Boarderline? Me, nah......

thanks for the link DSF.

> the diagnostic systems that are in current use (DSM-IV and ICD-10) are broad, descriptive, and have relatively few exclusionary hierarchies (whereby one disorder is assumed to be responsible for, and therefore supercedes the diagnosis of, another).

'relatively few' compared to what, i wonder? there are exclusionary criteria all over the place. in fact... i'd be surprised if they could find a classification system with more exclusionary criteria!

one thing that interests me considerably is how much one dx is a 'subset' of another dx (or one symptom is a 'subset' of another symptom).

for example... the DSM definition of hallucination seems to definitionally include that the person takes their experience to be veridical. i'm concerned about this making certain kinds of delusion to be a proper subset of hallucination. so if, for example, someone says 'i hear the voice of god commanding me to do x' that counts as a hallucination (hearing the voice of god) and a delusion (hearing the voice of god).

if we say that the person (in virtue of that statement) is both hallucinating and deluisonal then we would be counting the same symptom twice when we say the person has two sniederian (however you spell that) first rank symptoms for schizophrenia.

add in some social withdrawal (c'mon give him a break he's listening to the voice of god!) and hey presto sounds a lot like the supposedly 'chronic' schizophrenia to me...

So you mean over-diagnosing / misdiagnosing on that basis?

What would the diagnosis be if he had hallucinations but the delusion was not counted?

one first rank symptom and hence he would need another.

it is unclear how over-diagnosing / misdiagnosing is supposed to be judged.

one thing that can happen is that a person is diagnosed with a disorder (which is meant to be chronic) and then that person recovers.

do we then say 'wow look there is evidence that that disorder isn't necessarily chronic after all'
or do we then say 'wow look there is evidence that that person was misdiagnosed and didn't actually have that disorder after all'

validity (the generalisibility from symptoms to course) suffers if we make the first choice.
inter-rater reliability (identifying individuals according to their symptoms) suffers on the second.

what o what are we to do?????

maybe... disorders aren't natural kinds after all. maybe... generalisations from symtpoms to likely course simply aren't that good after all. maybe it is because we haven't found the relevant kinds yet... or maybe it is because there simply aren't kinds there to be had (in the cases that are paradigmatic of mental illness). hard to say... social causal mechanisms are often neglected methinks. hard to say how much social causal mechanisms undermine the notion that there are natural kinds in psychiatry. depends on your theory of natural kinds, i suppose...

> Does anyone use the ICD-10 (showing my ignorance here) but I remember there was some argument for DSM over that ..

yeah. i used to get both ICD and DSM codes. ICD is used more in Europe while the DSM is used more in the US (being the product of the American Psychiatric Association and all). I think (though I could be mistaken) that DSM codes are required in the US for health insurance reimbursement. DSM is taking over the world... there is a lot of collaboration between the DSM and ICD to try and make sure that the ICD and the DSM are in line (helps with the appearance of 'we are discovering the objective facts).

i've heard (though i could be mistaken) that specificity varies a little between the DSM and ICD. the ICD is an 'international classification of diseases' so it is meant to list ALL medical conditions. it is meant to have more specific dx categories for neurological disorders and (kind of by extension) the 'cognitive' and neuro-developmental / neuro-degenerative / acquired cerebral injury disorders. i'm not sure about this... but there are conditions like prosopagnosia and aphasia etc etc which are typically studied by neuropsychologists that are coded in the ICD (though i could be wrong about that) though they do not feature in the DSM. anyhoo... i heard that the ICD provides more detailed coding for those kinds of conditions (especially sleep disorders, apparently) whereas the DSM provides more detailed coding for other kinds of conditions. the more paradigmatically 'psychiatric' conditions, i guess.

