Temper Dysregulation Disorder in DSM-V

[erg923]

I finally got around to reading the paper put out by DSM-V.org regarding the changes and the new developmental approach to Bipolar Disorder in the DSM-V.

What does everyone think of this "Temper Dysregulation Disorder with Dysphoria?" Personally, I think its a bunch of ****. But other opinions are welcome. 🙂

1. It seems to reinforce the wrong thing…the thing I thought we were so upset about and trying to get away from. That is, that slapping a Bipolar D/O label on kids and adolescents who are irritable and angry is sloppy, overpathologizing, and most of all, ignores the REAL (psychosocial and environmental) reasons for their acting out. It also probably also leads to an over Rx of mood stablizers in this population. To me, this disorder is just another way of doing that, but under another name.

2. The proposition that mania is NOT episodic in children/young adolescents and manifests as irritability rather than euphoria is a specious claim, to say the least. We have no real scientific validity to back this up, yet we are going to create a diagnostic entity based on it?

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[roubs]

I read this a while back so the memory may be fuzzy.

My reading of it was that the point is to reduce the # of bipolar dx and the prescribing. Giving the Bipolar diagnosis almost begs for a rx, but is rx appropriate for temper dysregulation? Not so much. I think the intended purpose is opposite from doing the same thing under a different name, its hoping that a different name will lead to a different conception of treatment. Whether it will work is a whole other question.

The DSM criteria is for something they call manic episode, so the idea that it's not episodic is, uhm, interesting. I think the point is that this is not a manic episode, it's 'temper dysregulation' which is not necessarily episodic.\

edit: It looks like this might be called "Disruptive Mood Dysregulation Disorder" now?

 

[Ollie123]

I can see the intent, but I'm far less confident it will achieve its purpose. That said, I haven't looked through the changes carefully outside of my own area (substance use).

For what its worth, the name itself might as well have been "Mini-Borderline". At least that's sure what it sounds like to me. Not sure that's a bad thing though...its probably a bit closer to reality than bipolar dx is.

 

[roubs]

I can see the intent, but I'm far less confident it will achieve its purpose. That said, I haven't looked through the changes carefully outside of my own area (substance use).

For what its worth, the name itself might as well have been "Mini-Borderline". At least that's sure what it sounds like to me. Not sure that's a bad thing though...its probably a bit closer to reality than bipolar dx is.

That's interesting considering they put it under Mood Disorders, where to me it sounds a little like mini conduct disorder(with mood disturbance).

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=397 --Just to clarify, this is what we are talking about, right?

Also, I dunno if I should bring in other DSM5 stuff to this thread or start another, but I noticed this interesting statement explaining the proposal to eliminate the bereavement time restriction from dx of a depressive episode: http://www.dsm5.org/about/Documents/grief exclusion_Kendler.pdf

 

[Ollie123]

Hmm...if so appears they changed the name. I looked and couldn't find a reference to Temper Dysregulation on that website. I do remember hearing the name erg used before though...so they are either different things or they modified it more recently.

The diagnostic criteria in that link definitely do sound more like conduct disorder. I just meant that the actual name itself "Temper dysregulation with dysphoria" sounds VERY much like a description of Borderline PD. If we take the self-harm out of the equation, I'm guessing you could pull any layperson who has a relative with borderline PD off the street and some lay equivalent of "Temper dysregulation with dysphoria" would be the first thing out of their mouth if asked to describe them.

 

[DrGachet]

...the actual name itself "Temper dysregulation with dysphoria" sounds VERY much like a description of Borderline PD.

why not call it "Mood dysregulation" instead? Something disconcerting about using the word "temper" there.

 

[roubs]

why not call it "Mood dysregulation" instead? Something disconcerting about using the word "temper" there.

They have changed it to Disruptive Mood Dysregulation Disorder.

 

[DrGachet]

They have changed it to Disruptive Mood Dysregulation Disorder.

Thanks. In this case, I have an issue with the word "disruptive" which sounds a little vague. But I should not nitpick though. These labels are really for insurance purposes and not meant to describe an actual illness; at least, that's what I think.

 

[Neuropsych2be]

Thanks. In this case, I have an issue with the word "disruptive" which sounds a little vague. But I should not nitpick though. These labels are really for insurance purposes and not meant to describe an actual illness; at least, that's what I think.

And why does psychology use a diagnostic system developed by another profession ?Why do we use a diagnostic system lacking in validity and reliability?? Aren't we the specialists in assessment and the creation of assessment methodologies with established indices of reliability and validity? Why do we passively sit by and allow another profession to recreate another version of this scientific monstrosity yet again?? To take a leaf from William F. Buckley, should we not "stand athwart history and yell stop!"

