Wednesday, April 28, 2010

Temper Dysregulation Disorder

I had talked earlier about some proposed changes in psychiatric diagnoses under the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) which has come out in draft version to allow time for professional and public comment. There is a proposal to include a new diagnosis, Temper Dysregulation With Dysphoria Disorder, which to me seems ridiculous. The proposed criteria include severe recurrent temper outbursts grossly out of proportion to the situation or provocation that are inconsistent with developmental level and occur on average three or more times per week. The ridiculous part to me is identifying a symptom which can be manifested in a variety of conditions and labeling the symptom a disorder when there is no scientific basis for it. General nonspecific symptoms do not mean diagnosis.

So why is this being proposed? Primarily it is being proposed because of the significant embarrassment to the profession due to extremely way over diagnosis of bipolar disorder in children which has occurred in the past ten years. Bipolar disorder is a serious mental illness and affects about 1% of the population. But the number of outpatient visits for bipolar disorder increased 40-fold in the past decade and the number of prescriptions for antipsychotic medications for children and adolescents have doubled in the last few years. All these children cannot have bipolar disorder. It is not possible.It may be that what is being medicated is troublesome impulsive and irritable/aggressive behaviors but bipolar disorder is just one of many causes for these behaviors. With no scientific evidence to support it a diagnosis of temper dysregulation disorder would be a non bipolar category for these patients and may also provide some "cover" for prescribing mood stabilizing and antipsychotic medication.

There are children and adolescents with serious mental illnesses who definitely need these type of powerful medications. Many could not function without them. But I am afraid that if we psychiatrists cannot "police" ourselves in appropriate use of these medications that someone else will and will impose restrictions or regulations that will have the unintended consequence of denying mood stabilizing and antipsychotic medication to the children and adolescents who truly do need them for real illnesses. Temper Dysregulation Disorder is a big step in the wrong direction.

Thought for the day

I honestly thought when I first read about this that it was some kind of April fool's joke. It's not.

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