First, I disagree that inclusion of paraphilic coercive disorders will lead to lighter sentences. Although Dr. Grohol is correct that offenders can claim this as an excuse, lawyers and judges are going to thoroughly question it each time it is brought up because it labels the behaviour but doesn’t indicate the person is not/less guilty. If this were so, many criminals who have anti-social personality disorder would have lighter sentences simply due to their psychiatric illness. It also won’t lead someone to being deemed, “not criminally responsible due to mental disorder” (NCRMD, as used in Canada) or “not criminally responsible due to insanity” (term used in parts of Europe).

Second, I disagree with Dr. Grohol’s view on paraphilic coercive disorders because it doesn’t exclude someone from going on the sex offender registry, which is criticized as being punitive on its own.

Third, I disagree with DSM-V’s inclusion of self-injury as a psychiatric illness. It seems to just clutter the diagnosis up because people who self-injure likely already have a mental illness. I feel it should be replaced by being a specifier for mental illnesses instead of its own mental illness. I feel that if someone were given this diagnosis, their GAF score would be lower.

I also disagree with the DSM-V’s “mild neurocognitive disorder”. While Dr. Grohol presented a good argument, my reasoning is a bit different. Particularly, the DSM-V seems to be pushing itself into the field of neurology because these neurocognitive disorders have a purely biological basis and cannot be remedied by psychotherapy. For example, “Minor/Major Neurocognitive Disorder Associated With Prion Disease” cannot be remedied at all by psychotherapy. It’s like saying Creutzfeldt-Jakob Disease can be remedied by psychology and psychiatry, when the onset, progression and treatment is purely biological at the brain level. The DSM-V is extending its arms into areas psychologists and psychiatrists are not trained in.

On the other hand, I do favour the inclusion of behavioural addictions. There is considerable research to indicate they exist. There is also a good deal of social experiences with it, however, I do wonder whether it will justify medications for such disorders.

I do think, however, that self-injury should classified as part of the Impulse Control disorders rather than be given the label Non-suicidal Self-injury; a label that will only create a worse stigma that is already out there and will deter people from seeking help.

Recognizing self-injury as a disorder is an important break through, and this is a step in the right direction, but I think more research needs to be conducted to ensure that the acknowledments of the disorder are correct. Will someone who hurts or thinks about hurting his or herself almost everyday seek help if they may be told they suffer from NSSI, or will they benefit more positively if they explain to a clinician that they’re urges are unctrollable and they hurt themselves in order to provide relief which may suggest to the clinician that he or she suffers from Impulse Control Disorder Self Injury type?

It will be interesting to see in a few years what the outcome will be.

-Ryan Harris

Have you seen these reports? (Try http://www.ageofautism.com, if not.) Can you comment, or do you know if this is true or not true?

Thanks.

I think the use of “spectrum disorders” is to acknowledge that mental disorders are often not “black and white” — that they occur on a spectrum of behavior, some of which may be milder than others — but still troubling and life-altering.

People don’t need a new disorder to over-prescribe; that’s happening quite nicely right now. So I’m not sure the new version can accelerate an already-significant trend.

Remove the Autism Spectrum from the MENTAL ILLNESS MANUAL since it is a GENETIC VARIATION THAT ALL SPECIES HAVE AND NEED TO SURVIVE THE EVER CHANGING PLANET.

It seems the creators of this “manual” are just lookin for an excuse to shove more pills down more people’s throats.