There's much buzz about the blogosphere, as I have written before about the proposed revision of the "Pediatric Bipolar Disorder" in the new DSM-5 being worked on at present time in the Temper Dysregulation Disorder with Dysphoria being a proposed revision.
I feel it's important not to lose sight (become blind) to the heavy stake the pharmaceutical industry has in the Pediatric and Adult Bipolar disorder label, as well as the psychiatrists that will most likely be skeptical about shifting their idea, belief about the diagnosis just because the new DSM-5 shifts the description.
I do not believe that this is a time to ring the "It's finally over!" bell on Childhood Bipolar, and here is why:
In the fine print of the Revision
"F. Chronological age is at least 6 years (or equivalent developmental level).
G. The onset is before age 10 years.
Let's say you have a child fit this description at age 6, and before age 1o
BUT
"The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) and are not better accounted for by another mental disorder (e.g., Pervasive Developmental Disorder, post-traumatic stress disorder, separation anxiety disorder).
(Note: This diagnosis can co-exist with Oppositional Defiant Disorder, ADHD, Conduct Disorder, and Substance Use Disorders.)
The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition. "
You have an acknowledgement of an assessment of the child not having Bipolar Disorder etc, while observing the temper dysregulation...does that make sense?
THIS is an open door for a psychiatrist to suggest to the parent of the 6 year old that the child could be on their way to a Pediatric Bipolar Diagnosis, use off-label medications commonly given to kids currently, (such as Abilify and Risperdal approved for use in kids 10 and up) to the young child, until age 10 when the Pediatric label is added.
MY example of this happening, is when a decade ago, the psychiatrist told me "I have just returned from the APA meeting and you know what they said? that many kids who are now diagnosed with OCD are actually bipolar."
With that comment, he proceeded to change the label and drug her for "Early Onset Childhood Bipolar Disorder".
What I see happening here, with the proposal in the DSM-5 is just another shift of description, a new buzz word TDDD---where upon when the child is still acting out the psychiatrist will simply say, "You know, I think it's Pediatric Bipolar".
Any parent who has lived this life as I have in the appointments with the doctors, knows how it works. They add more drugs, add a drug for a side effect, and another for anxiety, another for sleep, another for afternoon agitation....I have been there and done that and after a decade entrenched in the mental health system, where now the Childhood Bipolar Diagnosis is removed from my daughter as a label, and damage has been done to her body (and most likely her brain) from the years of doctors trialing their own idea of medication cocktails on her.
The (worst happened inpatient hospitals in the adult wards/units where many times they would for example trial 11 medications in 13 weeks, or discharge her on as many as 5 drugs).
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More from the Revision proposal
C. Mood between temper outbursts:
1. Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad).
2. The negative mood is observable by others (e.g., parents, teachers, peers).
D. Duration: Criteria A-C have been present for at least 12 months. Throughout that time, the person has never been without the symptoms of Criteria A-C for more than 3 months at a time.
E. The temper outbursts and/or negative mood are present in at least two settings (at home, at school, or with peers) and must be severe in at least in one setting. "
With that, I say don't breathe a sigh of relief just yet, the Pediatric Bipolar paradigm has some very strong concrete holding the base of the Harvard, Mass General, Joseph Biederman, Child Adolescent Bipolar Foundation, and drug industry paradigm, and it's all about profit.
It would be nice if there was less drugging of American children, and Rebecca Riley's tragic death didn't repeat itself in the future, but I fear this is only another way to broaden the spectrum, to increase the off-label use of psych meds to a younger generation. My daughter was 11 when this happened to her, I cannot imagine a child any younger suffering like she did, gaining 100lbs, losing friends, and becoming virtually disabled as a result of a doctor being certain of what he believed in, and this paradigm is one hella of a paradigm they believe in, and I am certain that many will not shift their ways when the new book arrives.
AS much as I would like to breathe a sigh of relief, I simply will wait and read in a few years how many of these TDDD kids are on the same bipolar medications being given out today.
MORE from the proposal
"I. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) and are not better accounted for by another mental disorder (e.g., Pervasive Developmental Disorder, post-traumatic stress disorder, separation anxiety disorder).
(Note: This diagnosis can co-exist with Oppositional Defiant Disorder, ADHD, Conduct Disorder, and Substance Use Disorders.) The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition."
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Does ADHD co-existing with Pediatric Bipolar ring a bell? (the last decade) anyone with a child who was diagnosed with ADHD and then Bipolar should be paying attention. Nothing is really changing. It's just a new buzz word to enter the drugging of children arena.
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MORE
PDF Proposed Revision Rationale:
"Specific changes being recommended:
One possible way to identify and study those with short duration episodes is to include them as a specific sub-subcategory within an improved Bipolar Disorders Not Elsewhere Classified (BD-NOS) category. The Mood Disorders Work Group is considering several ways to capture subsyndromal presentations of clinical importance and frequency, and is conducting further data analyses to assess the 4-day duration criteria currently required for a diagnosis of hypomania. While the exact recommendation and format for recognizing and labeling this clinical presentation is not yet known, the Mood Disorders Work Group, in collaboration with the Childhood and Adolescent Disorders Work Group, is working on a proposal to identify this population (in both children and adults) in order to facilitate the clinical identification of this subgroup and to foster research on the treatment and nosological importance of short-duration episodes." (page 8/11)
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Read the pages at the DSM-5 website, and decide for yourself. There's much to think about.
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