DSM Presentation - S. Lara Cross
Summary
TLDRSuzan Lross discusses the evolution of the Diagnostic and Statistical Manual of Mental Disorders (DSM), highlighting its pivotal role since the DSM-III in 1980. She argues that the DSM is a dynamic document, subject to scrutiny and change with new research. Critiques include its reliance on symptomology rather than underlying causes and the potential for medicalizing normal life events. The DSM's influence on insurance, education, and treatment is noted, along with concerns about overmedication and diagnosis overload.
Takeaways
- 📚 The DSM (Diagnostic and Statistical Manual of Mental Disorders) has evolved significantly over time, reflecting changes in understanding and treatment approaches.
- 🏥 Post-World War II, mental health providers were unprepared for the scale of mental health issues faced by returning soldiers, highlighting the historical context of mental health care.
- 🌟 The release of DSM-3 in 1980 was pivotal as it was widely accepted by the public, insurance companies, and educational institutions, setting a new standard for mental health diagnosis.
- 💊 Changes in FDA laws following DSM-3 emphasized the importance of pharmaceutical drugs being approved for specific diseases or disorders, impacting treatment protocols.
- 📈 The DSM is described as a 'living, breathing document' that is subject to ongoing scrutiny and revision in light of new research and societal perspectives.
- 🤔 There is a debate over the reliability and validity of the DSM, with critics questioning its approach to identifying the root causes of psychiatric disorders.
- 🧬 Some argue that psychiatric diagnoses should be backed by other sciences such as physiology, genetics, and imaging, not just psychology.
- 💼 The cost and practicality of alternative diagnostic methods, such as genetic testing or brain imaging, are significant barriers to their widespread use in mental health diagnosis.
- 👥 A study by Fredman found inconsistencies in diagnoses given by different psychiatrists, suggesting variability in the application of the DSM.
- 🛑 Concerns about the medicalization of normal life events are raised, where some events are included in the DSM because they frequently present in clinical practice.
- 💊 There is a worry about over-medication, with psychiatrists being cautious about starting patients on medication and adjusting dosages as needed.
- 🧐 The DSM serves as a valuable tool for providers, offering a snapshot of current understanding and treatment approaches for mental health disorders.
Q & A
What was the situation of mental health treatment for soldiers returning from World War II?
-Mental health providers were not prepared for treatment of these patients, as mental health was typically seen only in institutions.
When was the DSM-III released and what was its significance?
-The DSM-III was released in 1980 and was pivotal as it was widely accepted by the public, insurance companies, and educational institutions, with textbooks being based on it.
How did the release of DSM-III affect the FDA's laws?
-The release of DSM-III led to changes in FDA laws, where only pharmaceutical drugs were approved when they were made for a specific disease or disorder.
What is the most recent version of the DSM and when was it released?
-The most recent version of the DSM, referred to as 'DSM-5', was released in 2013, with a new version released in 2022.
Why is the DSM considered a 'living, breathing document'?
-The DSM is considered a 'living, breathing document' because it is ever-changing, with improvements and new research being incorporated as they are verified.
What is one of the main arguments against the DSM regarding the etiology of psychiatric disorders?
-One of the main arguments is the lack of a clear etiology or root cause of psychiatric disorders, as everyone's brain is different and develops disorders in various ways.
Why is it currently difficult to find the root cause of psychiatric disorders?
-It is difficult because neurology is a newer field than psychology, and there is not enough information about the human brain to understand the development of disorders.
What is another critique of the DSM regarding psychiatric diagnosis?
-Another critique is that psychiatric diagnoses should be backed by other sciences such as physiology, genetics, imaging, or cognitive data.
Why is it argued that the root cause of a psychiatric diagnosis doesn't change the treatment approach?
-Regardless of how the diagnosis was made or where it came from, the treatment for the diagnosis remains the same, which is why the root cause doesn't change the treatment approach.
What is the concern with using genetic tests for psychiatric diagnoses and their cost implications?
-Genetic tests for psychiatric diagnoses can be very expensive, with a single test costing $1,200 before insurance, making it cost-ineffective for widespread use.
What study by Fredman showed regarding the consistency of psychiatric diagnoses by different psychiatrists?
-Fredman's study showed that when clients were evaluated by three different psychiatrists, there was a lack of consistency in diagnoses, with less than 28% of clients being diagnosed similarly.
What is the concern about the medicalization of normal life events in the context of the DSM?
