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.