 

[cara susanna]

Like Ollie, I've mostly read about the updates in my own area of research (personality disorders), so take my comments with a grain of salt. I agree that this sounds like mini-Borderline without the self-harm and interpersonal components. But if this does decrease the number of people diagnosed as bipolar when they clearly just have emotional lability (which I see constantly), I will withhold any criticism.

 

[erg923]

when they clearly just have emotional lability (which I see constantly), I will withhold any criticism.

Why does "emotional lability" need its own diagnosis?

My overall point, and problem with the diagnosis, is that not every maladative or troublesome behavior needs to be a "disorder." Turning it into a "disorder" 1.) has the potential to pathologize reactions to chronic enviormental stressors/situations 2.) takes the focus away from the root-cause by simply chalking the behavior up to this "disorder." Remember, in most peoples minds, "tempermant" suggests that its just their constitional make-up. That is, it puts the etiology soley on the person rather than the enviornment and/or parents.

 

[cara susanna]

It doesn't, I agree, but I'd rather see that as a diagnosis than bipolar. I do think that it sounds more like a symptom than a disorder in itself (much like people have said about non-suicidal self-injury).

 

[sunlioness]

It seems I can't read anything about DSM-V that doesn't make me want to rant and throw things. [What disorder is that?] I honestly don't know that our understanding of mental illness has progressed enough since DSM-IV-TR to justify a whole new edition. What is sure, though, is that it's a huge money-maker for the APsychiatricA. As to why psychologists go along with it? You got me. 🙂

 

[PsyDLICSW]

I finally got around to reading the paper put out by DSM-V.org regarding the changes and the new developmental approach to Bipolar Disorder in the DSM-V.

What does everyone think of this "Temper Dysregulation Disorder with Dysphoria?" Personally, I think its a bunch of ****. But other opinions are welcome. 🙂

1. It seems to reinforce the wrong thing…the thing I thought we were so upset about and trying to get away from. That is, that slapping a Bipolar D/O label on kids and adolescents who are irritable and angry is sloppy, overpathologizing, and most of all, ignores the REAL (psychosocial and environmental) reasons for their acting out. It also probably also leads to an over Rx of mood stablizers in this population. To me, this disorder is just another way of doing that, but under another name.

2. The proposition that mania is NOT episodic in children/young adolescents and manifests as irritability rather than euphoria is a specious claim, to say the least. We have no real scientific validity to back this up, yet we are going to create a diagnostic entity based on it?

Perhaps "Dysregulation Disorder with Dysphoria" should have a subtype called "Poor Parenting Disorder."

 

[erg923]

They have changed it to Disruptive Mood Dysregulation Disorder.

Correct. However, the criteria is exactly the same as when it was name "Temper Dysregulation Disorder with Dysphoria" seen on page 3 here...right?

http://www.dsm5.org/Proposed%20Revision%20Attachments/APA%20Developmental%20Approaches%20to%20Bipolar%20Disorder.pdf

 

[cara susanna]

It seems I can't read anything about DSM-V that doesn't make me want to rant and throw things. [What disorder is that?] I honestly don't know that our understanding of mental illness has progressed enough since DSM-IV-TR to justify a whole new edition. What is sure, though, is that it's a huge money-maker for the APsychiatricA. As to why psychologists go along with it? You got me. 🙂

Temper Dysregulation Disorder - DSM-Specific Subtype? 😉

I agree, I am not looking forward to this new DSM edition.

 

[roubs]

Correct. However, the criteria is exactly the same as when it was name "Temper Dysregulation Disorder with Dysphoria" seen on page 3 here...right?

http://www.dsm5.org/Proposed%20Revision%20Attachments/APA%20Developmental%20Approaches%20to%20Bipolar%20Disorder.pdf

Yep, even they realized putting the word "temper" in their made it sound silly :/

Gah, I feel the urge to play devil's advocate and defend the DSM even though the ambivalence is strong...must...resist..

 

[erg923]

Yep, even they realized putting the word "temper" in their made it sound silly :/

Gah, I feel the urge to play devil's advocate and defend the DSM even though the ambivalence is strong...must...resist..

What I find most odd about this new diagnosis is that (as I alluded to earlier) it tries to fix one problem by completely overloooking the much bigger, and probably more important problem. Namely, that THE KID is being framed as the one with the problem. It seems quite obvious that the point of this diagnosis is to quit overdiagnosing bipolar disorder in children and adolescents, and to quite over-pathologizing children's reactive behavior to chaotic homelives or environmental stressors/situations. Their solution? Diagnose yet another disorder where the child is seen as the only one with the problem. Brilliant!