Psychiatry Throws a Tantrum

Over at Slate I have a story, “The New Temper Tantrum Disorder,” about the “Disruptive Mood Dysregulation Disorder” I wrote about more briefly here a couple weeks ago, when DMDD was still a proposed diagnosis. Last week the DMDD diagnosis was approved for inclusion in the American Psychiatric Association’s forthcoming Diagnostic Statistical Manual, Fifth Edition — and some in the field are upset:

[T]he alterations the APA announced for DSM-5 this week sparked unusually ferocious attacks from critics, many of them highly prominent psychiatrists. They say the manual fails to check a clear trend toward over-diagnosis and over-medication — and that a few new or expanded diagnoses defy both common sense and empirical evidence. This medicine is not going down well.

Nothing burns the critics worse than “Disruptive Mood Disregulation Disorder,” a new diagnosis for kids 6 to 18 years old who three or more times a week have “temper outbursts that are grossly out or proportion in intensity or duration to the situation.” It actually started out as “temper dysregulation disorder with dysphoria” (tantrums, plus you feel bad) but got changed so as not to openly malign tantrums. But the diagnosis still focuses on tangrums, and critics say it is so broad and baggy that it’s ridiculous — and dangerous. Duke University psychiatrist Allen Frances, who chaired the revision of DSM-IV in 2001, says the DMDD diagnosis “will turn temper tantrums into a mental disorder.” In a recent blog post at Huffington Post, Frances put DMDD at the top of his list of DSM-5 diagnoses we should “just ignore,” because “a new diagnosis can be more dangerous than a new drug.” Clinical social worker and pharmacist Joe Wegmann called DMDD a diagnosis based on “no credible research” that would help drive a “zealous binge” of over-diagnosis.

Is the outcry legitimate? Or are Frances and Wegmann just having themselves their own conniption fit?

As the story reveals, the outcry is shrill, but likely not out of proportion, and speaks to far deeper problems in psychiatry. Do saunter over and get the whole thing at Slate. The comments thread is growing richer by the second.

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