We’re All Crazy

February 8, 2013

Disruptive Mood Dysregulation Disorder (DMDD) is in.  Childhood Disintegrative Disorder (CDD) and Pervasive Developmental Disorder (PDD) are out, having been absorbed by Autism Spectrum Disorder (ASD).

These are among the latest changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which will be published this spring by the American Psychiatric Association.

While the manual took more than a decade to update, I wonder who is being served by the creation of Disruptive Mood Dysregulation Disorder.  Given that more than 1,500 mental health experts contributed to the manual and it took more than a decade to produce, you’d think that someone would have pointed out that dysregulation is not a word.

And what about Autism Spectrum Disorder?  Why not just call it autism?

Of course, respecting the English language is not a high priority for psychiatrists.  Coming up with new acryonyms is.

DMDD was initially going to be called Temper Dysregulation Disorder with Dysphoria (TDDWD), so it could have been worse.  But what it amounts to is putting a label on kids who have temper tantrums.  In other words, we don’t want to malign parents for failing to discipline their children and we don’t want to criticize children for being spoiled brats … so we create a brand new disorder.

This could be the biggest breakthrough for psychiatry since the creation of Attention Deficit Disorder (ADD).

When I was growing up, ADD didn’t exist.  I’m sure that, like every other boy ever born, I had ADD.  I probably still do.  Somehow, I survived into adulthood without taking drugs.

My precocious oldest son, conversely, was diagnosed by a psychiatrist as having ADD – by a psychiatrist who never even met him.  The psychiatrist offered to prescribe Ritalin for him.  Let me repeat that, for those of you with ADD: a psychiatrist who never even met my son wanted to put him on Ritalin.

On top of coping with ADD, at this time of year, those of us who are stuck in New England and other areas north of the Carolinas are suffering from Seasonal Affective Disorder (SAD), which also didn’t exist when I was growing up.  Why is it a disorder, though?  Isn’t it normal to feel a bit depressed when the temperature drops below zero?

I have a client that treats EDNOS.  That stands for Eating Disorders Not Otherwise Specified.  About half of all patients with eating disorders have EDNOS, because they don’t fit all of the criteria for anorexia, bulimia or binge-eating disorder.  Psychiatrists frequently worry about “stigmatizing” patients by labeling their disorders.  Is there anything more stigmatizing than having a disorder that’s “not otherwise specified?”

There are still plenty of disorders waiting to be discovered.  For example, many psychiatrists suffer from Acronym Deficiency Disorder (ADD2), in which they have a compelling need to create acronyms for obscure disorders that no one would treat if there weren’t an acronym for them.  Then there’s Psychiatric Additive Disorder (PAD), in which psychiatrists “pad” their billings by inventing non-existent disorders.

Look for them in DSM-6 a decade or so from now.


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