Grief is a Mental Illness…Really?

By LAUREN PAXMAN

A controversial decision to reclassify grief as a mental illness has been criticised by medical experts.

Should grief be treated like depression?The change in classification was intended to add flexibility to how early people can be treated for depression following the death of a loved one. But it has led to worries that bereaved people will be treated with pills rather than empathy.

An editorial in influential medical journal, The Lancet, argues that grief does not require psychiatrists and that ‘legitimizing’ the treatment of grief with antidepressants ‘is not only dangerously simplistic, but also flawed.’

The unsigned lead editorial reads: ‘Grief is not an illness; it is more usefully thought of as part of being human and a normal response to the death of a loved one.’

The Lancet’s comments follow the American Psychiatric Association’s decision to add grief reactions to their list of mental illnesses in their fifth edition of the psychiatry ‘bible’, Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), which is due out in 2013.

But The Lancet, along with many psychiatrists and psychologists have called for the changes to be halted – saying they would lead to a ‘tick box’ system that did not consider the wider needs of patients but labelled them as ‘mentally ill’.

They agree that in rare cases, bereavement will develop into prolonged grief or major depression that may merit medical treatment. However, they suggested that for the majority of the bereaved, ‘doctors would do better to offer time, compassion, remembrance and empathy, than pills.’

The DSM-5 proposal – which has been opposed by The Lancet’s editorial writers – would eliminate the so-called ‘grief exclusion.’

This ‘exclusion’ means that anyone who has experienced bereavement cannot be diagnosed as depressed for a certain period of time.

In a previous edition, DSM-III, that period of time was set at one year.

The DSM-IV reduced that period to two months and DSM-5 plans to reduce the period to just two weeks.

Although the proposed changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) would not directly affect clinical practice here, where doctors tend to use different international guidelines, experts say it would eventually influence research and thinking in the field.

Defending the change in timeframe, Dr. Kenneth S. Kendler, a member of the DSM-5 Mood Disorder Working Group, said it would allow for an earlier diagnosis but would by no means force it.

Simon Wessely, of the Institute of Psychiatry, King’s College, London, said ‘We need to be very careful before further broadening the boundaries of illness and disorder.’

‘Back in 1840 the Census of the United States included just one category for mental disorder.

‘By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision. Do we really need all these labels? Probably not. And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.’

Whereas people who are bereaved are currently given help where necessary, in future they might find themselves labelled as having a depressive disorder if their symptoms lasted longer than a certain period of time, he added.

Peter Kinderman, Professor of Clinical Psychology and Head of Institute of Psychology, University of Liverpool, said ‘It will exacerbate the problems that result from trying to fit a medical, diagnostic, system to problems that just don’t fit nicely into those boxes.

‘Perhaps most seriously, it will pathologise a wide range of problems which should never be thought of as mental illnesses. Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labelled as ‘mentally ill’.

Dr. Arthur Kleinman, a Harvard psychiatrist, social anthropologist and global health expert, says that the main problem is the lack of ‘conclusive scientific evidence to show what a normal length of bereavement is.’

According to the Lancet writers, ‘it is often not until 6 months, or the first anniversary of the death, that grieving can move into a less intense phase.’

They added that grieving is individual, shaped by age, gender, religious beliefs and the strength of the relationship with the lost loved one.

Source: http://www.dailymail.co.uk/health/article-2102618/Lancet-urges-doctors-treat-grief-empathy-pills.html#ixzz1mfIHkK3A

Should grief be treated like depression?

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Possible DSM Changes Spark Controversy

By Rick Nauert, PhD – PHD Senior News Editor

Possible DSM Changes Spark ControversyProposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the fat text used to help identify and categorize mental illness, are not sitting well with many mental health professionals and the public.

Suggested changes to the definitions of autism spectrum disorders and depression, among others, are eliciting great concerns. And experts say there are larger concerns about the DSM as a whole.

“Almost no one likes the DSM, but no one knows what to do about it,” said University of Michigan psychiatrist Dr. Randolph Nesse.

The current round of revisions is the fifth since the DSM was originally published by the American Psychiatric Association in 1952.

Nesse and University of Cape Town psychiatrist Dr. Dan Stein combined for an article in the current issue of BMC Medicine titled “Towards a genuinely medical model for psychiatric nosology.”

The article provides a candid appraisal of the difficulty of categorizing mental disorders that the authors expect will not make a lot of their colleagues happy.

“The problem is not the DSM criteria,” Nesse said. “The problem is that the untidy nature of mental disorders is at odds with our wish for a neat, clean classification system.”

The proposed abolition of the grief exclusion, for example, in diagnosing major depression is just one example of a push to define psychiatric disorders according to their causes and brain pathology.

“A huge debate over when depression is abnormal seems likely to be resolved by removing the so-called ‘grief exclusion,’” Nesse said. “At the moment, depression is not diagnosed in the two months after loss of a loved one.

