Saturday, December 31, 2011

Instant Cure

If you wait long enough, the DSM will simply edit you out.
Miss Bender is not a clinician, or medically trained to any degree.  She is simply an enthusiastic spinster with literary training and an obsession for deconstructing text...

Like new sports in the Olympics, and slang in the American Heritage Dictionary, society awaits the generational sweep-up of the Diagnostic and Statistical Manual of Mental Disorders .  Version 5 is upon us!
Oooh, it feels like Christmas.

Who's Out:  It's the social register you are glad excludes you, and with Version 5 the following Disorders are being redefined.

Mental Retardation.  Well, what do you know about that.  Intellectual Developmental Disorder will no longer be coded mild, moderate, severe, profound by IQ range.

Autism Spectrum Disorders will be more specifically identified, over DSM-IV, including the simple, but key description: "Symptoms together limit and impair everyday functioning."  Limit and impair, which means you high functioning austistic types just became less autistic.  On the other hand, you might now be obsessive/compulsive, so stick with the devil you know, I say....

My favorite sentence from the APA might be that the current "criteria [for austism] were equivalent to trying to “cleave meatloaf at the joints”.

Body Dysmorphic Disorder no longer limited to body fat or weight.  This is not specified in Version IV, but apparently assumed, since Version 5 stipulates, "appearance preoccupations are not restricted to concerns with body fat or weight in an eating disorder."  

Blanket Narcissism (what I call the Ass-tism Spectrum, or.. no more meds for being a general jerk).  Version 5 puts the screws to narcissists just where they want them, but making it more about them.  To appreciate the big change to our friend T-05, Narcissistic Personality Disorder, you can study the current diagnosis, which emphasizes a "pattern of behavior,"  against the proposed revision, which emphasizes the results of those patterns, to self and interpersonal relationships.  Says the APA, "Impairments in the self and interpersonal domains were deemed by the Work Group to be most characteristic of personality disorders."

Gender Identity Disorder is renamed Gender Dysphoria, and for an interesting look into identity, read the Rationale for the change, which was originally proposed as "Gender Incongruence" until a consult from the World Professional Association for Transgender Health.

 "disorder" has a specific clinical definition, which is,
A clinically significant  behavioral or psychological syndrome or pattern that occurs in an individual [which is] associated with present distress...[and is not]  merely an expectable and culturally sanctioned response to a particular event...
In the case of Gender Dysmorphia,  also note that the Sexual and Identity Disorders Workgroup stated
We also debated and discussed the merit of placing this condition in a special category apart from...psychiatric diagnoses to reflect its unusual status as a mental condition treated with cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired gender.... We chose not to make any decision between its categorization as a psychiatric or a medical condition and wished to avoid jeopardizing either insurance coverage or treatment access (Drescher, 2010).  (emphasis is again mine.  None else italicizes quite this much.)

Childhood Gender Identity Disorder  is severely specified as a mental illness as 6 of 8 traits must now be present to classify as Gender Dysphoria in Children, where DSM-IV requires only 4 of 5 traits, and does not include the statement "clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability."
 (those italics were actually already there)

DSM-5 may revive the definition of "disorder" as well, thanks to the worst-named workteam in the world of corporate bureaucracy, the Anxiety, Obsessive-Compulsive, Posttraumatic, and Dissociative Disorders Work Group.

I hope they ordered mugs.
Next time you think your little mission statement task force spends too much time arguing over its acronym, you might just let them take their time.

The committee of the sad would like to tweak this language somewhat; for example "reflects an underlying psychobiological dysfunction" rather than "is a manifestation of..."    That sort of thing.

So....What's In:
Obsessive-Compulsives, this is your time! Skin-Picking Disorder and Hoarding -- now rate their own entries!

Exhibitionists, you've become so diversified that we need Types for you:   
Sexually Attracted to Exposing Genitals to Pubescent or Prepubescent Individuals (Generally Younger Than Age 15)
Sexually Attracted to Exposing Genitals to Physically Mature Individuals (Generally Age 15 or Older)
Equally Sexually Attracted to Exposing Genitals to Both Age Groups

You must be so proud...

Unspecified Depressive Disorder - still under review, but on the table for Version 5.  In case Big Pharma can not reach you on one of the 8 other categories (including Premenstrual Dysphoria, so watch your "edginess."  That's also a clinical term), they may soon have a catch-all bucket for you.

Medical codes for Agoraphobia!  It's all about the coding for you and your IN'sharns company.  In exchange, you must now be agoraphobic for more than 6 months, it must impair your functioning (WoW does not qualify),  and you have to test out of 5 other disorders first (which is true today).

Back to Body Dysmorphia, proposed revision would include repetitive behaviors in response to the dysmorphia, which at a stretch could include cosmetic surgeries.

Dyslexia - was always in there, but called "Reading Disorder."  In addition to its new name, it aligns better with IDEA regulations, which address achievement potential in people with learning disabilities, a potential DSM-IV does not recognize. And for those of us in the adaptive technologies and access game, the removal of "comprehension" as one of the reading difficulties associated with dyslexia is a major win.  With the right access to the written word, people with dyslexia comprehend just fine.

As for the switch to Arabic numerals, the APA has gone digital with the rest of American Medicine -- this allows them to make point revisions like 5.2 and 5.3, which translate better than IV-TR did.  Because no one could figure out what number TR was.


  1. My favorite disorder that has simply disappeared, favorite, mind you, not because I have it, but because I know so many who do, is Hystrionic Personality Disorder. Grab your DSM-IV (or maybe even III), read it and weep.

  2. Ms. Bender, I am truly awed. Truly. Having once labored in the fields of counseling - altho not mental health - there was a time when I could read AND comprehend this stuff [I nearly used a four letter word there - use your imagination.] but cannot now imagine pulling together enough brain cells to even try. Thanks so much for parsing it out for me, especially that part about exposing genitals. I try to stick to folks older than 15. Don't know if that makes me a better person or not.

    Happy New YEar!


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