FAQ About Mental Health From A Biased Source...ME! Part 5!!! Listen to Me Yell About Stuff!

Hey, weren't you doing that '60 days of Rocksmith' thing?

Hey, shut up.

Ok, well, so what sort of questions are you answering today?

...I'm not really. Instead, I'm going to throw a temper tantrum about the DSM 5!

What's the DSM 5?

The mental health field's Bible. It has all the diagnoses that a mental health professional can diagnosis and still get paid because of insurance companies and whatnot. This new one, the DSM 5, is the newest and I have finally really took the time to read through it and am now ready to bitch about it!

So it is all bad?

Well, not all bad. They tried to do add more detail to the different diagnoses. They actually say the word 'clinical formulation'! I like that.

That's it?

Kinda. I mean a lot of it is the same. And even some of the stuff I'll eventually bitch about are older things from the DSM 4. And they kept personality disorders which I like because there was a fear they may get rid of them. So that's good.

Ok, so what's to bitch about?

Well! First, they got ride of the 5-axis diagnosis system! Man!

Yeah...

Yeah! Well, I guess I don't miss it really. But now I need to re-write our assessment paperwork. That sucks. By the way, the five axis system basically was a way to signify what you, as the clinician, were diagnosing over 5 categories; relatively short term mental health disorders, long term mental health disorders, medical problems, social and environmental factors, and a general functioning assessment represented by a number score. Now you just sort of diagnose. Full stop.

What else?

They changed how trauma disorders work. So, a trauma used to be defined as a life threatening, whether actually life threatening or not, that occurred directly to directly or witnessed. And a bunch of other criteria. NOW, you can experience a trauma, apparently, simply by hearing about someone you loved who was traumatized. You don't even have to be there. You simply have to hear about it.

What?

Yeah! And there are two primary diagnoses you can diagnosis with trauma. PTSD and Acute Stress Disorder (ASD). Before, you could diagnosis ASD if a certain number of symptoms were present following a trauma for up to a month. If the symptoms persisted after a month the diagnosis would change to PTSD. These symptoms, before, were pretty severe. They may or may not be considered beyond a normal response to, say, being raped or having a gun to your head or some other terrifying experience depending on who you ask. But there were at least enough severity that not everyone who experienced a trauma would get an ASD diagnosis.

NOW, the symptoms are much more broad and you need fewer of them to make the diagnosis. I have a feeling everyone who is traumatized would meet criteria for that diagnosis.

What do you mean by broad?

Basically, the more broad and general a diagnosis the easier it is to diagnosis more people with that disorder. If the disorders are too broad the eventually you'll describe EVERYONE as having a disorder. This is bad because disorders are meant to describe abnormal behavior. If it describes all behaviors it isn't really describing abnormal behavior anymore. We'll be describing normal behavior as being abnormal. Then everyone has a mental disorder. Good for therapists' wallets for sure. But it's inappropriate and gross.

This is a common problem with the DSM 5. There's a ton of disorders in that book and a lot of them overlap. In each diagnosis explanation there's a 'differential diagnosis' section. That section is there for the disorders that overlap with the disorder being described so that it's easier to make the diagnosis. You would hope to only see a few disorders in these sections. In the DSM 5, there are usually 5 or more disorders in this section for each diagnosis. If there's so much overlap, wouldn't we want to wonder why? Maybe we have too many diagnoses and they are all to general in their definition?

What else?

This is one of the old problems but I'm really bothered they didn't fix it. There's a sexual dysfunction category of disorders. In it there's a disorder that describes a lack of interest in sex. The silly part is that there are two distinct diagnoses for that one problem; one for men and one for women. Here's the kicker that makes this just so shitty.

So the male disorder, called 'Hypoactive Sexual Desire Disorder', has a set description for what a lack of interest means. The female disorder, called 'Sexual Interest/Arousal Disorder', has the same basic definition for disinterest. However, the female disorder has the description broken down into 6 distinct symptoms. Three of those symptoms need to be represented in order for a diagnosis to be made. For men, there is no such requirement. So, theoretically, you could justify a diagnosis for a man if he meets for 2 or even 1 of those six symptoms. But for women, she needs to meet for 3 or more.

So, in other words, men who have any disinterest in sex is considered abnormal. Women have to have moderate to significant disinterest in sex in order to be considered abnormal. A little bit of disinterest is normal in women apparently. Because men only want sex all the time forever and women don't actually desire sex. Right?

WE are in 2013 and that is allowed! That's considered scientifically appropriate! What the fuck?

Yikes.

