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New mental health diagnostic manual debuts

Children diagnosed with bipolar disorder
A new category that indirectly impacts the diagnosis of mood disorders is the proposed new disorder for children called “temper dysregulation with dysphoria” for “persistent negative mood with bursts of rage.” This new behavior disorder is expected to apply to many of the growing numbers of children currently being diagnosed with bipolar disorder. Recent studies have shown that many of these children, who may be aggressive and irritable, do not have bipolar disorder. Rather than powerful antipsychotic drugs, the primary treatment may be behavioral.

Mixed Anxiety Depression
This new diagnosis combines some of the symptoms of major depression with anxious distress. Critics argue that its definition is too broad and would apply to vast numbers of the population.

What’s missing?
Categories and criteria for mood disorders remain largely unchanged.

For many years, bipolar disorder experts have been referring to bipolar disorder as a “spectrum disorder” rather than as two distinct diagnoses – Bipolar I and II – with symptoms that occur from one end of a continuum to another. Many of them had hoped to see this view reflected in the new DSM.

“I’m deeply disappointed,” says psychiatrist Jim Phelps, MD., Samaritan Mental Health, Corvallis, Oregon.  “I fear we’re in for continuing controversy about whether there is a middle ground between bipolar and unipolar, for another decade. Meanwhile, patients and families will create the change. They will start arriving at the psychiatrists’ offices with completed bipolar screening tools (e.g. Mood Disorders Questionnaire or Bipolar Spectrum Diagnostic Scale, including the rest of the Bipolarity Index. Then the psychiatrists will be forced to keep up. Of course some will, and some will push patients’ efforts away, just as they do now…  But over time, change will come and this time patients and families will drive it, probably more than the DSM committees.”

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