Sexual Fetishes Likely Still Included In DSM-V

Sexual Fetishes Likely Still Included In DSM-V — But Not Necessarily As Mental Illnesses

The Huffington Post  |  By Emma Gray

Posted: 04/04/2013 10:03 am EDT  |  Updated: 04/04/2013 3:13 pm EDT

Those who hoped to see sexual fetishes removed completely from the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of psychiatry published by the American Psychiatric Association, will likely be disappointed when the new edition is released in May. The DSM-V will probably still mention certain sexual predilections, reported LiveScience, but they won’t necessarily be labelled as mental illnesses.

The DSM currently defines “unusual” sexual turn-ons as paraphilias. Paraphilias include everything from foot fetishes, S&M and erotic eating to exhibitionism and pedophilia. These paraphilias are considered harmless unless the person experiencing them feels distressed about their preferences or if their unusual sexual practices are harmful to others. “Simply put, the DSM V will say that happy kinksters don’t have a mental disorder. But unhappy kinksters do,” wrote Slate’s Jillian Keenan.

See rest of article here: http://www.huffingtonpost.com/2013/04/03/sexual-fetishes-dsm-v_n_3008421.html?utm_hp_ref=canada-living&ir=Canada%20Living

The DSM Does Things Right….SOMETIMES!

DSM-V To Rename Gender Identity Disorder

Yes, you read that right and how exciting!!!!!!

Here is an article from The Advocate.

DSM-V To Rename Gender Identity Disorder ‘Gender Dysphoria’

The newest edition of the psychiatric diagnostic manual will do away with labeling transgender people as “disordered.”

BY CAMILLE BEREDJICK

JULY 23 2012

The newest edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, will replace the diagnostic term “Gender Identity Disorder” with the term “Gender Dysphoria,” according to the Associated Press.

For years advocates have lobbied the American Psychiatric Association to change or remove categories labeling transgender people in a psychiatric manual, arguing that terms like “Gender Identity Disorder” characterize all trans people as mentally ill. Based on the standards to be set by the DSM-V, individuals will be diagnosed with Gender Dysphoria for displaying “a marked incongruence between one’s experienced/expressed gender and assigned gender.”

“All psychiatric diagnoses occur within a cultural context,” said Jack Drescher, a member of the APA subcommittee working on the revision. “We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.”

Homosexuality was diagnosed in the DSM as an illness until 1973, and conditions pertaining to homosexuality were not entirely removed until 1987. According to Dana Beyer, who helped the Washington Psychiatric Society make recommendations on matters of gender and sexuality, the new term implies a temporary mental state rather than an all-encompassing disorder, a change that helps remove the stigma transgender people face by being labeled “disordered.”

“A right-winger can’t go out and say all trans people are mentally ill because if you are not dysphoric, that can’t be diagnosed from afar,” Beyer told the AP. “It no longer matters what your body looks like, what you want to do to it, all of that is irrelevant as far as the APA goes.”

From a legal perspective, the classification of Gender Identity Disorder is extremely harmful to some trans people, but surprisingly beneficial to others.

In one legal case, says San Francisco psychiatrist Dan Karasic, a trans woman from Utah risks losing the children she fathered before her transition. Because she is trans, a lawyer has argued that her GID is a “severe, chronic mental illness that might be harmful to the child.”

But in other cases, a GID diagnosis justifies insurance coverage for gender reassignment surgery and other medical procedures that sometimes accompany a transition. Having a diagnosis is the difference between a necessary medical procedure and something that can be perceived as cosmetic surgery that insurance won’t cover, Drescher says.

Others argue that GID should stay in the DSM in some form because it provides a solid legal defense for transgender people who have experienced discrimination based on their gender identity.

“Having a diagnosis is extremely useful in legal advocacy,” said Shannon Minter, legal director of the National Center for Lesbian Rights. “We rely on it even in employment discrimination cases to explain to courts that a person is not just making some superficial choice … that this is a very deep-seated condition recognized by the medical community.”

Mental health professionals who work with trans clients are also pushing for a revised list of symptoms, so that a diagnosis will not apply to people whose distress comes from external prejudice, adults who have transitioned, or children who simply do not meet gender stereotypes.

Correction: An earlier version of this story misidentified the American Psychiatric Association.

Will Tell You More Later

I had my meeting with CAMH today about their Defeat Denial ads. I will tell you more on Wednesday or maybe tomorrow actually.

Also need to blog about gender identity disorder and the DSM V.

So much to blog and so little time!

See:

http://prideinmadness.wordpress.com/2012/06/14/maybe-you-need-to-be-committed/

http://prideinmadness.wordpress.com/2012/06/14/thought-15-minimize/

http://prideinmadness.wordpress.com/2012/06/14/stop-denying-environment/

 

 

BPD Awareness Month- Day 15: A Previous Type of Borderline?

