Shirah Vollmer MD

The Musings of Dr. Vollmer

DMDD Walks Into DSM 5

Posted by Dr. Vollmer on October 7, 2013

Disruptive Mood Dysregulation   Disorder entered DSM 5 in May, 2013. Kids that tantrum beyond some line of “normal” now have a mental disorder, which is supposed to be an improvement over calling these kids “childhood bipolar”. By my way of thinking, these kids are “higher maintenance” and they need intensive behavioral interventions in order to control their “dysregulation”. However, they do not need a mental illness label. I do not see how this diagnosis helps parents or children manage. Now, whether medication can help these children is another story. Medication may help, but that still does not mean they have a mental illness. Tylenol helps with headaches, even though the person with a headache does not have a diagnosis; they have a symptom.  Once again, Psychiatry, in this case Child Psychiatry, has lost its way.

 

 

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Disruptive_Mood_Dysregulation_Disorder_DMDD_110.aspx

see also…https://shirahvollmermd.wordpress.com/2010/02/14/a-kids-temper-is-dysregulated-my-musings-on-dsm-5/

4 Responses to “DMDD Walks Into DSM 5”

  1. Ashana M said

    A diagnosis doesn’t imply a value judgment–just a treatment protocol. It also has legal and ethical ramifications, which I think are important. As a teacher, if I have a child who tantrums a lot, but who doesn’t have any medical diagnosis, I am not required to do anything in particular about it and since my specialty isn’t emotional disorders, I may not really know what to do. A school can continue to discipline the child in the way we normally would a child who disrupts the learning environment for others. So a kid who tantrums a lot might just spend a lot of time in the principal’s office or suspended from school. But if he has a diagnosis, and the condition is severe enough, then he begins to have certain legal rights, which include having a team meet to discuss modifications and strategies that will help him to stay on an even keel at school so that he can be his most successful. And that approach may have long-term benefits as, with success under his belt, he’s more able to see himself in a positive light as an adult. Changing the name of the disorder, so that it doesn’t imply a future prognosis it doesn’t seem to have, seems like a good step.

    • Shelly said

      Ashana, what do you do with a child who seems to tantrum alot but has no labeled medical diagnosis? What can the principal do to help reduce the amount of tantrums? Suspend a child for tantruming? Doesn’t throwing tantrums indicate something is wrong? Why does it take a medical diagnosis to actually convene a medical team to convene and discuss strategies? Maybe there is pressure at home, or a child is unhappy in the class environment or is being bullied? Why does it take a medical label to make someone sit up and listen?

      • Ashana M said

        The reality is that most of us have about 150 students to consider–all of whom would like to tantrum and disrupt instruction if that were allowed. I usually teach about 5 hours a day. Most courses require about an hour per day of preparation. So, if I am teaching 2 or 3 different courses, that is already a 7 or 8 hour day. In addition, I need to meet regularly with my department to maintain continuity and work towards goals. There may be other meetings required of me as well–for students with learning disabilities, for those with language needs, and so on. If I also intend to grade anything, which is part of my professional duties, then you are looking at a 9 or 10 hour working day at a minimum. Finding time to consider the particular needs of a single student is a luxury, and usually responsibilities that are required tend to be prioritized.. Given that about a 1/2 of my students have special language needs and 1/10 of them have a mental illnesses, and about a 1/10 have a specific learning disability, it’s incredibly difficult to do detective work to determine the root causes of problems that in many cases I can do nothing about–if the problem is at home, my hands are basically tied anyway. In addition, there are questions of fairness: if one child gets special consideration just because he’s difficult, how is that fair? We would all be difficult if we could. However, a medical diagnosis alters perceptions and it becomes acceptable to other students and parents if some students get different treatment based on a diagnosis. I do, in fact, try to help children without a diagnosis, but if I actually had children I don’t see how it would be possible. It’s just how we’ve set up our school systems–they are not based on considering the needs of individuals, but how to provide instruction that works for the majority of students for the lowest possible cost. I don’t like it, but I didn’t make it up either.

      • Ashana M said

        I should add that by the time students get to me who have emotional difficulties that impede their learning significantly but are not diagnosed, they have usually given up on school and the adult world altogether. They drop out of school, or have made their way into alternative placements (continuation high schools or independent study), or into the juvenile justice system.

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