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An updated edition of a mental health bible for doctors may include diagnoses for “disorders” such as toddler tantrums and binge eating, experts say, and could mean that soon no-one will be classed as normal.
Leading mental health experts gave a briefing on Tuesday to warn that a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is being revised now for publication in 2013, could devalue the seriousness of mental illness and label almost everyone as having some kind of disorder.
Citing examples of new additions like “mild anxiety depression,” “psychosis risk syndrome,” and “temper dysregulation disorder,” they said many people previously seen as perfectly healthy could in future be told they are ill.
“It’s leaking into normality. It is shrinking the pool of what is normal to a puddle,” said Til Wykes of the Institute of Psychiatry at Kings College London.
The DSM is published by the American Psychiatric Association (APA) and contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It is seen as the global diagnostic bible for the field of mental health medicine.
The criteria are designed to provide clear definitions for professionals who treat patients with mental disorders, and for researchers and pharmaceutical drug companies seeking to develop new ways of treating them.
Wykes and colleagues Felicity Callard, also of Kings’ Institute of Psychiatry, and Nick Craddock of Cardiff University’s department of psychological medicine and neurology, said many in the psychiatric community are worried that the further the guidelines are expanded, the more likely it will become that nobody will be classed as normal any more.
“Technically, with the classification of so many new disorders, we will all have disorders,” they said in a joint statement. “This may lead to the belief that many more of us ‘need’ drugs to treat our ‘conditions’ — (and) many of these drugs will have unpleasant or dangerous side effects.”
The scientists said “psychosis risk syndrome” diagnosis was particularly worrying, since it could falsely label young people who may only have a small risk of developing an illness.
“It’s a bit like telling 10 people with a common cold that they are “at risk for pneumonia syndrome” when only one is likely to get the disorder,” Wykes told the briefing.
The American Psychiatric Association did not immediately respond to a request for comment.
The scientists gave examples from the previous revision to the DSM, which was called DSM 4 and included broader diagnoses and categories for attention deficit hyperactivity disorder (ADHD), autism and childhood bipolar disorders.
This, they said, had “contributed to three false epidemics” of these conditions, particularly in the United States.
“During the last decade, how many doctors were harangued by worried parents into giving drugs like Ritalin to children who didn’t really need it?,” their statement asked.
Millions of people across the world, many of them children, take ADHD drugs including Novartis’ Ritalin, which is known generically as methylphenidate, and similar drugs such as Shire Plc’s Adderall and Vyvanse. In the United States alone, sales of these drugs was about $4.8 billion in 2008.
Wykes and Callard published a comment in The Journal of Mental Health expressing their concern about the upcoming DSM revision and highlighting another 10 or more papers in the same journal from other scientists who were also worried. DSM 5 is due to be published in May 2013.
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Despite what many social observers have described as a generally dark and brooding take on life, a new report suggests that Russians are actually less likely than Americans to be depressed.
In fact, researchers have uncovered indications that the Russian cultural tendency to dwell on the negative may ultimately insulate them from feelings of distress when engaged in self-reflection.
“Among Westerners, focusing on one’s negative feelings tends to impair well-being, but among Russians, that is not the case,” study co-author Igor Grossmann, a doctoral candidate in psychology at the University of Michigan, said in a university news release.
“Russians focus more on their negative feelings than Americans do,” Grossmann explained, “but they spontaneously distance themselves from their emotions to a greater extent than Americans, who tend to immerse themselves in their recalled experiences.”
Grossmann and co-author Ethan Kross, a University of Michigan assistant professor of psychology, published their findings in the August issue of Psychological Science.
Grossmann and Kross reported on two studies, funded by the U.S. National Institute of Mental Health, that explored cultural influences on depressive tendencies.
The first study focused on 168 Russian and American students who underwent testing to measure their degree of brooding and depressive symptoms. While the Russians were found to brood more, they also displayed fewer indicators of depression than their American counterparts.
The second study involved 162 students who were measured for distress after being asked to remember and discuss a not-too-distant unpleasant memory involving themselves and another individual.
The Russians appeared to experience less distress than the Americans after retelling the experience, and placed blame less often on the person involved in the incident. The Russians were also able to immediately distance themselves from their recollections, even while discussing them — a skill linked to less distress and feelings of blame, the study authors noted.
Culture, concluded the authors, has an impact on the emotional and cognitive consequences of bad experiences.
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Some obese adults may be at increased risk of having their breathing difficulties misdiagnosed as asthma, a new study suggests.
Researchers found that among nearly 500 Canadian adults who said a doctor had diagnosed them with asthma, objective lung-function testing ruled out the lung disease in 150, or 30 percent.
When the investigators looked at risk factors for misdiagnosis, obesity in general did not play a clear role. However, among patients who had sought emergency care for breathing problems in the past year, obese men and women were four times as likely as their normal-weight counterparts to be misdiagnosed with asthma.
The study, reported in the journal Chest, could not ascertain the reasons for patients’ misdiagnoses or for the higher risk among obese adults who sought urgent care.
But past research has indicated that spirometry, a standard test of lung function, is not used as often as it should be in diagnosing asthma, said Dr. Smita Pakhale of the Ottawa Hospital in Ontario, Canada, who led the new study.
Asthma should be diagnosed based on both symptoms and lung-function testing, and underuse of the latter could be a factor in some of the incorrect diagnoses in this study, Pakhale told Reuters Health — though, she added, that is just speculation.
Pakhale also pointed out that obese adults are at heightened risk of a number of health problems that could cause asthma-like symptoms such as breathlessness and chest tightness. Those include low fitness levels, acid reflux and heart disease.
Pakhale said that people who are told they have asthma after seeking care at an emergency room or walk-in clinic should be sure to follow up with their primary care doctor. That way, she said, they can get any additional evaluation or testing that may be needed — which may uncover the actual cause of the symptoms, if it is not asthma.
The study included 496 randomly selected adults from eight Canadian cities who said a doctor had diagnosed them with asthma. Roughly half were obese and the rest were normal-weight.
Overall, lung function testing confirmed the asthma diagnosis in 70 percent of study participants. Of these men and women, 14 percent and 15 percent of obese and normal-weight people, respectively, had sought emergency care for breathing problems in the past year.
Of study participants who turned out not to have asthma, 21 percent of obese individuals had sought urgent treatment for respiratory symptoms in the past year. That figure was less than 10 percent among normal-weight men and women.
When Pakhale’s team considered other factors, including socioeconomics, obese study participants who needed emergency care were four times more likely to have been misdiagnosed with asthma as their thinner counterparts.
The researchers also found that the time since diagnosis mattered: study participants who had been diagnosed in the past few years had a higher likelihood of misdiagnosis than those who had been told they had asthma “many” years ago.
It’s possible, Pakhale speculated, that increased asthma awareness among the general public and doctors — possibly via the recent proliferation of asthma-medication ads — could have something to do with that finding.
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