Gifted Issues Discussion homepage Forums Twice Exceptional NIMH withdraws support for DSM-5

In practice the hope is within ten years time there is a new diagnostic tool that uses actual research and points to functional, physiological, and genetic causes for mental disorders.

Making stuff up to illustrate...
So ADHD might become:
1) Genetically based reduction in core dopamine production with executive function impact(requires < .09ug...)
2) Prefrontal sensory overload (attention shutdown accompanied by increased xxx waves in yyy system)
3) Hyperglycemia accompanied by active burning of excess glucose

Where #2 might lead to ADHD like symptoms, it could also lead to exhibiting ASD like symptoms with pragmatic language issues and the inability to maintain eye contact or being overstimulated in crowds.

Under the current DSM approach, the #2 child chould be place on stimulants or placed in 12 months of pragmatic language training. Where what they really need is sensory management training.

The medical equivalent to the current DSM would be like:
Excess Mucus Disorder
Any 4 of these:
1) Runny nose
2) Watering eyes
3) Coughing
4) Sneezy
5) Doc
6) Bashful
7) Expectoration
Treatment: Tissue and chicken soup for 7 to 10 days.

Newtonian-esque mechanistic reductionism works well with a significant portion of the body.

Not so much the mind/psyche.

As my psychiatrist BIL notes, often the problem is "limited education" coupled with "piss-poor coping skills".

It's got to be an improvement to actually call it out, though-- either there IS a problem, and look, here's what it is, and gosh, I guess that means that we'll work our way through THIS set of best-practices here, or...


there isn't really anything but fumbling around in the dark and it's all just idiosyncratic to start with, in which case, why bother with the DSM with all of it's oh-so-official checklists?

I'm not arguing that people in the mental health professions can't-- or shouldn't-- help people who are probably best classified as "other" but it would be a vast improvement to be able to tease them apart from those with problems that can be diagnosed as something in particular using evidence that isn't subjective or opinion-based.

The current state of affairs is like going to the doctor and describing a series of vague aches and pains, and having him/her respond with:


You have arthritis.

a) Let's try more exercise for a month.
b) if that doesn't work, let's try having you rest it for another month.
c) if that doesn't work, we'll do steroid injections and pain management for six months.
d) if that doesn't work, we'll do a hip replacement.
e) if that doesn't work, let's reevaluate in six months.

Clearly that is crazy.


"Aches and pains" can mean so many different things-- some of them self-resolving/transient-- that it's not really diagnostically useful in terms of differential diagnosis. To use it that way anyway is nuts.

Had someone when I was little done evaluation on me and gone through the checklists for Asperger's or high functioning autism, I can guarantee you I would had gotten a diagnosis right there and then! As it turned out in the end, I was just gifted with really bad anxiety. So I just cringe when my kids are now dealing with a lot of the same issues I was back then. I wish there was some magic trick to give a 100% correct diagnosis so we would know if they really are or are not on the spectrum!

And let's not forget that college students claiming to need Adderall for their ADHD will have a tougher time getting a script when the doc can say, "Well, but your SLC9A (or whatever) values are well within the normal range."

Signed,

The annoyed mother of a kid diagnosed with ADHD by a school pyschologist who had never met him "because he fits so many of the criteria [handing me the DSM]." She wanted to drug him!

I am a huge fan of taking mental health beyond the checklists so I was really excited to hear about this headline when my husband told me. One reason I did not pursue graduate work in my mental health undergrad degree was because I became disillusioned with the whole set up of the field.

I believe we are doing a huge disservice to patients to continue to practice medicine on the mental health side of things in the same way as we have for over a century. Other than disorders falling in and out of socio-political favor, the practice has changed little. I think it's time mental health joined us in the age of technology and science and left the imprecise checklist based system behind. I have so much enjoyed finding those on the cutting edge of this change to work with my family's needs and I would be thrilled to see an industry-wide shift. I applaud the NIMH for coming out with this statement.

THANK YOU! (So it's not just me who thinks this?) sigh.

Me too... exactly.