But then we family therapists have only been saying “the most powerful location for change is between people, not inside people” since the late 60s/early 70s.  Not that DSM-V is going to do squat to improve the ghettoization of the V-codes or get insurers to reimburse for them, never mind the giant body of evidence we have of the effectiveness of conjoint treatment for all kinds of “individual” disorders.

There are more ways of dealing with ODD than just improving parental hierarchy, but yes, that’s a big piece.  Unfortunately the medical model won’t let us diagnose the symptom as residing in the family system – there are couple and family “V-codes” at the back of the DSM but the psychiatric establishment has no regard for them and no insurance company pays for them.  So you have to diagnose the individual kid, and then treat the family system, which sucks, but this is life under the for-profit insurance system and the medical model of mental health.  As a family therapist, I can assure you, it’s way more complicated than the picture you lay out.

I’ve known parents whose kids had a diagnosis of early-onset bipolar, who would fit the criteria for this new proposed disorder.  They are loving, wonderful people, with kids who can be TERRIFYING.  You do not want to see how much damage a 3-year-old can do to his fully grown mother in the throes of this kind of over the top rage. This is not a normal kid upset because someone said “no” – this is a kid whose brain is totally haywire in a way that’s terrifying for both them and the adults around them. 

One mother I knew took to carrying business cards with her that read something like “My son has severe early onset bipolar disorder. This means he has severe, uncontrollable fits of rage that are sometimes violent. He is being treated by a doctor and a team of therapists. If he has an outburst in public, please do not try to intervene, talk him down, or give me advice.  I am dealing with him in the way that our treatment team suggests is best for him.”

Because she couldn’t leave him with a sitter and you have to go get groceries and toilet paper sometime.  And having your kid go full Hulk in the middle of Target is hard enough without know-it-all strangers getting involved, and likely getting hurt.

This is not a “let’s medicate kids and make them zombies” pseudo-diagnosis – this is REAL.  I’ve worked with pre-adolescent and adolescent kids with behavior problems, and a very few who’d actually fit this category.  The difference is exponential, and a competent, trained mental health professional knows that this isn’t just a label to slap on any kid who throws a wobbler over having to turn off the TV.

You also left off a vitally important part of this particular criteria: “The temper outbursts are inconsistent with developmental level.” That means it might be okay for a two year old to throw three tantrums per week, but not okay for a five year old to do the same. The third criteria is that the child’s mood between tantrums is “persistently irritable or angry”. Even two year olds who throw consistent tantrums aren’t usually irritable or angry between them. Tantrums for most two year olds are brief affairs. The tantrum is thrown, and in a few minutes, they’re off doing something else.And then there’s the important fourth criteria: This behavior has to be going on at least an entire year. 

I have a lot of problems with the DSM. The DSM diagnosing strictly based upon symptoms while most of medicine, it is based upon physiological testing. We might suspect someone with certain symptoms may have diabetes, but we don’t diagnose diabetes except through a blood glucose test. Unfortunately, Psychology and Psychiatry haven’t been able to do the same. Also, many of the criteria tend to be subjective.

I can understand how someone can be skeptical of psychiatry and psychology. But, get the facts straight. Under these criteria, the standard two year old can’t be diagnosed with DMDD.

The study found that between 1996 and 2007, the proportion of patient visits in which antidepressants were prescribed but no psychiatric diagnoses were noted increased from 59.5% to 72.7%.

http://www.ama-assn.org/amednews/2011/08/22/hll20822.htm

It’s an extraordinarily widespread plague of medical malpractice.

Dismissing the claim that psychiatry is “pathologizing normal behavior” with an anecdote about a kid who smashed someone’s face in with a brick and burned down a house is rhetorical sleight of hand. The face-smasher and (for example) the troublesome kid who’s medicated with stimulants at the behest of an overburdened educational district are not equivalent cases.

And that, in turn, illustrates my basic problem with the field as it now exists: psychiatry’s societal reach far exceeds its grasp. You yourself admit that its primary diagnostic criteria are terrible, and yet those criteria are used to dispense powerful medications to tens of millions of people in the US alone every year.

There’s something fundamentally wrong with that.

