Of specific interest is the ADA's proposal to change the basic definition of a mental disorder and their rationale. This would indeed be a sweeping change; by removing clinical significant distress from the criteria, there is little question that there would be substantially greater diagnosis of mental disorder.
Frances addresses why clinical significance is important here.
posted by eschatfische at 7:44 AM
"Heck. Look at the definition for Oppositional Defiant Disorder. I challenge you to find any child on the planet who does not meet those criteria, let alone the reduced criteria proposed under DSM-V. This isn't science, and in practice has the potential to do a whole lot of evil, even when used in good faith."
This is the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV. The utility and credibility of DSM-IV require that it focus on its clinical, research, and educational purposes and be supported by an extensive empirical foundation. Our highest priority has been to provide a helpful guide to clinical practice. We hoped to make DSM-IV practical and useful for clinicians by striving for brevity of criteria sets, clarity of language, and explicit statements of the constructs embodied in the diagnostic criteria. An additional goal was to facilitate research and improve communication among clinicians and researchers. We were also mindful of the use of DSM-IV for improving the collection of clinical information and as an educational tool for teaching psychopathology.[emphasis added]
DSM-V includes neither of those criteria. It tells us that mental illness means "a behavioral or psychological syndrome or pattern that occurs in an individual that is based in a decrement or problem in one or more aspects of mental functioning." Perfectly content people who are functioning well in society are made candidates for treatment by this change.
ODD, for example, is a persistent pattern of behavior, as described in DSM, over a period of months. I have known kids like this, and they are hell on earth to live with, and treat. It's pretty well known that treating kids like this can also stress a good therapist, because the kids are habituated to defiance.
"In public mental health DSM diagnoses are required, collected, analyzed, and used to determine benefit levels and requirements"
"all of the psychopathology textbooks I use are predicated on the DSM, comprehensive exams in my department reference the DSM, and the licensing exams for clinical social work reference the DSM"
And reading midmarch snowman. Virtually every psychiatrist I have met uses the DSM-IV to diagnose and suggest treatment. I've had it read verbatim to me regarding cases.
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