. So, as a parent, it is helpful to have this recognized this behaviour as something real and out of the norm. But, as some of mentioned above, the goal would be to get assistance with this behavior, rather than stigmatizing our child (and drugs don’t really interest me). And, I can see that there would be people (parents and professionals) who would abuse the diagnosis when it didn’t really fit. But, what about for those of us that it does. We need to be able to turn somewhere for legitimate assistance to help our children function at a “normal” social level so they can succeed in society as a child and as an adult.

    • The first and obvious question I would have to ask you is, is there another person entrusted with helping you handle the responsibilities of parenthood? When we say parents usually we mean mom and dad, and dad is the one often charged with handling disciplinary measures. Even in gay and lesbian households four hands work better than two (2 heads are better than 1 goes the expression). In single mother/father situations, of course, this is not the case, but also in such households the complications involved in childrearing can become overwhelming.

      I see the ADHD label as a way devised to deal with academic issues more than anything else, and it is a way that is not working so well. Children, mostly boys, labeled ADHD, often become career mental patients when they don’t become career criminals. When the issue is one of unruly kids, that is a conduct issue, and not a matter of pathology. Kids develop at different rates, and it is wrong to expect the perfect student at a very early age. The child brain is not an adult brain, and you shouldn’t expect adult behavior from a child. If it’s small, give it time (together with nutrients), it will grow.

      TDD describes a child who has temper tantrums. Most children do at one point or another. The question is one of excess, and that is a relative matter. I don’t see the benefit of making 3 disorders out of 2 when you began, way back when, with 1. Go back even farther, and you’ve got 0. We are experiencing an epidemic of people receiving disability payments for psychiatric conditions currently, and with this epidemic goes the parellel epidemic of iatrogenic disorders due to the damage done by the drugs given to treat those psychiatric ailments.

      I tend to think the real issues here have to deal with the expression of filial affection. Is the child being raised in a loving environment, and if so, what is the frustration that is bringing about these tantrums? This is about perceiving the child as a person rather than as a problem. If you think Mommie and Daddy come first, think again.

  7. I have no doubt that temper dysregulation with dysphoria will be tomorrow’s “label du jour.” Parents – be on the lookout for the “your kid has mood swings” phone call from school personnel. Many parents have already heard that one, and it’s likely to increase yet again exponentially.

    The schools are already “setting the stage.” I was listening to an educational programming channel the other night and the Special Education Advisory Council for a local school district announced a seminar on the topic of “Explosive Kids.” The purpose of the seminar was to discuss a “new” book by a Dr. Ross Greene entitled “Treating Explosive Kids.” I jumped on the internet and researched Dr. Greene and wasn’t surprised to learn that he heads the psychotherapy arm of the Clinical and Research Program in Pediatric Psychopharmacology at Harvard’s Massachusetts General Hospital. The director, Dr. Joseph Biederman, a child psychiatrist, vigorously promotes the use of psychiatric medications in children. A Congressional inquiry in 2008 revealed that Dr. Biederman earned at least $1.6 million in consulting fees from Big Pharma from 2000 to 2007, but only reported $200,000 to Harvard officials – a major conflict of interest. Many credit Dr. Biederman for the exponential increase in the diagnosis of “bipolar disorder” in children and adolescents.

    Dr. Greene’s “new” book was written in 1998, but it’s being released this year in paperback form – just in time for the new DSM V revision.

    It’s no secret that the pharmaceutical companies have been spending large sums of money conducting research in an effort to persuade the FDA to remove the black box warning for pediatric use of many medications used to treat so called “bipolar disorder.” It won’t surprise me if the FDA agrees to do so just in time for the DSM V revision.

    So mark my word – all within the next year or so (maybe two years) we’ll observe schools conducting seminars and identifying more and more kids, and we’ll observe the promotion of new books on the topic of TTD, and we’ll observe the FDA remove the pediatric use black box warning on the drugs, and then we’ll see the official codification of the disorder in the new DSM revision.

