Temper tantrums considered for addition to DSM

The American Psychiatric Association is set to add "disruptive mood dysregulation disorder" to the Diagnostic Statistical Manual (DSM), the bible of psychiatric disorders. A kid has "DMDD" if she or he has "severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation... at least three times a week."

As Wired's David Dobbs notes, this describes basically all kids ("No, I don't want to wear my rain boots!") at some time or another. So why is this being considered? Here's Neuroskeptic's explanation:

DMDD seems to be nothing to do with mood, but instead covers a pattern of misbehavior which is already covered by not one but two labels already. Why add a misleadingly-named third?
Well, the back-story is that in the past ten years, many American kids and even toddlers have got diagnosed with ‘child bipolar disorder‘ – a disease considered extremely rare everywhere else. To stop this, the DSM-5 committee want to introduce DMDD as a replacement. This is the officially stated reason for introducing it. On the evidence of this paper and others it wouldn’t even achieve this dubious goal.
The possibility of just going to back to the days when psychiatrists didn’t diagnose prepubescent children with bipolar (except in very rare cases) seems to not be on the table.

Psychiatry Set to Medicalize Hissy Fits

I write books. My latest is a YA science fiction novel called Homeland (it's the sequel to Little Brother). More books: Rapture of the Nerds (a novel, with Charlie Stross); With a Little Help (short stories); and The Great Big Beautiful Tomorrow (novella and nonfic). I speak all over the place and I tweet and tumble, too.

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Robert

Perhaps they’re pining for the good ol’ days when they could diagnose women with “hysteria”?
cfuse

Once it has a label in the DSM, then it has the capacity for pharmacological intervention.
- Cornan
  
  Bingo!
- Jake0748
  
  That’s a really scary thought. Now all I can imagine is a bunch of screaming 3-year olds just doped up to keep them quiet. Brrr.
  - Radka
    
    Maybe we are heading back to the good ol’ days… My grandma told me back in her day, moms used to give their kids poppy tea – mellow them right out with some opiates. God knows why that was ever discontinued… ;-)
  - fuzzyfuzzyfungus
    
    Back before the feds ruined everything with their ‘Pure food and drug act’, “Soothing Syrups” were a pretty excellent class of child care aids.
    
    It turns out that morphine, sometimes in combination with other opiates, or alcohol, mixed with enough sugar to get kiddo to open up and swallow, does indeed sooth the heck out of the little monsters…
    - blissfulight
      
      My great grandmother from Russia used a ‘cough’ syrup made from opium and presumably vodka that she gave to her (little) kids when they had any ‘problem’, like a bellyache or temper tantrum. Shut them up pretty quick. The seeds for the poppy plant were brought over on the boat from Russia, and she would grow, harvest, process, and administer them in the traditional manner herself.
      - fuzzyfuzzyfungus
        
        Apparently, powerful opiates are actually pretty decent cough suppressants, if the potential side effects don’t bother you…
      - Antinous / Moderator
        
        They make Vicodin cough syrup.
        
        For those nights when you can’t be bothered to use the cocktail shaker.
      - IamInnocent
        
        Well, if one hardly breathe, one doesn’t cough after all…
  - Henry Pootel
    
    It happens already really - “I’ll buy you a candy bar if…” or “We’ll go to McDonalds if…”
- BarBarSeven
  
  *Kaaaa-CHING!!!*
- http://imcravingpresidency.tumblr.com/ SedanChair
  
  By dart gun.
  
  “MOMMY I DON’T WANT—” *thunk* *zzzzzz*
- Cher Thomason
  
  And to be billable.
- Antinous / Moderator
  
  11% of Americans are on anti-depressants. That’s the number that’s been reported; I don’t know the accuracy, but let’s assume that it’s in the ballpark.
  
  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.
  - allenmcbride
    
    Your first question seems to assume that there’s no overlap between psychiatric and societal problems. It also seems to assume that 11% is above some sort of threshold beyond which it isn’t possible that so many people could have a medical problem. Neither assumption seems obvious to me. Your third question seems to suggest that you don’t think doctors look for the cause of depression when they see it. Well, the good ones do and the bad ones don’t, of course, roughly speaking. We could estimate the proportion that fall into each category, but what would that tell us about the prevalence of depression or how best to treat it? Your third question also suggests that doctors aren’t looking for cures for depression. But of course they are… not all of them, naturally, because they’re mostly too busy treating patients, but those who research depression. Also, I’ve heard some doctors say that antidepressants themselves can sometimes cure depression for a lucky few. I don’t know if that’s true, but I don’t know if your implicit claim that they can’t is true either.
    - Antinous / Moderator
      
      I haven’t seen any studies claiming that anti-depressants effect a cure. The biggest problem with anti-depressants is that it’s legal for any physician to prescribe them. It should be limited to psychiatrists.
      
