DSM Presentation - S. Lara Cross

Slc
25 Jul 202409:33

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

00:00

📚 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.

05:01

🧠 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

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a publication by the American Psychiatric Association that provides a common language and standard criteria for the classification of mental disorders. It is central to the video's theme as it discusses the evolution and importance of the DSM in mental health treatment, insurance, and education. The script mentions the pivotal changes in DSM-III in 1980 and the more recent DSM-5 in 2013, highlighting its role as a 'living, breathing document' that evolves with new research.

💡Mental Health Providers

Mental health providers are professionals who offer treatment and support for individuals with mental health disorders. The video script discusses the unpreparedness of these providers for the mental health issues faced by soldiers returning from World War II, emphasizing the historical context of mental health treatment and the development of the DSM to better equip providers.

💡Pharmaceutical Drugs

Pharmaceutical drugs are medications used to treat various health conditions, including mental disorders. The script refers to the FDA's change in laws post-DSM-III, which led to the approval of drugs for specific diseases or disorders, illustrating the influence of the DSM on medication development and prescription practices.

💡Neurology

Neurology is the branch of medicine dealing with disorders of the nervous system. The video script contrasts neurology with psychology, noting that our understanding of the neurological basis of psychiatric disorders is still limited, which is a point of contention in the validity and reliability of DSM diagnoses.

💡Genetics

Genetics refers to the study of genes, genetic variation, and heredity in living organisms. The script discusses the potential role of genetics in psychiatric diagnosis, mentioning the high cost and limited research in this area, which contributes to the ongoing debate about the scientific backing of DSM diagnoses.

💡Psychiatric Diagnosis

A psychiatric diagnosis is the identification of a mental disorder based on established criteria. The video script explores the complexities and criticisms of psychiatric diagnoses made according to the DSM, including the variability in diagnoses given by different psychiatrists and the potential for medicalization of normal life events.

💡Medicalization

Medicalization refers to the process by which non-medical problems become defined and treated as medical conditions. The script raises concerns about the medicalization of normal life events within the DSM, which can lead to over-diagnosis and over-medication.

💡Over-Medication

Over-medication is the prescribing of more medication than is necessary or beneficial. The video script expresses worry about over-medication in the context of psychiatric treatment, where psychiatrists, being medical doctors, may start patients on medication and adjust dosages as needed.

💡Neurocognitive

Neurocognitive refers to cognitive processes that are influenced by neurological factors. The script cites a study by Fredman, where neurocognitive scores were used to evaluate the consistency of psychiatric diagnoses among different psychiatrists, highlighting the challenges in achieving diagnostic reliability.

💡Insurance Companies

Insurance companies play a significant role in healthcare by providing coverage for medical expenses. The video script mentions that the DSM is scrutinized by insurance companies, which use the manual to determine coverage for mental health treatments, emphasizing the DSM's impact on healthcare policies and practices.

💡Mental Health Care Professionals

Mental health care professionals encompass a range of individuals involved in the treatment and care of those with mental health disorders, including psychiatrists, psychologists, and therapists. The script discusses the role of these professionals in critiquing and utilizing the DSM, as well as their training to overcome potential diagnostic shortcuts.

