Naming a syndrome gives it power, which is why changes to the Diagnostic and Statistical Manual of Mental Disorders, or DSM, are so closely watched. When the American Psychiatric Association adds or deletes from this listing every decade or so, they are shaping how mental disorders are viewed and treated.
Next year will bring the fifth revision in the manual’s history -- to be called DSM-V -- and one possible addition has caught the eye of those who watch closely. As neuroscience blog Neuroskeptic reported recently, the newest edition might contain “disruptive mood dysregulation disorder,” and that site and others are questioning whether this is truly something new in need of medical attention, or something old as time, instead -- just medical-ese for temper tantrums.
The proposed criteria for a DMDD diagnosis would include: “severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation” at least three times a week, leading David Dobbs, who writes the “Neuron Culture” blog for Wired to ask:
"Do you know any kids like that? If you don’t, then you don’t know many kids. This could be anything, like the meltdown when the shoes can’t be found, the homework got lost, or the braids aren’t quite right. Crimey, I met this criteria last week, just yelling at Karl Rove."
Previously announced changes to the manual are already causing controversy, particularly the decision to eliminate Asperger’s Syndrome as a separate diagnosis and merge it into the broader category of Autism Spectrum Disorder. In an age when diagnosis has become identity, that move was widely criticized by “Aspies” who take pride in their diagnosis.
The reaction to the possibility of a new DMDD diagnosis, in turn, is raising almost the opposite objection. Rather than “unlabeling” something some felt was unique, as was the case with Asperger’s, the charge here is that something “run of the mill” -- misbehavior, rather than hard-wired difference -- is being pathologized.
“Psychiatry Set to Medicalize Hissy Fits,” reads the headline on the Wired story, which goes on to note that two existing diagnoses -- “conduct disorder” and “oppositional defiant disorder” -- already cover much of what is included in DMDD.
Neuroskeptic has been following the evolution of the DMDD diagnosis for several years, comparing it to “fighting a fire with kerosene.” The reason the syndrome was named in the first place, the website author, described as a British neuroscientist, writes, was because psychiatrists believed that bipolar disorder was being overdiagnosed in American children, and this would provide an alternative. “Is the only way to stop kids from getting one diagnosis, to give them another one?" he asks. "Can’t we just decide to diagnose people less?”
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