Comments on: Overdiagnosis, Mental Disorders and the DSM-5

By: Lynn Thomas

Lynn Thomas — Tue, 21 Dec 2010 22:27:48 +0000

I remember when the DSM 3 was published, It was widely considered to have been an exercise in getting medical aid to people who otherwise were not eligible due to a lack of a consistent diagnostic crieria recognised by the HMO’s in the USA. Apparently the reasoning went: 1. there is no consistent diagnostic criteria (ignoring ICD)so no funding for care/hospitalisation
2. establish criteria so that people can receive treatment.
3. Diagnostic criteria established (so simply said) and funding bodies had a term to put in their forms. With a criteria and a diagnostic label,an average length of time and treatment patterns established so average length of stay or treatment established and set.
4. establish costs
5. now know what to charge, open the doors to people with a diagnosed mental illness, HMO’s pay fees and everyone is supposedly better off. hmmmm.

It has opened the doors to increased diagnosing not necessarily more accurate diagnosis. We still lack a predictive diagnostic criteria or knowledge ie fall out of tree, land at such a speed and angle and break ones arm … not so for any of the mental illnesses. Mental Health Professionals need to get to know the client, spend time with them and have an attitude of being curious not judgemental, and then we can establish behaviours and attitudes that negatively affect someones life – not a diagnosis but an indicator (signs & symptoms as we nurses say)that can lead to a diagnosis. Then of course diagnosis remains fluid often but the symptoms are treated and the person can work towards recovery.

By: Ken

Ken — Tue, 03 Aug 2010 15:54:21 +0000

I think there is too much over diagnosing going on just for the sake of getting the insurance companies money. I just finished my 3rd psychology course. The instructor is a Dr. and she told the class that she Has to assign some type of mental disorder to every patient that pays with insurance, because it is the only way the insurance will pay for the therapy sessions. That is a very good indicator that over diagnosis is a serious problem within the mental health industry.

By: Bobbi

Bobbi — Sat, 31 Jul 2010 14:05:16 +0000

I believe that there is a real concern over too many diagnosis for one patient. I was actually diagnosed as having a “facticious disorder” by a doctor who saw me ONCE and only read my last discharge summary from the hospital. The nurses had no problem reaffirming my own diagnosis of PTSD- they saw the full picture. I believe that a diagnosis need to be made only after careful investigation.

For the insurance companies can’t we use a “differentional diagnosis” like they do when trying to rule out issues? Some Dx cling to a patient and result in errors down the line; While I understand DSM V to better classify disorders- how many people actually READ all the different classifications that have been updated?

By: Lynn

Lynn — Sat, 31 Jul 2010 03:22:27 +0000

ummm. Many many people in the mental health field (probably most) have or have had mental health disorders. My therapist even admitted that she has OCD as well. That’s why they go into the field. However, the DSM criteria are based on Research, not personal experience.

Also, being a “highly academic university functional successful graduate” does NOT mean that they can’t have even severe mental health problems. I successfully completed a couple of semesters of college while severely depressed and had panic disorder. I know several people who have Bipolar disorder and are in med school. Some people can compensate.

By: Domingo Mauricio Rodriguez

Domingo Mauricio Rodriguez — Fri, 30 Jul 2010 13:23:02 +0000

July/30/2010
I think that most normal people are too much egotistical to accpet the reality that they miss-diagnosed many pacients fo having cronic mental illness when in reality those paciente where highly academic university functional successfull graduates at bacherleratte degree level.

It appears that for security reaosns ( the government ís afraid the an avalanch of radical-revoluntional movement of masses of mental pacientes that are victums of miss-diagnosis would go wild if the governmente revealed the truth that there are about 10% percent of proesionals employees of many important businesses that are successful profesionals individuales with themself being mental pacients).

By: teo

teo — Thu, 29 Jul 2010 14:46:08 +0000

I think that the WHO’s definition of health allows the overdiagnosis at the first place: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

The people who write it can do something about keeping diagnosis useful and reasonable. I completely agree with: “Perhaps it’s time for a more nuanced, psychologically-based diagnostic system …”

By: Alexander Fürstenberg

Alexander Fürstenberg — Wed, 28 Jul 2010 16:57:53 +0000

There can’t be enough differentiation, if there is, at the same time, an opposing movement towards integration. Only that way, professionals will one day discover the true causes of all the seemingly different mental illnesses — and what to do about it.

By: Athirson

Athirson — Wed, 28 Jul 2010 14:13:24 +0000

RE: Perhaps it’s time for a more nuanced, psychologically-based diagnostic system to adopted by mental health professionals, one that doesn’t medicalize issues and turn every emotional concern into a problem that has to be labeled and medicated.

Without that, how will the mental-health industry (and yes, I wrote that correctly) make money?