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

play00:01

hi my name is suzan lross and I did my

play00:05

research on the DSM for mental health

play00:09

providers um in the history of the

play00:12

DS

play00:14

DSM um it's important to know that the

play00:18

soldiers that were retured from World

play00:20

War

play00:21

II um the mental health providers were

play00:25

not prepared for treatment for these

play00:28

patients

play00:30

um mental health was typically seen in

play00:37

a

play00:39

institution and that was the

play00:43

only way that patients were seen um the

play00:48

DSM 3 was released in 1980 and this was

play00:51

really pivotal pivotal because it was

play00:55

radically accepted by the public

play00:58

usland insurance compan

play01:01

and even educational institutions

play01:05

textbooks were based on the

play01:08

dsm3 um the next important thing the

play01:12

FDA their laws

play01:16

changed as a result of the

play01:19

dsm3 and only pharmaceutical drugs were

play01:24

approved when they had they were made

play01:28

for a specific disease or

play01:30

disorder um then most recently the ds75

play01:35

was released in 2013 and a new version

play01:38

was released in

play01:42

2022 so my argument is the DSM is a

play01:46

living breathing

play01:49

document that is Ever Changing um as

play01:54

improvements are made new research as

play01:58

new research is verified

play02:00

um the DSM is scrutin by scrutinized by

play02:04

the media insurance companies public and

play02:07

the US government and other Mental

play02:10

Health Care Professionals as well

play02:12

because they think of the DSM as an

play02:17

encyclopedia type

play02:19

document

play02:22

um there's a clear difference between

play02:26

the people that make the DSM and the

play02:30

people

play02:32

that critique the

play02:34

DSM and so I'm going to explain that

play02:39

arguments they have the re liability and

play02:43

validity of the DSM

play02:46

is one of the arguments is the itology

play02:50

or the root cause of

play02:53

psychiatric um

play02:56

disorders they think that by finding the

play02:59

root CA

play03:00

it'll show how

play03:04

the the disorder has developed but it

play03:08

can develop in many different ways

play03:10

because everybody's brains are different

play03:12

um currently we don't have enough

play03:15

information about the human brain to um

play03:21

understand how it is developed in the

play03:24

mind in the human

play03:26

brain

play03:28

um because is neurology is even newer

play03:33

than psychology is

play03:36

um there's

play03:39

another um critique is that there should

play03:43

be other Sciences

play03:45

backing the psych psychiatric diagnosis

play03:49

like a

play03:51

physiology genetics Imaging or cognitive

play03:56

data um mology

play04:00

doesn't negate your like the root cause

play04:04

of your

play04:06

psychiatric diagnosis doesn't change the

play04:11

fact that you have the diagnosis and no

play04:14

matter how you got the diagnosis like

play04:18

where it came from you the treatment for

play04:21

the diagnosis is still the same and so

play04:28

it um

play04:31

okay and if you want to provide a

play04:34

diagnosis through physical symptoms

play04:36

genetics Imaging or other disciplines I

play04:39

once had a genetic test and they were

play04:42

testing one little piece of my genome

play04:47

and the test with the genetic test for

play04:50

one genome was

play04:53

$1,200 before insurance and so if you're

play04:59

trying to find

play05:00

out if you have a genetic predisposition

play05:05

to a

play05:06

diagnosis then it would be very very

play05:10

expensive and then if you're doing other

play05:14

Imaging it's not very cost effective and

play05:18

that is why it has not been studied it's

play05:21

because it's so

play05:22

expensive um it would be really

play05:25

interesting to see if patients with the

play05:28

same or clients with the same disorders

play05:32

had similar physiology or genetics or

play05:36

Imaging in their

play05:40

brain um but it hasn't been studied as

play05:44

yet um fredman did a study

play05:47

of where clients were evaluated by three

play05:51

different

play05:52

psychiatrists and they did not diagnose

play05:56

the clients

play05:57

similarly 28 % of

play06:01

the

play06:03

um clients less than that were not

play06:07

diagnosed

play06:09

with um depression and the

play06:12

neurocognitive scored of 78 which is a

play06:18

moderate Psych in Psychiatry is a

play06:21

moderate reading of

play06:24

positivity and the 28 is considered

play06:31

important um the psychiatrists were

play06:33

given computer generated script that

play06:36

they had to follow and they couldn't

play06:39

deviate from that at all and I believe

play06:41

that contributed to the results of the

play06:47

study um there's also a concern about

play06:51

medicalization of normal life and the

play06:55

problem with this is it gets a little

play06:57

tricky there's like lots of life events

play07:00

that um are usually overcome by an

play07:05

individual and then these life events

play07:10

also they're seen by providers in a

play07:14

clinic because they get stuck in some

play07:16

part of their recovery process and so

play07:20

some life events are actually listed in

play07:23

the DSM

play07:26

because these patients are typ we seen

play07:30

in

play07:31

practice

play07:33

um there's also the worry of over

play07:36

medication um psychiatrists are actually

play07:39

medical doctors that have gone to

play07:42

medical school with an MD or a

play07:44

do and their best practice is to start

play07:49

the patient on Loos and adjust from

play07:51

there unless there's extreme

play07:55

circumstances um there's worry over nois

play07:59

and

play08:00

treatment um especially

play08:04

autism autism spectrum disorder ADHD and

play08:08

social

play08:09

anxiety um

play08:13

usually a diagnosis

play08:16

is um shown in the news and then

play08:20

patients who have symptoms come in to

play08:23

get diagnosed and when you have a whole

play08:26

bunch of people coming in for the same

play08:28

diagnosis sometimes you can get a

play08:32

humoristic overload

play08:35

but from the clinicians end and it just

play08:40

is like a shortcut in your brain to give

play08:43

them a diagnosis but therapists are

play08:45

trained to overcome this and

play08:49

so as part of their therapy training um

play08:53

the DS is a great tool for providers

play08:55

that includes updated information on

play09:00

mental health disorders it's the

play09:02

snapshot of a living breathing

play09:05

document and um the ds7 is kept in a

play09:10

looser

play09:11

format as opposed to a tight tighter

play09:15

format because health insurance

play09:17

companies the media and private

play09:20

individuals like to use the

play09:23

DSM it's important to remember that it

play09:28

is changing

play09:30

document thank you for your time

Rate This

5.0 / 5 (0 votes)

Related Tags
DSMMental HealthPsychiatryDiagnosisTreatmentHistoryResearchInsuranceEducationalCritiqueNeurology