      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.
      - allenmcbride
        
        Yeah, just now I couldn’t find anything to support what I’d heard about remission after discontinuation; you seem right about that. And I agree that the results of this study are worrying. But it seems extreme to say it shows “extraordinarily widespread … malpractice” and that non-psychiatrists shouldn’t be able to prescribe antidepressants. The study says that antidepressants are helpful for various non-psychiatric conditions. It also notes that their survey overcounts an unknown number of cases where doctors were refilling prescriptions based on past diagnoses. I think that problem hints at some of the harm that could come from banning non-psychiatrist prescriptions: In countries with shitty health care access, like the US, frequent visits to psychiatrists can be extremely expensive. I think the ability to get medicine from primary care doctors could be the difference between treatment and neglect for a lot of people.
EH

Next up: glaring.
- http://www.facebook.com/jorgen.fleisterman Jorgen Fleisterman
  
  “Mrs. Smith, I noticed Johnny rolling his eyes more than once in class today. I really think he should see a doctor. He may suffer from Bored of Education Syndrome and need a nice heavy dose of hard, profit-building pharmaceuticals in order to fix his problems.”
  - Slartibartfatsdomino
    
    There’s already a name for Bored of Education Syndrome. It’s called Attention Deficit/ Hyperactive Disorder. At least it was when they tried (and failed) to pump me full of drugs in junior high.
Moribund Cadaver

Ah yes. The drive to turn everything into a syndrome, categorize it, and open up the pathway to medicate it.
- That_Anonymous_Coward
  
  Its a human failing.
  Unemployed? Blame illegals!
  Annoyed by being felt up to get on a plane? Blame terrorists!
  Your marriage sucks? Blame gays for attacking traditional marriage!
  
  Humans desire something to assign blame to, right or wrong. Once you can pinpoint the “problem” you don’t have to think about any thing else that might cause it, it is always the fault of X. They will waste time and resources to find where to assign the blame, before looking at how to fix what it is causing.
  
  Imagine a piece of trash on the ground, you can imagine people standing around it tsking away at how dare someone throw it there and we should make laws to make it illegal. They will debate how immoral that person must be, demonizing them… what is rare to see is the person who see’s the trash next to the can who just picks it up and throws it away and moves on.
  - LaylaSV
    
    I was unaware of any popular movement among parents to redefine temper tantrums as a disorder. To me, this seems less about shrugging off blame then about maximizing profit – although both are certainly human failings.
    - That_Anonymous_Coward
      
      Have you met the majority of current “parents”?
      No adults near parks, they might be pedos out to get my kids! (I don’t have time to watch them)
      We need the world wrapped in nerf to protect them. (Watch them I’m busy watching Dr. Phil seeing how other people screwed up their kids)
      We need the world filtered to protect them from feeling bad. (Not my job to have rules about using the internet or tv for my kid.)
      My kid won’t stop paying xbox, I know I’ll call 911. (It happened)
      Stop staring at my kid pulling stuff off the shelves and running around!
      Don’t you dare tell me how to raise my kid, but you should do these things to benefit my kid.
      etc etc etc…
      
      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.
      - LaylaSV
        
        Yeah. Sorry. I just don’t see it. While I understand some of your other examples and while I am aware of all the media hysteria surrounding crap parenting – from Honey Boo Boo to helicopters, I have never witnessed or read anything about actual, individual parents wanting their kids occasional temper tantrums reclassified as a psychological disorder.
        
        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.
allenmcbride

I don’t know if Neuroskeptic is right or not, but there’s more to the proposed diagnostic criteria than what was quoted here. For example, “The temper outbursts are inconsistent with developmental level.” So by definition this can’t cover normal tantrums (though obviously there would be disagreement over what’s developmentally normal). Also, “Nearly every day, most of the day, the mood between temper outbursts is persistently irritable or angry.” That doesn’t sound like a typical healthy kid to me. Here’s the full list: https://webcache.googleusercontent.com/search?q=cache:zLd46dXe00YJ:www.dsm5.org/proposedrevision/pages/proposedrevision.aspx
- jackbird
  
  Indeed. “Criteria A-C [highly memorable tantrums at least every other day plus angry all the freaking time] have been present for 12 or more months” makes this sound like pretty seriously problematic behavior. Also, it can’t be diagnosed before age 6, so tantrums should be getting somewhat rare by then.
- http://www.facebook.com/christy.corbett.79 Christy Corbett
  
  While I appreciate the additional diagnostic criteria listed, as clarification, it still seems to be vague enough to be too widely applied. Temper outbursts being inconsistent with developmental level? Does this include crying, screaming, throwing things, breaking inanimate objects? Because I, and my husband, have both done that as adults and we are fairly well adjusted. The mere fact that they include ODD as a companion piece really piques my interest. As I understand it, the only effective treatment for ODD is to retrain the parents, as the child has been led to believe that they have all the power in the relationship. I have witnessed a child with said diagnosis, and he is grossly underparented as is his sister. So, not that there are kids with problems, but this one seems pretty sketchy.
  - fuzzyfuzzyfungus
    
    The DSM authorship, given their intended scope, faces a basic problem:
    
    The DSM can be vague, broadly applicable, and available within a decade or two.
    
