Posted by ed_uk on December 1, 2004, at 10:07:06
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ladyofthelamp on December 1, 2004, at 9:06:23
Hello,
Overall, I think that the DSM is probably useful in clinical trials but that's about it!
Each diagnosis is essentially a list of rather subjective symptoms. 'Depressed mood' can be used as an example. So, what exactly is meant by 'depressed mood'. Surely everyone's experience of 'depressed mood' is different. Every psychiatrists definition of 'depressed mood' will be different........ Oddly, although these diagnoses are made based on symtoms, two people with the same diagnosis might have a completely different set of symptoms. Due to the fact that only 'x' out of 'y' criteria must be present in order to make a diagnosis, one person might have criteria 1,2,3 and 4 whereas someone else might have 5,6,7 and 8 and get the exact same diagnosis.
It is often argued that psychiatric diagnosis is needed in order to choose an appropriate medication. In reality, diagnosis is often of little help in choosing a drug since drugs seem to be effective in treating particular target symptoms rather than diagnoses. For example, whether a delusional individual has been diagnosed with MDD with psychotic features, schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or psychotic disorder NOS is of little help in choosing which antipsychotic would be most suitable. Other factors unrelated to diagnosis are often more important when it comes to medication choice eg. amisulpride might be a suitable first line AP for an obese person whereas Zyprexa would be undesirable.
Although many mental health problems may well be associated with physiological/biological problems this is not an argument in favour of the DSM............ In order to make a DSM diagnosis of schizophrenia, for example, known medical causes of psychosis must first be ruled out. Diagnosing a patient with 'psychosis of unknown cause' would be much more truthful than diagnosing schizophrenia.
Knowing a persons DSM diagnosis creates the misleading impression that you actually know something about that person when infact you know very little. If I was to tell someone that I was suffering from MDD it wouldn't tell them anything more about me than telling them that I was unhappy. It wouldn't tell them what my symptoms were, it wouldn't tell them what caused my symptoms, it wouldn't tell them which treatment would be best.... in fact, it would be considerably less misleading just to tell them that I was unhappy!
There is substantial overlap between the DSM categories.... for example the anxiety disorder overlap with each other, they also overlap with the mood disorders. The mood disorders overlap with the psychotic disorders and so on.......
It is often claimed that diagnoses such as bipolar disorder and schizophrenia are biological in nature. This is probably true in some cases but not all. For example, if you consider a family with a strong history of bipolar disorder you might suspect that the disorder was genetic in nature. This is all very well but it doesn't mean that the genetic anomoly present in one family is the same as the genetic anomoly which may or may not be present in another family afflicted with similar problems. Although bipolar disorder has been associated with genetic factors, it it not a discrete entity! Single gene genetic disorders are quite different because the diagnosis is actually made based on the presence of a specific gene variant.
I have always wondered whether my own problems were the result of some biological/genetic abnormality. I will probably never know! What I do know is that many of the people who have received the exact same DSM diagnoses as me probably have very different biological and psychological problems.
A single cause for bipolar disorder or for schizophrenia will never be identified because these diagnoses are vague and variable. They cause much suffering, but that does nothing to demonstrate their existence as discrete entities. Bipolar disorder, for example, might be better thought of as a collection of many different problems in very different individuals..... although a certain amount of symptoms overlap occurs.Some of the DSM categories are more specific than others. ADHD is especially vague. According to the DSM criteria, it would probably be possible to diagnose almost everyone with (inattentive) ADD!! On the other hand, other diagnoses such as gender identity disorder are rather more specific.
All the best,Ed.
poster:ed_uk
thread:422741
URL: http://www.dr-bob.org/babble/20041201/msgs/422782.html