at one point i tried to obtain statistics on the prevalence of DID in New Zealand. to see whether we had gone the way of the american epidemic or good old british denial. they were keeping the stats in accordance with ICD-9 criteria, which surprised me a great deal. there wasn't a condition of DID in the ICD-9, however, but there was some related condition that included dissociative spectrum disorders along with gansers syndrome (which surely doesn't appear in the DSM). Basically... It was impossible from that category (can't for the life of me remember what it was called - i actually think it was some hodge podge 'other' category) to figure out prevalence of DID dx in NZ. I asked them why they were using such an outdated classification system for their statistics and asked whether they had statistics from DSM or ICD-10 but no response. Damned statisticians in Wellington ;-)

one thing that is interesting (to me) is that the DSM never even tried to define mental disorder until the lobby groups put pressure on them to take 'homosexuality' out and the anti-psychiatry movement put pressure on them to justify why they regarded some conditions to be psychiatric while others were not. first definition appeared in the DSM III. the definition has remained largely unchanged since then but has been subject to all kinds of critique. one fairly important critique is that the definition is more about justifying decisions that have already been made rather than actually being used to determine whether a condition is a mental disorder or not (sometimes this problem is known as the 'likeness argument').

current 'hot topics' include: addiction, sociopathy, and (rather surprisingly not mentioned a great deal, probably due to decorum) pedophilia.

doc john has already made his determination on the latter ;-)

from DSF's link:

> There are 10 distinct personality disorders described in the DSM, with no hierarchical system provided to reduce comorbidity. According to this system, when an individual's pattern of behavior meets criteria for more than one personality disorder, all diagnoses should be listed in order of clinical significance. Widiger (8) has pointed out that certain psychiatric inpatients can be found to meet criteria for 3 to 5, and in some cases up to 7 personality disorders.

ah. no exclusion criteria on personality disorders.
i've heard (though i haven't seen the stats)...
that the most commonly diagnosed disorder (the disorder the health insurance companies should be most worried about: the real epidemic)... is for...
NOS
(not otherwise specified aka 'doesn't quite seem to fit any of our categories')
lol

So what is the current situation on PMDD?

I remember ages ago at uni it was in maybe the 'provisional' category? And a chick in the honours paper did a presentation on how it was medicalizing something natural, etc etc.

Yes I should google but I did and I can't access most of the better looking studies apart from the abstract ...

pre-menstrual dysphoric disorder?

think its still in the 'for further research' basket.

yeah, the feminists are having a field-day abotu that one.
i guess we will have to wait and see how many people get up in arms about their distress not being validated...

there is a lot of stuff on how child-birth got to be medicalised too. (how on earth did something so natural as child-birth get to be considered a 'disease' / 'disorder' / 'illness' / 'condition' that necessitated hospital?????)

yap .... that one ...

I guess if you apply the principle that for some small percentage of women it causes 'significant distress and impairment in functioning' (etc, etc) then ... shrug ... but it's still calling women somewhat crazy (excuse the terminology ...) for something that is related to being FEMALE. For that fact alone it is obvious why the feminists get up in arms.

But is it much different to I don't know, saying that middle-aged Maori males are more likely to develop heart disease and that is a function of age and gender and ethnicity - ok it isn't a very good analogy and i've left out all the environmental factors but i am sure you get my point ...

so: if you were having extremely severe premenstrual symptoms, would you rather have your symptoms 'medicalised' and be given a diagnosis which is included in a mental health diagnostic guide ...

(and be 'recognised' in that way)

Or not ... and by that definition you are not 'insane' due to having female related problems ...

I think I prefer the latter.

lots of disorders have a gender bias...

premature ejaculation.
female sexual dysfunction.
etc etc etc
;-)

(though the status of female sexual dysfunction is controversial because if dysfunction is supposed to be a breakdown in an evolutionary function then that kind of requires female orgasm to have an evolutionary function. and... it is far from clear that it does. that being said... it might be the case that male nipples don't have an evolutionary function - but would you want your daughter to marry a guy with no nipples :-p lol).

urm...

i guess it is a little like SAD (seasonal affective disorder). its just that instead of it following the seasons it follows the months. i'm not sure what i think about this one... i figure... take the darned painkillers already. one factor that will come into play will be whether the drug companies manage to develop a drug for the condition. this happened with some kind of panic disorder... by developing a drug that seemed to be effective to some subgroup of people with anxiety they carved off those people and created a new diagnostic category. could happen, i suppose.