    Or it can be precise, narrowly applicable, and available within a decade or two.
    
    Or, it can be precise, broadly applicable, and available once the disciplines of psychology, psychiatry, and neurology have been 100% completed.
    
    This tends to make heavy use of vague “The above symptoms are a problem if they are problematic for the patient and/or deeply atypical” type language in most of the definitions.
    
    On the minus side, this leaves a great deal of latitude for doctors to fuck it up.
    
    On the plus side, this leaves a great deal of latitude for doctors to treat patients and then come up with an applicable code for insurance purposes(which, in no small part, is what DSM codes or their close equivalents end up being used for).
    - http://twitter.com/writebastard Ian Wood
      
      Dr. Allen Frances, chair of the DSM-IV Task Force, is of the opinion that:
      
      …the work on DSM-V has displayed the most unhappy combination of soaring ambition and weak methodology. [...] The DSM-V goal to effect a “paradigm shift” in psychiatric diagnosis is absurdly premature. Simply stated, descriptive psychiatric diagnosis does not now need and cannot support a paradigm shift. There can be no dramatic improvements in psychiatric diagnosis until we make a fundamental leap in our understanding of what causes mental disorders. The incredible recent advances in neuroscience, molecular biology, and brain imaging that have taught us so much about normal brain functioning are still not relevant to the clinical practicalities of everyday psychiatric diagnosis. The clearest evidence supporting this disappointing fact is that not even one biological test is ready for inclusion in the criteria sets for DSM-V.
      
      This might seem like someone who’s protecting his particular project from a subsequent revision, but he’s not alone in his criticisms of the DSM-V process.
      
      There are fundamental problems with the entire field of psychiatry, and chief among them is that its diagnostic criteria are highly subject to the political and academic fashions of the committees charged with creating them.
      
      Which, admittedly, can be said of any discipline. However, this is a discipline which has been given broad cultural authority to dispense Official Drugs that alter the behaviors, and, potentially, the personalities of a large segment of the population in ways which are not fully understood.
      
      I’m no Scientologist, but the prevalence of psychiatric medication gives me the heebie-jeebies. There’s an entire medical-industrial infrastructure being set into place which, whatever actual good it may do for an as-yet-undetermined percentage of its subjects, has vast abuse potential as a system for forcing people to tolerate the intolerable.
      - IamInnocent
        
        Maybe she suffers from the new Pissed Off Former DSM Chair Syndrome ?
      - erx
        
        I’m a psychiatrist who also has a PhD in neuroscience, so you can either discount what I’m saying as biased or consider it as coming from a knowledgeable source. It is absolutely true that there are a lot of problems with psychiatry, but the point that most people miss is that there is a huge amount of psychiatric illness out in the community. You’re worried about the prevalence of psych meds, but epidemiology shows that it is the #1 category in terms of disease burden in the US. Lots of people SHOULD be medicated because lots of people are sick. There is a huge epidemic of mental illness in this country that the average person simply doesn’t know about, partially because mentally ill people do their best to hide it, and partially because they become socially withdrawn and fall off the map. Why do you think we have such a large homeless population? Why do you think prisons are overcrowded? If you spend any time working with the homeless or the prison population, the answer is obvious.As physicians, we are obligated to do our best to help these people, even though the science hasn’t caught up with us yet. When I look at cardiologists, I think “You lucky bastards.” They treat a relatively simple organ where measuring the various physiological parameters is relatively straightforward. As psychiatrists, we have to do things the old-fashioned way, by straight clinical exam, just like cardiologists did before EKGs and echocardiography. The utterly baffling thing is how effective the field of psychiatry is, given that our most effective treatments were discovered through careful observation and dumb luck, with minimal understanding of the actual underlying mechanism. However, that’s not psychiatry’s problem per se; we don’t understand the mechanism of brain drugs because we don’t understand the brain well enough. That doesn’t mean that we don’t understand the effect these drugs have on people – that part we do understand, quite well.
        