    Who plans this stuff?

    • I agree, and undoubtedly TDD is going to be associated with other and more severe disorders. So called “co-occuring disorders” serve as a convenient and easy excuse for a psychiatrist to resort to the polypharmacy that doctors use all the time. That this polypharmacy is one of the worst forms of treatment available, outcome and prognosis-wise, can always be glossed over. Oh, they’re focusing on this one particular case, that it reflects the general situation, they can ignore that fact as long as other people listen to their nonsense. When Dr. Biederman makes a fortune speaking for drug companies, and in the process increases the juvenile bipolar rate 40-fold, you know what this is about. It’s about profit. How, for instance, are we doing something about this matter by adding a brand new “disorder” to the DSM, the most likely outcome from this fiasco? Well, it’s not a problem for doctors and drug companies who profit from these matters, it’s a solution to them. They’re giving the appearence that they’re doing something about the matter while increasing their clientele. It’s a problem for people who really care about the health of children.

  8. I am coming at this from being a parent, and not a mental health professional, and I can too you that what you people are missing is that some people actually need help for this “disorder”.

    As an outsider to your industry, it seems you have a real problem with people incorrectly labeling kids and then politicizing things while there are actually people out there who have this problem and need your help.

    Months ago “mindfreedomvirginia” replied to an initial post by me and I was so flabbergasted by the judgmental and non-helpful reply, I could not even post a response. mindfreedomvirginia, your assessment was TOTALLY wrong (am not single mother, not divorced, very highly educated, etc.). But that is not the point. The points, despite your insider politicking and misdiagnoses, there are indeed kids out there with this type of issue and who legitimately could use help for this “disorder”. So what about them and their families? Seems to me, the misdiagnoses issue and judgmental-ism (made that word up) is YOUR problem and you need to find out how to help families who really do need it.

    • I agree that people with emotional problems as well as their surroundings need and deserve help. The question is whether labelling the individual “disordered” who reacts to his/her surroundings, when all s/he does is behaving in a for human beings completely natural way to “disordered” surroundings, is especially helpful to him/her. I seriously doubt it. It is very easy to explain any unwanted behavior away with psych labels, and “correct” it, with drugs or “therapy”. As long as it’s the individual, who’s “disordered”, and we don’t look at what the “disorder” is a response to, everybody else, parents, society, is off the hook. “Disordered” behavior is real, yes. But so is the dysfunctionality it’s a response to. And trying to run from having to take responsibility for ourselves, our dysfunctionality included, by labelling those who react to us/our dysfunctionality “disordered” won’t get us anywhere. Not as individuals, nor as a society.

    • I merely asked the question concerning your parental situation. I didn’t supply the answers. I was asking. You say you’re not a single mom, or divorced. Alright. Some moms, of course, are single and/or divorced. If it was a one parent situation, and this was the point I was trying to make, then it could have had something to do with the kid not having a father. This apparently, in your case, wasn’t the situation.

      If you are telling me that your child has this future “disorder”, temper dysregulation with dysphoria, you are merely telling me your child throws temper tantrums. I think there are better ways to deal with temper tantrums than by calling them TDD and fabricating a treatment for them. This is a very mystifying process, and the result could wind up being a permanent disability for your child. I don’t think of a permanent disability as a positive outcome. It may well be that there are reasons behind your child’s anger, and perhaps those reasons should be looked at more closely if they are ever to be resolved. Looking at children as unruly, and out of control, is not looking at children as a beings with needs of their own. I kind of think those needs are the most important things for us to consider here.