-The concern is that life events, which individuals usually overcome, are sometimes listed in the DSM because they are seen in practice when patients get stuck in their recovery process, potentially leading to over-medicalization.
What is the worry regarding over-medication in psychiatric treatment?
-The worry is that psychiatrists, being medical doctors, may start patients on medication and adjust from there, which could lead to over-medication without considering other therapeutic approaches.
How does the DSM serve as a tool for mental health providers?
-The DSM serves as a tool for providers by providing updated information on mental health disorders, acting as a snapshot of a living, breathing document.
Why is the DSM-5 kept in a 'looser' format compared to previous versions?
-The DSM-5 is kept in a 'looser' format to accommodate the needs of health insurance companies, the media, and private individuals who use the DSM, as it is an ever-changing document.
Outlines
📚 The Evolution of the DSM and Its Impact
Suzan Lross introduces her research on the DSM for mental health providers. She discusses the historical context, starting with the unpreparedness of mental health providers for soldiers returning from World War II. She highlights the significance of the DSM-3 released in 1980, which gained acceptance from the public, insurance companies, and educational institutions. She also mentions the FDA's changes in drug approval laws as a result of the DSM-3. The DSM-5 was released in 2013, with a new version in 2022, indicating that the DSM is a dynamic, evolving document. It is scrutinized by various entities, including the media, insurance companies, and mental health professionals.
🧠 Critiques and Challenges of the DSM
Suzan outlines the main arguments and critiques against the DSM, focusing on the reliability and validity of psychiatric diagnoses. She explains the complexity of identifying the root causes of psychiatric disorders due to the brain's uniqueness and the limitations in current neurological understanding. There is a call for integrating other sciences like physiology, genetics, imaging, and cognitive data into psychiatric diagnoses. However, the high cost of such studies, exemplified by a $1,200 genetic test, makes it challenging. Suzan references a study by Fredman showing inconsistencies in diagnoses by psychiatrists, which she attributes partly to the rigid computer-generated scripts used in the study.
🔍 Medicalization and Overmedication Concerns
Suzan addresses concerns about the medicalization of normal life events and the potential for overmedication. She discusses how life events, which individuals typically overcome, are sometimes seen in clinical practice when patients get stuck in their recovery. Some of these events are listed in the DSM. She highlights the issue of overmedication, noting that psychiatrists, who are medical doctors, usually start patients on low doses and adjust as needed. There is a particular concern with diagnoses like autism, ADHD, and social anxiety, where media coverage can lead to a surge in patients seeking diagnoses, potentially leading to diagnostic shortcuts by clinicians. However, therapists are trained to avoid this pitfall.
📖 The DSM as a Tool and a Living Document
Suzan concludes by emphasizing the DSM's role as a valuable tool for mental health providers, offering updated information on mental health disorders. She describes the DSM as a snapshot of a living, breathing document that is continuously updated. She notes that the DSM-7 is kept in a looser format to accommodate the needs of health insurance companies, the media, and private individuals. Despite its imperfections and ongoing evolution, the DSM remains a critical resource in the field of mental health.
Mindmap
Keywords
💡DSM
💡Mental Health Providers
💡Pharmaceutical Drugs
💡Neurology
💡Genetics
💡Psychiatric Diagnosis
💡Medicalization
💡Over-Medication
💡Neurocognitive
💡Insurance Companies
💡Mental Health Care Professionals
Highlights
Suzan Lross' research on the DSM for mental health providers and its historical evolution.
Mental health providers were unprepared for WWII soldiers' treatment due to institutional focus.
Release of DSM-III in 1980 marked a pivotal shift in public, insurance, and educational acceptance.
FDA laws changed post-DSM-III to approve pharmaceuticals for specific diseases or disorders.
DSM-5 released in 2013 and a new version in 2022, illustrating the DSM as an ever-evolving document.
Critique of DSM's reliability and validity, questioning the root cause of psychiatric disorders.
Neurology's infancy compared to psychology, affecting understanding of brain development.
Critique suggesting the need for backing psychiatric diagnosis with other sciences like genetics and imaging.
The argument that diagnosis and treatment remain consistent regardless of the root cause.
The high cost of genetic testing and its limited scope as a diagnostic tool.
Lack of study on the correlation between physiology, genetics, and brain imaging in mental disorders.
Fredman's study showing inconsistent diagnoses by different psychiatrists.
Concerns about medicalization of normal life events and its impact on diagnosis.
Over-medication worries due to psychiatrists' medical background and practice.
The issue of diagnostic overload in popular mental health conditions.