        The expansion of the number of diagnoses in the DSM bothers a lot of people because they don’t understand that it’s not expanding the number of people who have a diagnosis, it’s splitting the people who have diagnoses into smaller and smaller subgroups. Also, giving you a diagnosis does not mean that I can force treatment on you. What having a diagnosis means is that your insurance company has to acknowledge that you need treatment, if you and I both agree it’s necessary. 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. Spend a couple days on an inpatient child psychiatry unit, and it will absolutely blow your mind. I worked on one of those units during residency, and the typical kid there would be a five-year-old who smashed another kid in the face with a brick, set his foster parents’ house on fire, then tried to grab the cop’s gun while he was being brought in. Kids receiving diagnoses like this one are not normal kids by any stretch of the imagination.
        
        Finally, I’ll say that I think the DSM is a stupid and terrible system, and every psychiatrist I’ve ever met agrees with me. The problem is, no one has been able to come up with a better system. People are working on it, and I look forward to the day when we can move on to something better, but for now it’s the best we’ve got.
      - CH
        
        “it’s splitting the people who have diagnoses into smaller and smaller subgroups”
        Yes!!! And this is a good thing… but… I would like to go even further.
        
        I’m just a mom who has been incredibly frustrated with the state of child psychiatry in my country (not the US)… but … a lot of the diagnoses are just a big lump of “we acknowledge that there is something wrong of this kind”. Like if you went to the doctor and came out with a diagnosis of “Fever Disorder” when you have pneumonia. It’s often a big lump of symptoms that can have a lot of different reasons behind. I would rather throw a lot of current “diagnosis” in the trash bin and start diagnosing from the “why” instead of “how”,
      - http://www.genreville.com/ Josh Jasper
        
        Thanks. And keep in mind that not all Boing Boing readers are dismissive know-it-alls who’ll happily take time to slag psychiatry, but not actually give a damn about the problems it’s trying to solve.
        
        It’s just most of them.
      - BlackPanda
        
        Thankyou for saying that. I also work in mental health, and I was baffled by the number of people here who seem to think that what I see from the inside as a caring profession is some kind of evil conspiracy.
      - allenmcbride
        
        Thank you. Your comment is exactly what this discussion needed.
        
        When I see people comment without even reading the proposed diagnostic criteria, it makes me suspect that part of the problem is a lazy rationalism — people voicing opinions they’ve deduced from their worldview rather than following the evidence. “They just want to pathologize normal behavior” is simple, logical, elegant, and wrong.
      - novium
        
        I am replying here because I can’t reply further down, but this is kind of a general comment anyway. There is some profound mental illness in my family, and the family members that struggle with the worst of it have not been well treated by the mental health system. I agree with the idea that while psychiatry may be flawed, it’s the best we’ve got…but it’s also important to remember that the field is still capable of profoundly (and not rarely) mis-serving those in its care- with over-diagnosis, with pathologizing everything, with denying the suffers of mental illness any agency.
      - Antinous / Moderator
        
        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.
      - http://twitter.com/writebastard Ian Wood
        
        You’re knowledgeable, granted. And I fail to see how your statement that “the DSM is a stupid and terrible system” does nothing but undercut your statement that “epidemiology shows [mental illness] is the #1 category in terms of disease burden in the US.”
        
        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.
      - FoolishOwl
        
        I think a lot of us are complaining about “pathologizing normal behavior” because we have personal experience with it — either our own behavior being treated as pathological, or the behavior of our children or others close to us.
  - knappa
    
    Does this include crying, screaming, throwing things, breaking inanimate objects? Because I, and my husband, have both done that as adults and we are fairly well adjusted.
    
    Have-done or do-this-3-times-a-week? If you, as an adult, do this more than sporadically when something honestly bad happens, I really doubt that you are as well adjusted as you say.
  - ldobe
    
    ODD is interesting to me. My brother was diagnosed with it when he was 8. He and my parents went through family an cognitive behavioral therapy, which helped. But eventually he began acting out again worse than ever.
    
    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.
  - elusis
    
    All due respect, if you don’t know the difference between normal kid behavior and what qualifies for this diagnosis, that’s fine, but mental health professionals are trained to assess these kinds of things and believe me, there is a difference.
    
    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.
- Boundegar
  
  This is a pretty good description of my sister, as a small child. At least once a week she would get herself into an uncontrollable rage – always over some tiny thing. She got so worked up that she literally couldn’t stop screaming, until she had exhausted herself.
  
  I don’t think it was a psychiatric problem. Our family was plenty messed up, and she’s just the poor kid who got the symptoms. Nevertheless, if it had been recognized as something more than “bad kid syndrome,” maybe she could have got some intervention and some help.
  