In a previous BPD Awareness Month post (BPD Awareness Month- Day 6: A Brief History of Borderline Personality Disorder) I mentioned that BPD, as we know it, was not an illness until 1980. Psychology textbooks and past DSM’s still listed disorders that helped create the current BPD diagnosis.

I have an Abnormal Psychology textbook from 1972 which included two disorders that I felt possibly played a role on creating BPD: Cyclothymic Personality and Emotionally Unstable Personality (under DSM I).

I also found another personality, in the same 1972 psychology book, under Recent Classification of Personality Disorders (under DSM II): Explosive Personality (Epileptoid Personality Disorder).

Explosive personality is characterized by gross outbursts of rage, including both verbal and physical aggressiveness. These outbursts are strikingly different from the individual’s usual behaviour, and he often regrets them after they are over. These individuals are generally excitable, aggressive, and overresponsive to environmental pressures. The intensity of the outbursts and the individual’s inability to control them distinguish this group. Cases diagnosed as “aggressive personality” are classified in this grouping.  If the patient is amnesic (loss of memory) for the outbursts, diagnoses such as hysterical neurosis, nonpsychotic organic brain syndrome with epilepsy, or psychosis with epilepsy should be considered.

Jaen Wirefly, today, posted about another possible new BPD name: Disruptive Mood Dysregulation Disorder.

I like the mystery behind Borderline. It keeps me safe and allows me to explain in my own words what I feel I’m all about. This is something many other disorders do not have.

(Abnormal Psychology: Changing Conception by Melvin Zax and Emory L. Cowen)

Disturbed Minds or Manual?

I was supposed to attend this taping (plus to others) on Sunday but due to the emotional garbage I was feeling I stayed at home and watched the live stream/chat of the tapings.

What I find totally amusing is that one of my comments from the live chat was put on the screen! So, even though I did not attend I still had my say for the whole of Canada to see! I rule!

Woot!

It is almost an hour long but it is very good!

Video Description: The upcoming 5th edition of the DSM is causing major debate in the psychiatric community. The Agenda examines how changes to the psychiatric “Bible” will create opportunities to diagnose people with mental disorders. Part of tvo’s Mental Health Matters series.

The Agenda: Disturbed Minds or Manual

BPD Awareness Month- Day 5: New Criteria

Yesterday I posted about the DSM IV criteria that had been used to diagnose BPD in myself in 2008. With the new DSM V coming out eventually some time this year (I’m glad those in the mental health community and services are putting up a massive fuss about it, WOOT) there will be new criteria to meet in order to be diagnosed as Borderline.

The DSM 5 website has this handy dandy side-by-side comparison chart that looks at the changes in personality disorder and the changes in the individuals disorders.

Handy Dandy Side-by-Side Comparison Chart for Personality Disorders

My analysis is that the criteria has expanded but that is because they’ve gone into detail and broken down the current criteria. Borderline criteria in the DSM IV is, I guess, fairly vague. I may actually like this new version (ugh I don’t want to say that).

Borderline Personality Disorder, DSM V

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met:

A.   Significant impairments in personality functioning manifest by:

1.  Impairments in self functioning (a or b):

a.   Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress. 

b.   Self-direction: Instability in goals, aspirations, values, or career plans.

 

AND

 

2.   Impairments in interpersonal functioning (a or b):

a.   Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.

b.   Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.

B.  Pathological personality traits in the following domains:

1.   Negative Affectivity, characterized by:

a.   Emotional lability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.

b.   Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.

c.   Separation insecurity: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.

d.   Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.

2.   Disinhibition, characterized by:

a.   Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.

b.   Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger. 

3.   Antagonism, characterized by:

a.   Hostility:  Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

C.  The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D.  The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

E.  The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

 What do you think?

BPD Awareness Month- Day 4: Criteria

I want to continue spreading the awareness of BPD during this month of May and I can think of nothing better to talk about than the criteria to be diagnosed with BPD.

I was diagnosed using the DSM IV so those are the criteria I will use (we can talk about the new DSM V criteria tomorrow).

There are 9 criteria for Borderline Personality Disorder. They are:

Borderline love

(1) Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5

(2)    a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

(3)    identity disturbance: markedly and persistently unstable self image or sense of self

(4)    impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

(5)    recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

(6)    affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

(7)    chronic feelings of emptiness

(8)    inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

(9)    transient, stress-related paranoid ideation or severe dissociative symptoms

(www.dsm5.org)

When I was first diagnosed in 2008 I identified with 8 of the 9 criteria, not identifying with criteria 9. This was probably because I was in a horrible relationship.