Yeah. And here's the last thing, for now. At the end of the book there's a section for proposed additions for future DSM's. I can't diagnosis these disorders but they are being proposed for research and maybe, one day, I will be able to diagnosis them.

There's one diagnosis being proposed called 'Internet Gaming Addiction'. First, they specify online gaming only. The symptoms are things like lack of self-care due to the gaming, ignoring responsibilities, becoming angry and anxious when the game is taken away, etc. Things that are actual problems. I don't know if I'd agree with an entire category for the diagnosis but whatever. The dumb part is offline gaming with all of those symptoms and then some wouldn't meet criteria.

So, if you play COD offline and don't go to work, care for yourself, get angry when you can't play it, etc. you don't have an addiction (also using addiction for this is a little silly too but semantics). But if you have all those symptoms and then play COD online then, and only then, do you have a disorder I can diagnosis. So it's a selective addiction. That's how heroin works right? You aren't addicted when you use in your home five times per day. But you're addicted if you use five times per day while in your car right?

Also, the symptoms could literally apply to anything. You could be addicted to TV, movies, playing an instrument, staring at a wall. Anything fits. It's a silly disorder proposal for what could potentially be a real problem that isn't exclusive to video games, online or off.

So that's it?

For now. I'm sure I'll find something else to yell about later. I'm just disappointed. I want my field to be great. With tools like this it won't be. It makes us look like the laughing stock of the health care field and makes those people that yell about how psychology isn't a real science seem credible. It's kind of embarrassing.

19 Comments
19 Comments
Posted by shivermetimbers

So I guess this gives Scientology an upper hand when they say psychiatry is the devil? :/

Posted by Video_Game_King

@jasonr86 said:

What's the DSM 5?

The mental health field's Bible.

So where would I find the Song of Solochology?

For men, there is no such requirement. So, theoretically, you could justify a diagnosis for a man if he meets for 2 or even 1 of those six symptoms. But for men, she needs to meet for 3 or more.

Also, men have logically impossible sexual interests. And vaginae.

Posted by Quarters

As someone who's actually applying to college for this field right now(my interview's next week!), all of that sounds incredibly frustrating. I'm hoping to get more into the therapy end of things instead of just going, "yo, you got this thing, take this pill". I hate how the general populace is starting to use disorders and psychiatric issues as a complete crutch, and many therapists/psychiatrists are totally willing to allow them to do that, because it means more money for them. As you said, it's gross. If I recall, you said once that you counsel people so that they will one day no longer need it. I feel that's becoming rarer, even though that's the proper mindset to have.

Regardless, though I've missed most of your other parts, interesting as always.

Edited by Colourful_Hippie

Wait, the 5-axis diagnosis is gone now? What? Are they all condensed into one thing now?

and having a bunch of overlaps with the diagnoses sounds like a nice way to stack diagnoses on someone to money I guess? There's going to be repercussions from that shit which I'm expecting will result in a lot more streamlining in the next revision.

Posted by JasonR86

Wait, the 5-axis diagnosis is gone now? What? Are they all condensed into one thing now?

Yep. There's no axis two. There's no GAF.

Posted by Colourful_Hippie

@jasonr86 said:

@colourful_hippie said:

Wait, the 5-axis diagnosis is gone now? What? Are they all condensed into one thing now?

Yep. There's no axis two. There's no GAF.

In theory I liked how the diagnosis was organized over 5 categories, do you not give considerations then to what would have been included in axis 3 and 4 or are they just explicitly stated in the overall diagnosis but without saying axis #?

There are times when I like psych being a soft science because human behavior isn't always static and we can always learn more so change isn't bad but then there's going too far that it just looks like the people in the field are making up the rules as they go.

Posted by JasonR86

@jasonr86 said:

@colourful_hippie said:

Wait, the 5-axis diagnosis is gone now? What? Are they all condensed into one thing now?

Yep. There's no axis two. There's no GAF.

In theory I liked how the diagnosis was organized over 5 categories, do you not give considerations then to what would have been included in axis 3 and 4 or are they just explicitly stated in the overall diagnosis but without saying axis #?

There are times when I like psych being a soft science because human behavior isn't always static and we can always learn more so change isn't bad but then there's going too far that it just looks like the people in the field are making up the rules as they go.

I'm going to have to read more about the new diagnostic system as it works. I need to re-write a bunch of assessment paperwork now so I need to figure it out quick.

I don't like the idea of the science being soft but then stating exact criteria resembling a hard science. It ends up just looking arbitrary and random. Like they set limits because 'I suppose we have to right?'