  Surprisingly, I don’t think ridicule would have improved her situation. Actually, my father sometimes tried that, but it didn’t work. Blaming our parents might have helped, I dunno. I tried that sometimes, but it didn’t really change anything.
  - CH
    
    It would make it a psychiatric problem, with the underlying issue of family issues. The environment a child grows up in can cause psychiatric problems, or rather, the child needs a “good enough” environment to not cause psychiatric problems. Some children are more resilient than others, so it’s not that environment A will lead to issues for all children, but still… a child needs a good enough parent and a good enough environment to grow healthfully.
    
    And yes, your sister should have gotten help, and one help for her could have been help for your parents and your family.
    - Boundegar
      
      My understanding of “psychiatric” is that it implies a biochemical problem with a pharmaceutical solution, and I don’t think that’s her. But IANAD.
      
      The point is moot now. Her kids are in college and the problem is far in the past.
      - CH
        
        No it does not. And despite what all the hand wringers above are stating, no, there isn’t always a pharmaceutical solution. One example would for instance be Post Traumatic Stress Syndrome. A child living in a traumatic home environment may have Complex PTSD, which perhaps may have been the issue for your sister: http://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder
      - elusis
        
        And one of the PTSD treatments showing the most success in clinical trials (at VAs all over the country, no less) is Emotionally Focused Therapy, which is couple therapy based in attachment principles. A family therapy version is showing all kinds of results with child disorders as well.
        
        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.
      - elusis
        
        Family therapists have been treating all kinds of DSM diagnosis with couple and family therapy since the late 1960s, and we have a whole body of evidence to prove that it works. Just FWIW.
- elusis
  
  Thank you for making this point clear among all the skepticism and eye rolling.
  
  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.
Antinous / Moderator

Sounds like normal NPD behavior to me.
- blueelm
  
  Or BPD too.
  
  It also sounds like my father… his whole life.
  - http://www.genreville.com/ Josh Jasper
    
    Now imagine if there had been some treatment he could have taken that had a chance to help him get better.
    - blueelm
      
      Lol! My dad has been in psychiatric care my whole life.
      
      Our reality revolved around it. Well, that and his violence.
      
      But thanks for assuming otherwise.
      
      BTW, I’m not anti-mental health. Just don’t pretend popping a pill fixes everything FFS so you can pretend it’s a safe good world and forget about the rest of us.
      
      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 :)
      
      Not a mental health professional, but you don’t get to live this long under my circumstances without developing a hefty dose of compassion.
      
      Now imagine you knew what it was like to live with serious mental illness, to have your whole life be a part of some one else’s treatment plan, and that you have some problems of your own. Now tell me what treatment there is to make it better?
      
      Work. That’s what there is and always was. A lot of work. More work than pills, really.
      - chgoliz
        
        I am only alive because there were no guns in our home growing up. Knives and other weapons, I had a fighting chance….obviously, since I’m still here.
        
        One of my uncles committed suicide *because* he was the only sane person in his immediate family, and ended up dealing with too many self-destructive behaviors as a result.
        
        There are too many children suffering in their families. The answer has many parts, some of which include drugs (like antipsychotics).
        
        I’ve often wondered how differently our families’ individual lives would have turned out if there had been help for the older generations when they were young. How much would have been nipped in the bud?
        
        Yes, we prescribe too many drugs, from antibiotics through Ritalin. But it’s a first-world problem, kind of like having so much food available that we eat too much.
      - blueelm
        
        True. My concern is less that we prescribe too many drugs (not something I mind. Personally I think we should bring back some of the old stigmatized drugs as well).
        
        Rather my concern is that there is this idea that the drug is all there is.
        
        It takes MORE than the drug to even make progress.
        
        Boiling down the discussion to: BIG PHARMA/Lazy Parents/Moral Failing/Personal Responsibility vs WHEEE CURED is simplistic on both sides.
        
        One of the most important things I think is reducing the stigma on mental illness.
        
        And both sides of that argument fail to do so. One ignores the reality of it and downplays it (just money making scheme, bad parents, crooked doctors, ADDICTS) and the other downplays it (I don’t see it, so it’s fine! Psychiatry will fix EVERYTHING)
        
        I’ve nothing against the profession. Not surprisingly some of my family work in that field. To be honest I hear almost no psychiatrists actually with that sort of overly optimistic enthusiasm FWIW.
      - CH
        
        Cannot reply to blueelm directly anymore…
        
        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.
      - Antinous / Moderator
        
        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.
legotech

Yay, another way for inattentive parents to get drugs for their poorly socialized monster kids, cause the HORRIBLE behavior of the children could NEVER be the fault of the parents…it’s something beyond their control. See? A doctor even said so! It’s not my fault for ignoring the kid and dumping them in front of a TV 12 hrs a day.
- CH
  
  Um… like… what drug? You may take that as a flippant question, but in all seriousness… what drug? If you think child psychiatry has a wonder drug for every diagnosis you are unfortunately sorely mistaken.
  - blueelm
    
    This. Oh this. If only one could pop a magic pill. I mean, I guess you could argue that we could just sedate some people until they’re essentially comatose.
    