“The result of this proposed change would be that people experiencing normal grief will receive a diagnosis of major depression. Doing this would increase consistency in diagnosing depression, but at the cost of common sense. It’s clear that bereavement is not a mental disorder.”

Nesse and Stein point out that the rest of medicine recognizes many disorders that do not have specific causes.

“Conditions such as congestive heart failure can have many causes,” Nesse said. “This doesn’t bother physicians because they understand what the heart is for, and how it works to circulate blood.”

Furthermore, he said, physicians recognize symptoms such as fever and pain as useful responses, not diseases.

“These symptoms can be pathological when they’re expressed for no good reason, but before considering that possibility, physicians look carefully for some abnormality arousing such symptoms,” Nesse said. “Likewise, the utility of anxiety is recognized, but its disorders are defined by the number and intensity of symptoms, irrespective of the cause.

“It’s vital to recognize that emotions serve functions in the same way that pain, cough and fever do, and that strong negative emotions can be normal responses to challenging or anxiety-provoking situations.”

Instead of specific diseases with specific causes, many mental problems are “somewhat heterogeneous overlapping syndromes that can have multiple causes,” Nesse said.

“Most are not distinct species like birds or flowers. They are more like different plant communities, each with a typical collection of species. Distinguishing tundra from alpine meadow, arboreal forest and Sonoran desert is useful, even though the categories are not entirely homogenous and distinct.”

Source: http://psychcentral.com/news/2012/02/16/possible-dsm-changes-spark-controversy/34909.html

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DSM-5 May List Internet Addiction Among Illnesses

By Rheana Murray / NEW YORK DAILY NEWS

Surf the web too much? That might soon land you on a psychiatrist’s couch.

The American Psychiatric Association (APA) is catching heat over proposed amendments to its newest Diagnostic and Statistical Manual of Mental Disorders (DSM) — widely considered the “bible” of psychiatric symptoms in the mental-health industry.

Opponents say the new version would label millions more people as “mentally ill” for conditions such as extreme shyness — and qualify them for psychiatric drugs they don’t need.

“[It’s] hard to avoid the conclusion that DSM-5 will help the interests of the drug companies,” said Allen Frances of Duke University, according to Reuters.

DSM-5, the new mental illness ‘bible,’ may list Internet addiction among illnesses

Internet addiction might be considered a mental illness under proposed revisions to DSM-5, the mental-health industry’s guidebook.

The DSM-5, as the new edition will be called, is scheduled to be released in May 2013, and could list “Internet addiction” among its diagnoses.

The association says it is still considering how to address non-substance-abuse addictions.

“Gambling disorder has been moved into this category and there are other addiction-like behaviorial disorders such as ‘Internet addiction’ that will be considered as potential addictions to this category as research data accumulate,” the APA says on its website.

Experts say lots of the new diagnoses are problematic – like “oppositional defiant disorder.”

“That basically means children who say ‘no’ to their parents more than a certain number of times,” said Pete Kinderman of Liverpool University’s Institute of Psychology, according to Reuters.

“On that criteria, many of us would have to say our children are mentally ill.”

People who are excessively shy could also be diagnosed as mentally ill under the new guidelines, Kinderman said.

Kids’ temper tantrums might be explained by “disruptive mood disregulation disorder,” characterized by temper outbursts that occur at least three times per week.

David Elkins, president of the American Psychological Association’s society for humanistic psychology, helped launch a petition against the new manual, yielding more than 11,000 supporters, according to ABC News.

“Our main concern is that they’ve introduced some new disorders that have never been in a DSM before that we think are not scientifically based,” he said.

“We’re not opposed to the proper use of psychiatric drugs when there’s a real diagnosis and when a child or an adult needs pharmacological interventions,” he said. “But we are concerned about the normal kids and elderly people who are going to be diagnosed with these disorders and treated with psychiatric drugs.

“We think that’s very, very dangerous.”

Dr. Allen Frances, who worked on revisions for the current manual, DSM-4, agrees that the proposed changes are irresponsible.

“You don’t want to be inventing new diagnoses until you’re sure they can be accurately made, effectively treated that the treatments are safe,” said Frances, a psychiatry professor at Duke University, according to ABC News. “None of these conditions is fulfilled in DSM-5.”

“You can’t have one professional organization, like the American Psychiatric Association, responsible for vetting something so important,” he added.

The APA hasn’t commented directly on the backlash, but said in a statement that it considers “input from all sectors of the mental health community a vital part of the process,” according to ABC News.

“We are confident that the DSM-5 will be based on the most reliable scientific and clinical data.”

Source: http://www.nydailynews.com/news/dsm-5-mental-illness-bible-list-internet-addiction-illnesses-article-1.1020979#ixzz1mHYHMxjt

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The Joint Statement of the Autism Society and Autistic Self Advocacy Network on the DSM-5 and Autism

The Joint Statement of the Autism Society and Autistic Self Advocacy Network on the DSM-5 and Autism  As two national organizations committed to working to empower the autism and Autistic communities today and into the future, the Autism Society of America and the Autistic Self Advocacy Network issue the following joint statement regarding the definition of Autism Spectrum Disorder within the DSM-5.