First, if a tenth of the population is clinically depressed, the problem is not psychiatric, it’s societal.

Second, what percentage of those people are undergoing any treatment other than popping a pill?

Third, if a physician were prescribing pills to mask symptoms of any other illness without further exploration into the cause and possible cure, we’d call it malpractice.

You might consider that my social skill set includes talking a man
pointing a gun at you into putting it down and taking his antipsychotic

You stole my childhood!  Except I had to resuscitate him from ODing on 60s era sleeping pills.  In retrospect, that seems like a really counter-productive thing to have done.

Eventually he was reevaluated with ADHD and Depression. Now he has regular counseling and takes prozac and concerta. He feels much better now. He says he felt totally out of control before, but he’s now able to get a handle on himself.

My point is that childhood disorders are very difficult to peg down compared to adults who are more self aware.

It’s easy to say that we’re pathologizing normal behavior, but that kind of logic comes from a deep naivete about the prevalence and severity of mental illness in the community, and in the pediatric population in particular.

Your whole comment is circular logic.

If I can’t just say “kids throw tantrums” then you can’t get ‘wrong’ and ‘different’, so confused.

Something was different.

To me, the reclassification seems much more like the pharmaceutical industry’s first sally in a strategic marketing campaign to first create a disorder and then prescribe and sell a treatment. In this case, quite literally, the 21st century equivalent of “soothing syrups.”

On that note, heads up Little Wayne. Glaxo Smith Kline is coming for your purple drank.

By having a diagnosis to fall back on, parents can wipe their hands clean that it isn’t their fault while their kid melts down over not getting a candy bar.

While there are some children who have real problems, there are many more “special snowflakes” who have just had their parents browbeat society into accepting shitty behavior.  Handing parents a label lets them not have to deal with the real problem, I just need to get this pill to make them better.  If these parents weren’t looking for an “out”, it should be hard to convince them a temper tantrum is not just bad behavior and is instead a disorder.

I want to press more than once the “Like” button. This, this so much this!!!! I agree with very part of it!

When you get a fever you go to a doctor and get a pill and it goes away (may or may not have been thanks to the magic pill you got). That’s not how psychiatry works. I wish it did.

I also want to say that sometimes making a diagnosis is not so kids can be medicated but so schools can create certain plans for them. Here in WA state there are 504s and IEPs, certain services have to be provided by the school if the kid has a diagnosis. The school might say, I can’t do anything, your kid has tantrums, sorry, but with a diagnosis the school might have to provide an aide, train the teacher in deescalation skills, bring in weighted blankets/ other soothing or distracting measures, etc.

Third, re: the ADHD debate. I had ADHD as a child and was not put on medication, because I was able to do something that is now called “hyperfocusing” but back then was “If she can paint for 2 hours her attention is fine.” So I didn’t have ADHD, and the reason that I could not for the life of me organize anything, pay attention in class, stop daydreaming, remember assignments, turn in completed homework, was that I was lazy and/ or trying to annoy people. I went through my whole elementary school career feeling guilty for whatever character flaw caused me to do these things, apparently for the sole reason of disappointing and frustrating adults that I loved. My parents had a short fuse with me, my teachers harassed me in front of the class more times than I can count, including a charmer who would scoop everything out of my desk and throw it onto the floor and then tell me “pick it up and put it into piles this time,” etc. I was lucky enough to outgrow my ADHD, as many kids do, but the experience has always stayed with me, and greatly affected my teenage years in ways I won’t get into. 

Now I work with ADHD kids, and to me the mark of effective treatment is when a kid comes back relieved, so happy that they can finally do what they’ve been trying so hard to do and just couldn’t. We never medicate a kid against their will, or against their family’s will. We will never keep a kid on meds when side effects are bothering them, no matter what their parents want (including “not feeling like myself”). But PET and functional MRI scans show difference in brain activity between ADHD & non-ADHD kids, and in executive functions, etc. Do kids sometimes get medicated to “shut them up”? By poor practitioners, yes. Do kids sometimes get prescribed antibiotics when they don’t need them at all? By poor practitioners, yes. But please don’t throw the whole diagnosis of ADHD out the window because some practitioners/ parents have abused it.