Benedict Carey's article on DSMV makes particular note of the problems associated with the diagnosis of bipolar disorder in children. I found it a wonderful example of how psychiatric diagnoses are negotiated socially. What is a psychiatric diagnosis if its boundaries can be changed because of concerns about the side effects of the medications used to treat it? Here is an excerpt from the article.
One significant change would be adding a childhood disorder called temper dysregulation disorder with dysphoria, a recommendation that grew out of recent findings that many wildly aggressive, irritable children who have been given a diagnosis of bipolar disorder do not have it.
The misdiagnosis led many children to be given powerful antipsychotic drugs, which have serious side effects, including metabolic changes.
“The treatment of bipolar disorder is meds first, meds second and meds third,” said Dr. Jack McClellan, a psychiatrist at the University of Washington who is not working on the manual. “Whereas if these kids have a behavior disorder, then behavioral treatment should be considered the primary treatment.”
Some diagnoses of bipolar disorder have been in children as young as 2, and there have been widespread reports that doctors promoting the diagnosis received consulting and speaking fees from the makers of the drugs.
In a conference call on Tuesday, Dr. David Shaffer, a child psychiatrist at Columbia, said he and his colleagues on the panel working on the manual “wanted to come up with a diagnosis that captures the behavioral disturbance and mood upset, and hope the people contemplating a diagnosis of bipolar for these patients would think again.