The autism spectrum is broad and diverse, including individuals with a wide range of functional needs, strengths and challenges. The DSM-5’s criteria for the new, unified autism spectrum disorder diagnosis must be able to reflect that diversity and range of experience.

Over the course of the last 60 years, the definition of autism has evolved and expanded to reflect growing scientific and societal understanding of the condition. That expansion has resulted in improved societal understanding of the experiences of individuals on the autism spectrum and their family members. It has also led to the development of innovative service-provision, treatment and support strategies whose continued existence is imperative to improving the life experiences of individuals and families. As the DSM-5’s final release approaches and the autism and Autistic communities prepare for a unified diagnosis of ASD encompassing the broad range of different autism experiences, it is important for us to keep a few basic priorities in mind.

One of the key principles of the medical profession has always been, “First, do no harm.” As such, it is essential that the DSM-5’s criteria are structured in such a way as to ensure that those who have or would have qualified for a diagnosis under the DSM-IV maintain access to an ASD diagnosis. Contrary to assertions that ASD is over diagnosed, evidence suggests that the opposite is the case – namely, that racial and ethnic minorities, women and girls, adults and individuals from rural and low-income communities face challenges in accessing diagnosis, even where they clearly fit criteria under the DSM-IV. Furthermore, additional effort is needed to ensure that the criteria for ASD in the DSM-5 are culturally competent and accessible to under-represented groups. Addressing the needs of marginalized communities has been a consistent problem with the DSM-IV.

Individuals receive a diagnosis for a wide variety of reasons. Evidence from research and practice supports the idea that enhancing access to diagnosis can result in substantial improvements in quality of life and more competent forms of service-provision and mental health treatment. This is particularly true for individuals receiving diagnosis later in life, who may have managed to discover coping strategies and other adaptive mechanisms which serve to mask traits of ASD prior to a diagnosis. Frequently, individuals who are diagnosed in adolescence or adulthood report that receiving a diagnosis results in improvements in the provision of existing services and mental health treatment, a conceptual framework that helps explain past experiences, greater self-understanding and informal support as well as an awareness of additional, previously unknown service options.

Some have criticized the idea of maintaining the existing, broad autism spectrum, stating that doing so takes limited resources away from those most in need. We contend that this is a misleading argument – no publicly funded resource is accessible to autistic adults and children solely on the basis of a diagnosis. Furthermore, while the fact that an individual has a diagnosis of autism spectrum disorder does not in and of itself provide access to any type of service-provision or funding, a diagnosis can be a useful contributing factor in assisting those who meet other functional eligibility criteria in accessing necessary supports, reasonable accommodations and legal protections. As such, we encourage the DSM-5 Neurodevelopmental Disorders Working Group to interpret the definition of autism spectrum disorder broadly, so as to ensure that all of those who can benefit from an ASD diagnosis have the ability to do so.

The Autism Society and Autistic Self Advocacy Network encourage other organizations and groups to join with us in forming a national coalition aimed at working on issues related to definition of the autism spectrum within the DSM-5. Community engagement and representation within the DSM-5 process itself is a critical component of ensuring accurate, scientific and research-validated diagnostic criteria. Furthermore, our community must work both before and after the finalization of the DSM-5 to conduct effective outreach and training on how to appropriately identify and diagnose all those on the autism spectrum, regardless of age, background or status in other under-represented groups.

P.S. The Autism Society will continue to share its thoughts and feelings about keeping the community inclusive as more information about the revisions is known. In the meantime, we strongly encourage people to get involved in the discussion.

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Proposed DSM 5 Changes and Autism: What Parents & Advocates Need to Know

by Lee Anne Owens

Proposed DSM 5 Changes and Autism: What Parents & Advocates Need to KnowIn May of 2013 the new diagnostic criteria for Autism Spectrum Disorder will be distributed to doctors via the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Think of the DSM 5 as the Bible of diagnostic criteria, developed and written by the American Psychiatric Association (APA).

One of the most discussed changes in the DSM 5 Autism Spectrum Disorder (ASD) is the removal of Asperger’s syndrome and PDD-NOS as individual diagnoses. Under the new diagnostic criteria, Asperger’s and PDD-NOS will come under the umbrella of ASD. For example a child whose diagnosis is currently Asperger’s syndrome would receive a new diagnosis of Autism Spectrum Disorder with specifiers included, such as “Autism Spectrum Disorder with fluent speech” or “Autism Spectrum Disorder with intellectual disability.” According to Dr. Bryan King, of the APA’s Neurodevelopmental Disorders Workgroup, this change could mean a decrease in the differentiation of services available to those previously diagnosed with Asperger’s syndrome. (http://autism.about.com/od/diagnosingautism/a/Why-Asperger-Syndrome-Will-Disappear.htm) In layman’s terms this means that some children will benefit from a greater availability of needed services because they have a diagnosis of ASD, rather than Asperger’s.

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