I can see how being in a more positive relationship has helped me improve but I have also changed criteria.

I now currently identify with 6 of the criteria. What’s changed?

I no longer identify with: 

• Criteria 3- unstable self image. My self image is fairly stable and would not be labeled persistent.
• Criteria 4- impulsivity. I am not impulsive although I do fear this and avoid situations that may cause impulsive behaviour or thoughts to occur.
• Criteria 7- chronic feelings of emptiness. I do not feel this way often.

What was added:

• Criteria 9- stress related paranoia. Due to my previous horrible experiences with relationships I can become very paranoid when in stressful situations involving my current close relationships.

This is progress if I’ve ever seen it

I hope people can begin to understand what BPD is and that with the right support, time and effective treatment (although I haven’t pursued it until recently) BPD can be managed or completely recovered from!

What I Should Have Been All Along?

http://www.dsm5.org has been a source of irritation for me and it has been for many other people within the mental health field. When I stumbled across the proposed disorder of Non Suicidal Self Injury I was at first outraged! “Of course! Here’s another things to make me and other people fucked up!” I knew I had to blog about this eventually but I began to realized I didn’t know what I thought about a non suicidal self injury disorder.

I first began cutting when I was 13 years old. It was my response to feeling horrible about myself. My peers at school were very mean, letting me know regularly that I wasn’t good enough. Cutting for me was and is the same as someone using yoga to relax. Cutting was punishment, relaxation, expression, a recreational activity. It was everything to me. As I’ve gotten old and have learned new coping skills cutting is now a last resort for me. I possibly do it once a month instead of daily. I’m very proud of this accomplishment especially when I thought I’d never be able to stop. I had always thought that cutting and other forms of self harm where symptoms of a bigger problem, a mental illness but this addition of non suicidal self injury changes the story.

The idea of a separate self injury disorder isn’t new to me. When I was in my 3rd year of university I wrote an essay entitled “Understanding Self Injury” for my social work practice class. This was my chance to tell them facts and share bits of my story. While researching I found an article called “Self-injurious Behaviour as a Separate Clinical Syndrome” by J. Muehlenkamp. One important piece of information has stayed with me from this article is that identifying self injurious behaviour as its own entity could improve treatment. Currently self injury is predominantly associated with depression and borderline personality disorder. Self injury is actually a symptom of BPD. I have been thrown into both categories and it’s mostly because of the cutting I engaged in. We cannot go off of one behaviour to make our diagnosis. The scant research done of self injury has shown that for some they do not actually qualify to depression or BPD but because we have nothing else they are put in those categories.

Non suicidal self injury disorder could be exactly what those who self injure need to begin building new, positive coping skills. This could lead to specialized care which is so greatly needed in treating this sometimes addiction.

On the other hand this new diagnosis makes me scared. I could easily be diagnosed with non suicidal self injury disorder (http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=443#). I find it a horrible reminder that I may smile more than I cry and feel I have myself under control that there are a few things about me, such as my self harming behaviour, that will keep me trapped in the mental health world. It makes recovery seem even more far away that. As I said earlier, I am cutting possibly once 1 month. This new disorder only requires a minimum of 5 days a year of self injurious actions……my progress is disordered.

I can’t get too down about it though because it’s not like I’m going to go to a psychiatrist to double-check on my sanity. I don’t care what they think. I am proud of how far I’ve come and I hope that those who receive this diagnosis in the future are helped in the ways that I wasn’t.

We’ll have to wait and see how this goes. How the whole DSM 5 goes.

Let’s Talk About The Bible

I can think of nothing better than to take a look at psychiatry’s “bible” itself to understand how we got to where we are. Maybe it can provide clues as to how we can get out of it!

The Diagnostic and Statistical Manual of Mental Disorders (DSM) contains diagnostic information on all recognized mental disorders (and not officially recognized mental disorders found in the appendix) and available treatments. The DSM is nicknamed the “psychiatric bible” because it contains EVERYTHING.  They are numbered from 1-5 (I, II, III, IV,V) with R or TR standing for revised.

For the most part the DSM’s have grown and by grown I mean exploded in size!

 

 

DSM I (1952): 130 pages, 106 mental disorders

DSM II (1968): 134 pages, 182 mental disorders

DSM III (1980): 494 pages, 265 mental disorders

DSM III-R (1987): 567 pages, 292 mental disorders

DSM IV (1994): 886 pages, 297 mental disorders (no changes effecting page length or number of disorders were done in the 2000 revision)

DSM V (May 2012): check out http://www.dsm5.org/Pages/Default.aspx and go to Proposed Revisions find out what’s being added and taken away (so far I’ve noted a reduction in diagnostic criteria and adding of disorders such as Binge Eating Disorder and Premenstrual Dysphoric Disorder)

(other DSM information was found at http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders#cite_note-8 which as a laundry list of sources at the bottom of the page)

Is anyone else concerned by the massive jump seen from 1968 to 1980? Or the jump from 1987 to 1994? ALL OF THE JUMPS!!!!!!