    I think some people really don’t understand what it’s like to be mentally ill or have serious mental illness around you.
    
    The thing is if you were the kind of parent to think you don’t have to take care of your kid, having a kid with a mental problem means you’re going to be an EVEN WORSE and MORE DAMAGING parent to that kid.
    
    It’s so much easier to pretend that problems are easy to fix I guess.
    - legotech
      
      See my reply up there, and sedating kids until they are zombies is EXACTLY what the amazing number of ADHD diagnosis are for. Parents and teachers don’t want to deal with actual, active kids. So the teachers tell the parents that the kids are misbehaving to an unbelievable degree and the parents find a doc to give them drugs. That way neither the teacher or the parents need to actually deal with active kids.
      - blueelm
        
        Are you kidding me? Do you even know what methylphenidate is?
        
        It’s not sedating anyone, and it works the same way on people with ADD as it does on people without it. The last thing it’s doing is making anyone comatose.
      - heckblazer
        
        To expand a bit, Ritalin is an amphetamine derivative. It would be inaccurate to describe the drug’s effect along the lines of “doping up kids so that they turn into zombies” as the drug is a powerful stimulant that is also used to treat narcolepsy. Giving a stimulant to an already hyperactive kid might seem like adding gasoline to a fire, but stimulants also increase the ability to focus and it’s the inability to focus that’s the problem for kids who really do have ADHD.
      - elusis
        
        Congratulations on totally failing to read the story about what kids with ADHD say about their meds that was posted here just a few weeks ago.
    - legotech
      
      Oh, and to both of you? Where exactly did I say that there are no LEGITIMATE problems? I was making fun of the non existent problems that get kids medicated into zombiedom because parents and teachers don’t want to deal with kids who want to run around and actually talk to them.
      - blueelm
        
        And you know the existent problems from the non existent problems how?
      - CH
        
        Yeah… sure… that’s what is happening.
  - legotech
    
    So ALL of the kids on ADHD meds actually NEED to be and it’s not just a convenient diagnosis so parents and teachers don’t have to deal with normal kids and instead get little zombies who sit still? If you believe that this would not be just as abused as that, you are nuts. Too many parents today have kids as accessories and don’t have/make the time to actually interact with their kids in a healthy way and instead search for a medical diagnosis to get them off the hook for the kid actually wanting to run around and, you know, TALK to their parents.
    - CH
      
      You are saying it will be abused, I say, again, what medication would be abused for this diagnosis?
Dave X

On the plus side, if I have to re-visit the days where my kid hollers at me that I’m fixing a box of mac n cheese wrong by cooking it– no kidding, this used to be a thing– then I’m going to enjoy their fat social security check, lol.
BarBarSeven

Anyone remember when Art Linklater would allow dysfunctional children speak their mind? And the world was entertained?
- cub
  
  kids take the darnedest drugs.
jimmyhaha

Thetans! Am I right?
- Slartibartfatsdomino
  
  Just because Scientology is a bunch of extortionary nonsense does not make their bugaboo, psychiatry (and particularly its tendency towards over-prescribing pharmaceuticals), an invalid target for criticism.
  
  Just like al Qaeda being a bunch of murderous a-holes does not automatically turn US foreign policy into the work of angels.
  
  Although given the quality of logic of most media commentary on both issues, I can see how one might be drawn into that fallacy, if one is prone to uncritically accept the word of authority.
  
  Call it Logic Deficit Disorder.
PathogenAntifreeze

The assertion that urchins *normally* have meltdowns as described 3 or more times a week makes me very glad about my decision to never ever have any. I live in the south east US, and see/hear enough of that horrible crap in nearly every restaurant and store anyway… Frankly, I think medication would indeed be an appropriate solution, even if the failing is on the part of the parents, because nothing is correcting that problem anytime soon.
http://www.flickr.com/photos/stefan_e_jones/ Stefan Jones

Yes, fine, but what about Hissy Fits, Conniptions, and Spazz-Outs?
aikimoe

Though I’m highly skeptical of the addition to the DSM, it is absolutely, positively NOT true that, “severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation… at least three times a week,” “describes basically all kids.”