Therapists' training to overcome potential shortcuts in diagnosis due to popular trends.
DSM as a valuable tool for providers, offering updated information on mental health disorders.
The DSM's format evolution from rigid to loose to accommodate various stakeholders.
The DSM as a snapshot of a living, breathing document subject to change.
Transcripts
hi my name is suzan lross and I did my
research on the DSM for mental health
providers um in the history of the
DS
DSM um it's important to know that the
soldiers that were retured from World
War
II um the mental health providers were
not prepared for treatment for these
patients
um mental health was typically seen in
a
institution and that was the
only way that patients were seen um the
DSM 3 was released in 1980 and this was
really pivotal pivotal because it was
radically accepted by the public
usland insurance compan
and even educational institutions
textbooks were based on the
dsm3 um the next important thing the
FDA their laws
changed as a result of the
dsm3 and only pharmaceutical drugs were
approved when they had they were made
for a specific disease or
disorder um then most recently the ds75
was released in 2013 and a new version
was released in
2022 so my argument is the DSM is a
living breathing
document that is Ever Changing um as
improvements are made new research as
new research is verified
um the DSM is scrutin by scrutinized by
the media insurance companies public and
the US government and other Mental
Health Care Professionals as well
because they think of the DSM as an
encyclopedia type
document
um there's a clear difference between
the people that make the DSM and the
people
that critique the
DSM and so I'm going to explain that
arguments they have the re liability and
validity of the DSM
is one of the arguments is the itology
or the root cause of
psychiatric um
disorders they think that by finding the
root CA
it'll show how
the the disorder has developed but it
can develop in many different ways
because everybody's brains are different
um currently we don't have enough
information about the human brain to um
understand how it is developed in the
mind in the human
brain
um because is neurology is even newer
than psychology is
um there's
another um critique is that there should
be other Sciences
backing the psych psychiatric diagnosis
like a
physiology genetics Imaging or cognitive
data um mology
doesn't negate your like the root cause
of your
psychiatric diagnosis doesn't change the
fact that you have the diagnosis and no
matter how you got the diagnosis like
where it came from you the treatment for
the diagnosis is still the same and so
it um
okay and if you want to provide a
diagnosis through physical symptoms
genetics Imaging or other disciplines I
once had a genetic test and they were
testing one little piece of my genome
and the test with the genetic test for
one genome was
$1,200 before insurance and so if you're
trying to find
out if you have a genetic predisposition
to a
diagnosis then it would be very very
expensive and then if you're doing other
Imaging it's not very cost effective and
that is why it has not been studied it's
because it's so
expensive um it would be really
interesting to see if patients with the
same or clients with the same disorders
had similar physiology or genetics or
Imaging in their
brain um but it hasn't been studied as
yet um fredman did a study
of where clients were evaluated by three
different
psychiatrists and they did not diagnose
the clients
similarly 28 % of
the
um clients less than that were not
diagnosed
with um depression and the
neurocognitive scored of 78 which is a
moderate Psych in Psychiatry is a
moderate reading of
positivity and the 28 is considered
important um the psychiatrists were
given computer generated script that
they had to follow and they couldn't
deviate from that at all and I believe
that contributed to the results of the
study um there's also a concern about
medicalization of normal life and the
problem with this is it gets a little
tricky there's like lots of life events
that um are usually overcome by an
individual and then these life events
also they're seen by providers in a
clinic because they get stuck in some
part of their recovery process and so
some life events are actually listed in
the DSM
because these patients are typ we seen
in
practice
um there's also the worry of over
medication um psychiatrists are actually
medical doctors that have gone to
medical school with an MD or a
do and their best practice is to start
the patient on Loos and adjust from
there unless there's extreme
circumstances um there's worry over nois
and
treatment um especially
autism autism spectrum disorder ADHD and
social
anxiety um
usually a diagnosis
is um shown in the news and then
patients who have symptoms come in to
get diagnosed and when you have a whole
bunch of people coming in for the same
diagnosis sometimes you can get a
humoristic overload
but from the clinicians end and it just
is like a shortcut in your brain to give
them a diagnosis but therapists are
trained to overcome this and
so as part of their therapy training um
the DS is a great tool for providers
that includes updated information on
mental health disorders it's the
snapshot of a living breathing
document and um the ds7 is kept in a
looser
format as opposed to a tight tighter
format because health insurance
companies the media and private
individuals like to use the
DSM it's important to remember that it
is changing
document thank you for your time
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