Posted by MariachiMacabre

My cat of 16 years died about an hour ago of a suspected heart attack. I'm kind of destroyed over the whole thing. I need some reassurance. :(

Edited by JasonR86

@mariachimacabre said:

My cat of 16 years died about an hour ago of a suspected heart attack. I'm kind of destroyed over the whole thing. I need some reassurance. :(

Sorry dude. Better?

@video_game_king said:

@jasonr86 said:

What's the DSM 5?

The mental health field's Bible.

So where would I find the Song of Solochology?

For men, there is no such requirement. So, theoretically, you could justify a diagnosis for a man if he meets for 2 or even 1 of those six symptoms. But for men, she needs to meet for 3 or more.

Also, men have logically impossible sexual interests. And vaginae.

Shut up so-called "King".

I fixed it.

You jerk.

Posted by JasonR86

"Modern day video games may be even more addictive, he added, because they are open-ended and allow players to save their place and pick back up again, unlike the older generations of games like Pac-Man, where players lose their allotted lives and are forced to start over."

This is a quote from this article about the internet gaming addiction. How silly. This dude goes on to say that people can go into video games to escape real problems. Isn't that what leisure activities are there for? I mean it is a real problem if the real-world problems are never addressed. But this isn't a problem exclusive to video games. So why simply pick on games, or the internet, or any one thing? This is a broader problem. Why think so small and in the process demonized the concept of a leisure activity? Ugh.

Edited by HerbieBug

Interesting. I took a glance at the proposed modifications to autism spectrum back when this thing was running through edits and debate stage. I kinda liked the general thrust of what they did there, removing some of the extra names for particular presentations of autism (Asperger's, PDD, etc.) and folding them into a single spectrum to be diagnosed with a level of functioning bit at the end. That simplifies things, at least for the patient, or maybe I should only speak for myself and say that it simplifies things for me.

Didn't know there were such problems with the rest of it. That explains why it is not universally accepted in north america as yet.

Posted by Colourful_Hippie

That part about the low sex drive diagnoses requirements feel like they were arbitrarily set by someone who just looked at some stats that show how males commonly have a more active libido than females.

"Oh so if two of these things show up in a dude then something must be seriously wrong here."

Posted by Colourful_Hippie

@jasonr86 said:

"Modern day video games may be even more addictive, he added, because they are open-ended and allow players to save their place and pick back up again, unlike the older generations of games like Pac-Man, where players lose their allotted lives and are forced to start over."

This is a quote from this article about the internet gaming addiction. How silly. This dude goes on to say that people can go into video games to escape real problems. Isn't that what leisure activities are there for? I mean it is a real problem if the real-world problems are never addressed. But this isn't a problem exclusive to video games. So why simply pick on games, or the internet, or any one thing? This is a broader problem. Why think so small and in the process demonized the concept of a leisure activity? Ugh.

Those sound like the kind of observations of someone who only looks at video games as a bystander instead of someone who actually plays games and therefore possibly have a deeper understanding of the medium that one wouldn't get by just observing from a distance on an academic level.

Posted by audioBusting

@jasonr86: are specific classifications of addictions like that "Internet Gaming Addiction" actually be useful for anyone in your line of work? It sounds rather frivolous to me, so why did anyone propose it in the first place?

Posted by JasonR86

@jasonr86: are specific classifications of addictions like that "Internet Gaming Addiction" actually be useful for anyone in your line of work? It sounds rather frivolous to me, so why did anyone propose it in the first place?

I think it would be pointless and that I would never use it. But, as of now it's there for research reasons. No one can diagnosis it as of now. But it's being proposed which is code for 'yo we need to research this.' Clinically, I don't see the point of it. I think in a situation where this diagnosis would fit, for video games or anything else that is not being experienced in relative moderation, another diagnosis would likely be much more prominent and relevant.

Posted by Brodehouse

Good read. Interesting part about expanding definitions or scope of disorders to encompass things we consider to be relatively normal, or at least relatively common or habitual. Which leads perfectly into the video game/activity addiction placement.

Posted by indieslaw

Is Dissociative Identity Disorder in there?

Posted by JasonR86
Posted by JasonR86

I reread the sexual dysfunction part of the DSM just to make sure I got it right (I was away from my DSM 5 when I wrote this). The female disorder is broken up into 6 symptoms and three must be present for a woman to be deemed abnormally disinterested in sex. The male disorder, however, barely explains what 'disinterest' means. Basically, you could justify any and all disinterest as fitting the description given.

Gross.