It might describe enough kids that it’s not terribly unusual, but I spent years working with kids with behavior problems and I doubt seriously that even most kids display behavior like that.
- cub
  
  agreed. one of the benefits of having a control-freak mom was that my brother and i were never given to anything approaching a tantrum. never.
dmc10

Then just about every toddler, age 18-36+ months will fall into this categorization.
- giantasterisk
  
  One of the commenters above pointed out that the diagnosis couldn’t be made until after age 6.
  - dmc10
    
    Thanks for the clarification, I stand corrected.
bzishi

The DSM 5 is such a mess, it would probably be better if they just threw out all the work they’ve done so far and start anew. Each version of the DSM doesn’t need to add another 100 new disorders. What is needed is better diagnostic criteria for the disorders that everybody agrees that exist. The DSM 5 will certainly not provide this.
giantasterisk

The only part of this that isn’t obviously misguided is the statement “DMDD seems to be nothing to do with mood.” Surely a kid must be in the mood to throw a tantrum at the very least. Isn’t the entirety of the terrible twos (and not-so-placid threes) marked by massive, unpredictable changes of mood?
wazmo

Seems Szasz’s Therapeutic State continues to be further entrenched-not only for the young but the old as well: http://www.chicagotribune.com/news/local/ct-met-reinstein-lawsuit-20121116,0,2983707.story
ponzicar

I have worked at a school for special needs children, and “severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation… at least three times a week” sounds extremely familiar to me.This specific definition may be too easily applied to normal children or too broad. I’ll leave the specific criticisms to someone more knowledgeable about psychiatry. However, people seem to be dismissing the whole concept as normal kid behavior. Do you really think every person involved in this area of expertise are completely unfamiliar with children? The tantrums from kids with behavior problems are orders of magnitude worse than what normal kids do. If this new definition allows kids with severe problems that don’t fit neatly into any specific existing category to have a diagnosis that makes help more easily available to them, I won’t complain.
- CH
  
  This, so much this!
  
  Yea, I seriously don’t like the concern trolling kind of postings about children’s psychiatric issues like the OP is… “omg, they are now medicating children for temper tantrums!!!!!”. I don’t mean only here on BB, but in general, there seems to be some kind of “people are medicating their children for everything!!!” whenever there is some psychiatric issue being talked about. I don’t think most parents are out to medicate their children, quite the contrary, it seems to be incredibly hard for people in general to admit that there might be something wrong with any child, not just their own, to the point of going out of their way to describe how their child or their uncle’s neighbor’s babysitter’s child did _exactly_ the same thing at that age and that child was fine and your child must therefore, too, be fiiiiiiine! Oh… really? Your child did that and you were not looking for help? Or perhaps your child did _sometimes_ something like that? Not every day. Not year after year after something like that would have been appropriate but not anymore. Hmm?
  
  Children are children, and behave as children do. They are not green aliens with tentacles from Mars. It’s a matter of degree, of intensity and how often, and at what age. Something that might be appropriate when a 2 year old does it might not be anymore appropriate if a 10 year old is doing it every day and might be an indication of some issue.
http://voidstar.com/ jbond

I wanna speak louder than Ritalin
For all the children who think that they’ve got a disease (c Willy Mason)
http://twitter.com/mpwoodhead Michael Woodhead

Yet another step towards re-classifying behaviour and personality traits as medical disorders – and therefore something to be measured, diagnosed, treated and for children to be labelled.
Raziel Abulafia

Don’t ask a barber if you need a haircut.
http://evilbobdayjob.blogspot.com/ Deidzoeb

I don’t want to revere the DSM as an unquestionable sacred text either, but critics make this kind of minimizing comment about all mental illness. “You call that depression? The rest of us just call it being sad. I didn’t grieve that long after my mom died. Get over it.”
- CH
  
  Yes! Or they look at one aspect, like the “depressed” and go “oh, well I’m depressed sometimes, it’s totally normal to be depressed… omg, they are trying to medicalize being depressed!!!!!”, without looking at the whole diagnostic criteria. Yes, being depressed is normal. Being depressed so that it is interfering with your normal life is cause for concern, and at some point it starts to become a medical issue. But without a diagnostic criteria it’s hard to get help for a medical issue.
CH

I cannot say if I agree or disagree with the Neuroskeptic posting, I would have to read the diagnostic criteria and the research he is referring to more closely, but… I don’t agree that what the DMDD describes falls under ODD or Conduct Disorder (well, under Conduct Disorder you can put more or less anything, but anyway…). That is what children with this often gets labeled as, but… I don’t think it is the correct disorder for many.