i dunno what i think...

i dunno why some conditions (e.g., dyslexia) count as mental disorders...
i dunno why gender identity and pedophilia are in their either truth be told...
not sure what to make of addiction...

it is interesting the considerations that determine whether or not something gets in huh.

of course i'm sure the health insurance companies and employers will have a lot to say about time off from work due to mental illness...

over-medicalising i think.

mental disorder... a notion that was originally intended to apply to people who needed to be kept in custodial care because their families were simply unable to look after them... progressively made its way to all kinds of neurotic symptoms with the prescription of visits to the spa... nowdays prevalence is estimated to be... what... huge at any rate. and the funding gets thrown at what is supposed to be such a major health concern... mostly because... of the way we have extended the concept to apply to all sorts of things...

(how severe does something have to be to be regarded as a mental illness? what prevalence rates are acceptable? important questions... where the rubber hits the road for the concept / definition of mental disorder).

You make some interesting points lady ...

I have never understood how dyslexia is classified either.

Gender identity 'disorders' are so tied up with the conservative white middle class values of the people who probably campaigned for them to be included ... grrrr.

I will never forget the transgender woman I taught when I was tutoring Abnormal Psyc - Joanne. A larger older person with some seriously bad taste in dresses and wigs, and a pretty difficult home situation (2 boys with Asperger's, on her own).

But yea it was a very personal thing, obviously, one day I was a bit late and she had tipped out all her prescriptions for ADs and anti anxiety drugs over the table and was going on about needing them all because of being persecuted for her gender choice and how the DSM-IV said that she was mentally disturbed for her sexual preferences and habits etc etc ...

That was fun :> If you can imagine 14 students around 22 years old staring bug-eyed in embarrassment ...

I was actually really scared to mark her work because I had gathered there was major instability here - so I would cross-mark all her work with a colleague (and I am not one to normally question my own judgement, I just wanted to cover my ***).

The day I gave her 50% (a C) in an assignment where they had to design their own study into a disorder was the day she literally stopped speaking to me.

Ahhh well ... %#@&#! happens...

I have always wondered why half the population chooses to write a proposed study into SAD ... I swear I learned so much about light boxes when I marked that assignment ... lol.

I think PMing might be good for the two of you - your constant back and forth over such details leaves me confused and I'm guessing many others.

Please let's not get caught up to the point a thread like this basically becomes meaningless...

The thread simply evolved into debate of classification, which I am sure most people can understand.

If you really have an issue ask a mod to do a thread split.

Otherwise, deal with it. I think most of what was going to be said on the OP's post had been said by the time we debated what should be classified as mental illness or not.

:>

Good suggestion about a thread split

Deal with it - isn't that a bit harsh? The original poster is new here - I don't think this thread supported what the poster was looking for?

Maybe I'm wrong and it is just me...

I think you will find most threads of four pages tend to run off the original topic.

They sort of naturally evolve once the end of the topical conversation is reached.

But why don't you get a mod to do a thread split and call it something like Classification Issues if it is still bothering you.

peace.

Already took your suggestion - thanks!

I agree that the thread has gone way off course when reading the initial post.

If a new thread is begun, please remember to keep responses to others supportive.

KD

Kimmy, why don't you 'split' the thread from when it started going off course (when a_k and I started discussing classification?)

I think the topic is interesting ...

Oh, I think it's interesting as well, DSF.

Problem is...

It's lengthy and I'm not "in it", so it would be better for you to start a new thread and copy and paste the points of the new topic?

Thank you!

KD

Ummm maybe.

What happens in another forum I go to is if something gets off topic, a mod just chops everything off from the point where it starts to go haywire, and retitles it with a note.

I think it can be an effective technique, but maybe it is not possible on these boards / the way they are set up.

was just an idea for future ref.

You're right. It's not easily manageable here, DSF. At our sister site, I could do that pretty easily. However, here I can't.

That's why I asked you to, but also because you know what convo you'd like to continue discussion on.

KD

Ahhhh interesting. I don't know much about how boards are set up.

Maybe later

Just start a new thread.

dont really know where it would go