By: Lynn

Lynn — Tue, 27 Jul 2010 03:15:38 +0000

Non-mental health professionals shouldn’t be diagnosing mental disorders period. They should be recognizing possible mental health problems and then referring to an appropriate mental health professional. If none is immediately available, (a serious concern someplaces), then they may have to treat the patient to the best of their ability based on their symptoms until on is available. They should still not be diagnosing however. Even though reimbursement requirements sometime makes this neccesary. Would you trust a non-oncologist to make a breast cancer diagnosis? No, so why should a primary care physician or other non-mental health professional diagnosis Major depression? Or Bipolar disorder? They simply don’t have the training.

I agree that under diagnosis and misdiagnosis is a major concern. OCD comes to mind. A large portion of people with OCD don’t know they have it. In fact, it takes an average of 9 years after the onset of OCD to be diagnosed correctly with OCD. And 14 years to get appropriate treatment (ie CBT in most cases).

By: Justin

Justin — Mon, 26 Jul 2010 19:22:57 +0000

I agree with the underlying theme of this essay, that is, that issues related to diagnosing mental disorders are multi-faceted and complex and that there are two sides to the coin of diagnosing-over and under diagnosing. However I must point out out that you are naive if you believe that members of the DSM task force are not biased or do not have conflicting interests. 3/4 of the dsm task force are on pharamaceutical payrolls. In fact this conflict of interest became such an issue the dsm commite had to implement a rule that placed a cap on the amount of money that dsm members could receive from pharmacy companies. The dsm is becoming the mockery of psychopathology. There is no end to to the number of mental illnesses the dsm is including, and will continue to be including, in the manual which is thicker than the bible. Sex addictions or hypersexuality disorder, binge eating, compulsive shopping, Internet and video game addiction, and premenstrual dysphoric disorder are all being considered right now inclusion into the dsm v. I’ve looked at much of the research being produced on the validity of these so called medical illnesses, and there is certainly a plethora of it, it’s based on the faulty logic of the three d’s of a mental disorder- if a behavior is distressing, dysfunctional, and deviant it constitutes a form of psychopathology. Such a definition of mental illnesses is circular, tautological, and precludes the possibility of engaing in a detrimental behaviour without having a mental illness. I’m not arguing that those exhibit these behaviours- binge eating, abnormal sexual behavior- are feigning or even that they don’t have serious problems. I’m arguing that the behavior itself is not a mental disorder but rather a manifestation of other underlying psychological and emotional problems which are genuine psyciatric conditions-depression, anxiety, etc.

By: anonymous

anonymous — Mon, 26 Jul 2010 19:22:50 +0000

In total agreement here. As for the solution, I think creating a panel of mentally ill experts-many who are very intelligent and creative-to come up with a version of the DSM to compare with that of the ‘experts’ can help solve this problem.

“Nowhere on his list does he mention the most likely cause of ‘over diagnosis’ — the general unreliability of diagnoses in everyday, real clinical practice, especially by non-mental health professionals.”

By: Harold A. Maio

Harold A. Maio — Mon, 26 Jul 2010 16:04:44 +0000

Claims of “stigmga”

There is one very important aspect to the teaching, validating, passing on of a “stigma”:

One must know which one is “safe” to assert, or be rebuked. Direct your term at sexual assault, you will be rebuked, not just by women, but by the same professionals offering you permit for the one you expressed. Direct your term at Jews, you can expect the same. Direct it at me… well, you already know.

Harold A. Maio, retired Mental Health Editor
khmaio@earthlink.net

By: Kristen

Kristen — Mon, 26 Jul 2010 14:28:43 +0000

“I call such websites and support communities “education” and “self-help.” The research literature is full of studies demonstrating that these websites help people better understand issues and get emotional support and direct, immediate help for them. Could some people use them to inaccurately diagnose themselves? Certainly.”

America’s culture promotes the mindset of only seeing the doctor when something is wrong, and if you can’t describe what’s wrong, don’t see the doctor. These self-diagnoses websites help suffering individuals give names to their problems, which helps them find justification to get in the door to receive mental help. Whether or not they have the illness they suspect, they still benefit from seeking help. It’s no bad thing,

By: rita'sperson

rita'sperson — Mon, 26 Jul 2010 14:14:48 +0000

“Perhaps it’s time for a more nuanced, psychologically-based diagnostic system to adopted by mental health professionals, one that doesn’t medicalize issues and turn every emotional concern into a problem that has to be labeled and medicated.”

ABSOLUTELY!! Part of the problem is the current health care system and parity for mental health care. It demands that we find a biologically based diagnoses in order to justify treatment so that the client does not have to pay out-of-pocket. Not all of the reasons people come for therapy is biologically based, but the behavioral patterns that they are trying to change impact their lives every bit as much as any biologically based disease.

By: David

David — Mon, 26 Jul 2010 12:06:04 +0000

The Doc says ‘I call such websites and support communities “education” and “self-help.” The research literature is full of studies demonstrating that these websites help people better understand issues and get emotional support and direct, immediate help for them.’

Maybe at least partly because they promote dialog amongst those who have personal experience with these disorders, rather than by those who theorize about them from afar.