What I would perhaps rather assert is that DMDD is a _symptom_ not a _disorder_ (but I would say the same about ODD and Conduct Disorder). My daughter definitely falls under DMDD, but… it’s a symptom for her. I would also disagree with Neuroskeptic that it’s about “mood”… the operating word is “dysregulation”, or rather, not being able to regulate their moods. Like a 2 year old who isn’t able to regulate their mood and starts temper tantruming (that would be “normal” behavior, not falling under the DMDD, whatever the BB article may state), but at some point they are able to regulate. But some children never learn to regulate on their own, or their moods swing so fast that they are unable to… and that is a symptom of something.
Donaleen Kohn

paragoric was still used in the 60′s…
Donaleen Kohn

this proves that the psychiatrists are the crazy ones. and that the pharmaceutical companies run medicine. let’s call their disorder “imagined issues in other people”
Nytespryte

I understand the fear of over medication, but it is speculation at this point. There is no miracle drug being touted for this new diagnosis. As a matter of fact the diagnosis is meant to steer away from diagnosing bipolar disorder inappropriately early. The current inappropriate early diagnosis of bipolar disorder may come with questionable use of certain drugs. At worst the use of these drugs would just continue with the new diagnosis. That’s bad but the new diagnosis doesn’t really seem to stand to make it worse.

I had a relative that had violent, terrifying fits. They could last for an hour or more. People would always scoff until they finally saw one and heard the sounds that came out of her, or when they tried to move her or pick her up and realized they could barely do it will all their strength. She ended up with an ADHD diagnosis and her impulse control improved a bit when she was medicated. Her mother expected a miracle cure and didn’t understand whey she kept misbehaving so much even on the meds. This does show the parenting problems involved. But on the other hand, the rest of us could see how much different her thinking seemed. She was still choosing to misbehave alot but could stop as soon as she was caught and weigh consequences. When she wasn’t on meds she seemed out of control, unable to stop even when she wanted to. As she got older she was able to control herself more without the meds.

It was complicated. Bad parenting was involved but something was wrong above and beyond it. Maybe medication could have been avoided with better whole family therapy.

But regardless of how flawed our current approach may be you can’t just say that “kids throw tantrums” If your 13/14 year old is terrified of your 8/9 year old then something is wrong and does need to be addressed in some way.
- acerplatanoides
  
  “Bad parenting was involved but something was wrong above and beyond it.”
  
  If I can’t just say “kids throw tantrums” then you can’t get ‘wrong’ and ‘different’, so confused.
  
  Something was different.
Velocirapt42

First off, I have seen kids who not only scream, cry, throw things, etc., but who bite, run at their parents with weapons (granted they’re kids so it’s usually a butter knife but still), and cannot sit through a school day without overturning their desk, screaming for more than 10 minutes, trying to punch the staff who try to calm them, and bang their heads against the wall. I’m not saying most kids do this by any means, but there’s a spectrum of temper tantrum that starts at “lotsa whining” and ends at “cannot go 24 hours without a 1-hour long screaming, biting, property-destroying fit.” The question is, at what point on the spectrum does this become a disorder? This is true for most mental health disorders. If I hear voices very occasionally but they don’t bother me or tell me to do things, I realize they’re not “real”, and it’s not interfering with my functioning one bit, I might be watched but no good practitioner is going to diagnose me with psychosis.

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.
martinhekker

The truth (from my perspective as an academic psychiatrist) is somewhere in the middle. The problem is real and I think pointing out problems with this disorder early on (before reification in DSM-V) is a good idea.Sometimes the psychiatry critical blog posts bug me, but this one is valid. I would point out (though ultimately perhaps it is not so important) that the problem-ness of this diagnosis comes from lack of knowledge. It really is not born from an attempt by drug companies to market drugs. It also an attempt to view disorders related to disrupted brain processing of motivational/social information. It is possible though that drug companies may attempt to take advantage of the gap in knowledge to create new indications. We are not quite at a place where cybernetic science helps to provide conclusive answers. By the time we get there, psychiatry will have improved and along the way we’ll get robot friends as a bonus. For now, putting experimental constructs into the DSM-V is likely to result in unpleasant negative consequences as real people (not research volunteers) are subject to beta-testing. Expect Windows Vista-like wonderfulness.
http://twitter.com/qazwart David Weintraub

Did you actually read the criteria? You paraphrased two of the NINE criteria, and all the first four have to be met.

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.
surfthis

My daughter had this until she was 7. We didn’t want to medicate her, so we looked for what else might be causing a smart, funny little kid to have massive, screaming, belligerent freakouts. Turns out she is very sensitive to food coloring. We also took her off wheat, though I’m much less sure that’s causative. I’m sure there are kids with early onset issues, but try diet first.Britain has acknowledged this issue (food coloring), but in the US, government agencies would rather call kids and parents crazy than require food corporations to sell only clean, natural food.
http://www.independent.co.uk/life-style/food-and-drink/news/food-agency-calls-for-ban-on-six-artificial-colours-807806.html
http://fragmuffin.myopenid.com/ fragmuffin

A good general rule of thumb: when someone responds to individual diagnostic criteria for a psychiatric disorder with “but that describes EVERYONE”, you can stop listening to that person. They don’t understand how psychiatric disorders are diagnosed.