      • My own experience with children and with a psych degree behind it is that schools have much too much to do with childhood depression, which is shows itself as anger. Gifted children who are unrecognized and therefore forced to learn in regular classrooms end up depressed and underachievers. Many end up in prison because by the time they are 16 they’ve given up trying to understand themselves and trying to please adults and just go bad-ass so they can be good at something. Children with learning disabilities are missed and go through the same sort of frustrations until they too are depressed, and therefore angry. Elementary schools are too female oriented for little boys, so they are boy unfriendly environments where boy interests and energy levels are frowned upon and considered disruptive. At the same time, almost all recess time has been cut from elementary school schedules and children are forced to rush from transition to transition when they are not all capable of doing so at that pace without confusion and frustration building. Middle schools and high schools are too large, too crowded social jungles stressing out and even traumatizing a lot of our youth, and there are too many students for the teachers to know, bond with, and mentor and the kids know it. They feel like cattle being shoved through. What do teens look like when they are depressed? Angry and rebellious. Who do teens need to mentor them into adulthood? Adults OTHER than their parents, especially same gender adults. It is what is developmentally normal and how humans have raised adolescents into adulthood the world over for centuries. But we don’t have that for the majority of our young anymore, not even those blessed with two parents and economic security. For economic and “efficiency” reasons, adults have created a child and youth unfriendly society and then we blame individual parents and their children for the sad outcomes. It is inhumane and inaccurate to do so.

      • I couldn’t agree with you more on this one, Mrs. O’Malley. Many kids end up in the bad circumstances they end up in because they have never been given the chances they should have been given. Some of these kids, if they were under privileged in this sense, were never recognized as under privileged. If we use a garden analogy, where the flower has not proper sunshine, water, nutrition and ground soil, the flower doesn’t flourish. The same goes for people, young and old.

  9. I can see it is a very complicated issue. I would just ask you to remember that most people probably just want help – whether that means THEY need parenting classes or their child needs specific therapy or coaching. It seems drugs are seriously over-prescribed in our society. But also do not assume it is all in someone’s (the parent’s or the kid’s) head. If most people are like me, they are looking for real help addressing a problem (no matter where it comes from – parent and/or child) and are not looking for drugs (necessarily – I am not, but maybe that works in certain cases) or judgment, but are desperate for help and guidance. It behooves your profession to respect that trust and not abuse it with false diagnoses OR dismissing something as “not” a problem. Really, if a parent thinks it is a problem (whether they are the cause of it or not), it IS a problem in one way or another.

    Good luck to you!
    Eve

    • It isn’t the parents as often as people want to believe and claim. In modern America, from the time a child enters daycare, preschool, or Kindergarten, he or she is spending more waking hours a day and a week with people Other than his or her parents. Yet parents are blamed when their children have problems. If children are influenced by their time with their parents, then why assume they aren’t also influenced by the environments and people they are expose to the rest of the time? Of course they are! And from the age of 12-13 (even younger for some more precocious children) they are influenced by their peers and other adults than they are their parents because they are individuating from their parents in preparation for adulthood. That is when they need the close guidance and reliable attention of other adult mentors who can guide them while also helping them achieve a sense of achievement and self-worth within their communities. Parents can’t do that for them. They also care deeply about how they are viewed by their peers, yet adult society leaves them to flail among themselves like Lord of the Flies, and then expect good outcomes for all of them and those who fail at that are labeled negatively. How immature it is of adults to do that to young people! And how cruel it is to do to their parents, as if having a child who is struggling isn’t heartbreaking enough.

      • 1. Although casting blame doesn’t help, it could be the parents. There is this tendency of letting everybody off the hook in modern mental health theory. This tendency to blame everything on biology. We’re not dealing with defective children! When nobody is accountable, who’s minding the kids? 2. I’m certainly not saying kids aren’t influenced by peers and adults who aren’t their parents. Child rearing should be the parents job. This is where we might disagree on this issue. The Lord of the Flies presents us with a juvenile society without adults, and in particular, parents. 3. Change the situation and you change everything. A child could be struggling because that child is in the wrong situation for that child. Mussing kids up for failure has it’s setbacks that you don’t get where kids are groomed for success. I say if a child is being mussed for failure, let’s change the circumstance because that is not the kind of forgone conclusion anyone needs. Psychiatric labeling, essentially, is a form of mussing kids up for failure, and as such, it’s not something we should be doing to them.

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