In the end 297 human behaviours and combination of behaviours have been deemed abnormal and disordered. The reasoning has been linked to new research into mental disorders but I’m extremely skeptical (think back to my Neurodiversity post and you’ll understand why).

Psychologists and others who work within the mental health community have actually organized a petition (which I have signed) stating their concerns about new DSM V that is coming out in a few months.  They are demanding that multiple sources (such as mental health workers who interact with people with mental health issues for more than 5 minutes a day) be used to create the DSM, not just psychiatrists.

Other mental health professionals are worried about:

-          The lowering of diagnostic criteria

-          The effects on vulnerable populations such as youth

-          Lack of distinction between social norms and mental disorders

-           Revisions of already existing disorder groups

For the full petition see: http://www.ipetitions.com/petition/dsm5/

As I mentioned above, the rise in new disorders is claimed to be from new and improved research but can that justification work when explaining why the DSM task force wishes to remove diagnostic criteria? I personally say no. Would doctors remove symptoms to prove cancer or diabetes? Imagine if suddenly having a runny nose didn’t mean you had a cold anymore.  Symptoms are there in order to provide the most accurate diagnosis as possible. Removing criteria allows for a lot of error in diagnosis such as over diagnosing (examples of this and other diagnostic issues are in the above petition link).

Using the cold example again, if a runny nose didn’t mean a cold thousands of people could possibly be diagnosed with an allergy and be treated for that. What’s more irritating is you wouldn’t be able to pin point what you’re allergic to because it wouldn’t happen as frequently as most allergies. Because a running nose, combined with other symptoms such as sneezing, coughing, aches and pains create what we know as the common cold it is not treated the same as allergies.

It already doesn’t help that in the current DSM IV-TR one person could have a number of disorders because, as complex human beings, we all have “disordered” traits. I know we can’t trust online quizzes but try some of those (http://psychcentral.com/quizzes/) and you’ll find just how similar you are to a wide range of disorders. I could possibly have mild ADD, major depression, bipolar disorder, borderline personality disorder and narcissistic personality disorder based on quizzes I have taken. Doctors have tossed around hormones, dysthymic disorder, major depression, borderline personality disorder, bipolar disorder and post-traumatic stress disorder when trying to actually diagnose me (only two of those stuck with me).  Also in the DSM V they are adding Non Suicidal Self Injury Disorder which I would most likely be diagnosed with (I’ll discuss the addition of that disorder much later).

Since we can be so many different things this is why the DSM keeps growing and this is all the more reason to not remove diagnostic criteria!

Over the summer I read a book called The Psychopath Test: A Journey through the Madness Industry by Jon Ronson. I read something that made me nervous and really further enforced my belief that all was NOT safe and sound in mental health.

While Ronson began to realize that he could label many people, including himself, as having psychopathic tendencies he sat down to talk with Robert Spitzer. Spitzer was the editor of the DSM III and responsible for the first massive explosion in new mental disorders. This is part of their conversation:

“When I asked Robert Spitzer about the possibility that he inadvertently created a world in which some ordinary behaviors were being labelled mental disorders, he fell silent. I waited for him to answer. But the silence lasted three minutes. Finally he said, “I don’t know.” “Do you even think about it?” I asked him. “I guess the answer is I don’t really,” he said. “Maybe I should. But I don’t like the idea of speculating how many of the DSM III categories are describing normal human behavior.” “Why don’t you like speculating on that?” I asked. “Because then I’d be speculating on how much of it is a mistake,” he said. There was another long silence. “Some of it may be,” he said. (pg. 251, Ronson, 2011)

So, what do we do? We can sign that petition first of all! We can play more active roles in our diagnosing and not take the psychiatrists word on it (I actually did this. When I was diagnosed with borderline I said that I agreed but when he also said post-traumatic stress I said I disagreed and I didn’t get the label). We need to be critical of the DSM and its application, especially in children and youth who get diagnosed based on what I feel is kids just being kids (example: ADD and Conduct Disorder). We need to examine ourselves and find out who we are so we know if we actually fit within a certain diagnosis or not. The number one thing to do is not take their word for it. Don’t follow blindly. You are the expert of your life and who you are (regardless of whether you like yourself or not) and just because psychiatrists have a book doesn’t mean they have the answers to who you are. Most likely you have a “disorder” unique to you.  I firmly believe that I have “Kristen Disorder”.