DSM-V: TDD: Juvenile Bipolar Research Foundation responds

The Juvenile Bipolar Research Foundation has been involved in important and fascinating research on juvenile Bipolar Disorder. If you are not familiar with their research program and findings, you can read the first two parts of their three-part series at http://www.jbrf.org/news/newsflash1.html and http://www.jbrf.org/news/newsflash3.html.

In response to the DSM-V proposal to create a new diagnosis, Temper Dysregulation Disorder with Dysphoria, discussed in previous blog entries on this site, JBRF sent out a newsflash, which they have kindly given me permission to reproduce on this blog:

An important proposal that will affect the diagnosis of juvenile bipolar disorder for the next decade has just been released by the American Psychiatric Association (APA). It is part of the planned revision of the Diagnostic and Statistical Manual for Mental Disorders, commonly referred to as the DSM. The DSM contains the information upon which professionals assign their psychiatric diagnoses. It cannot be overstated how important and influential this manual is in YOUR life. It is the book by which clinicians and doctors are trained, insurance is reimbursed, school accommodations are approved, legislation is passed, justice is executed, and research is guided.

On February 10th, the proposed revisions were made public and covered extensively by the media. You can find the proposed draft on the American Psychiatric Association website:
http://www.dsm5.org/Pages/Default.aspx

Why should you be concerned? Because one of the recommended changes includes a new diagnostic classification that may prevent children who need treatment consistent with a bipolar diagnosis from receiving it.

Read more

DSM-V: TDD: American Psychiatric Association statement

As I’ve mentioned in previous blog entries, the newly proposed diagnosis of Temper Dysregulation with Dysphoria Disorder (TDD) has generated a lot of controversy.  In this blog entry, I’m reproducing part of a statement from the American Psychiatric Association about the proposed diagnosis.  In subsequent blog entries, I’ll provide statements from the Juvenile Bipolar Research Foundation and the Child and Adolescent Bipolar Foundation.

The American Psychiatric Association’s draft diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will include a proposed new diagnostic category, temper dysregulation with dysphoria (TDD), within the Mood Disorders section of the manual. [...] Criteria for the proposed diagnosis of TDD include severe, recurrent outbursts of temper occurring three or more times a week that are grossly out of proportion to the situation or provocation and that interfere significantly with functioning. Criteria also include extreme verbal and physical displays of aggression when faced with a common minor demand or stress. In between these outbursts, the individual’s mood is persistently negative: irritable, angry and/or sad. To be considered TDD, the symptoms must have begun before the age of ten. Only children over the age of six will be assigned the diagnosis, and children with the distinct manic episodes found in bipolar disorder will be excluded. "Many children with these symptoms have received a diagnosis of one of the disruptive behavior disorders, such as oppositional defiant disorder, and in most cases that would be appropriate," said David Shaffer, M.D., chair of the ADHD and Disruptive Behavior Disorders Work Group. Read more

DSM-V: Mood Disorders: TDD: rationale

As noted in my first post on this topic, one of the challenges facing the Mood Disorders and Childhood Disorders work groups stems from the fact that although some children do show the same type of clear cyclicity or episodes as adults with Bipolar Disorder, many children do not seem to have clearly defined mood episodes.  So is Bipolar Disorder being overdiagnosed in children? Are children being given a Bipolar diagnosis and treatment when what ails them is not really Bipolar Disorder? To address this problem, the work groups proposed:

1. refining the diagnostic criteria for mood episodes to clarify that an episode requires the presence of the symptoms "almost all day, every day," and the symptoms represent a change from baseline for the individual; and
2. introducing a new diagnosis that may be more consistent with what we see in many children, Temper Dysregulation Disorder with Dysphoria (TDD).

The diagnostic criteria proposed for TDD are provided here for reference and discussion purposes. In this post, I’ll try to summarize some of the research that led up to the proposal. As part of its consideration and work, a new (temporary) diagnosis was proposed and defined, called Severe Mood Dysregulation (SMD). The criteria for SMD included severe but non-episodic irritability with anger outbursts and hyperarousal/ADHD-like symptoms. The name SMD would subsequently be changed to TDD and the hyperarousal criterion dropped. Read more

DSM-V: Temper Dysregulation Disorder with Dysphoria: criteria

The following are the tentatively proposed diagnostic criteria for Temper Dysregulation Disorder with Dysphoria, being considered for inclusion in the DSM-V.  I am posting them here as a convenient reference to facilitate discussion of the topic in other blog entries. This thread is not open for comments, but comments are permitted in the blog entries that discuss the proposal.

Temper Dysregulation Disorder with Dysphoria

A. The disorder is characterized by severe recurrent temper outbursts in response to common stressors.

1. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.
2. The reaction is grossly out of proportion in intensity or duration to the situation or provocation.
3. The responses are inconsistent with developmental level.

B. Frequency: The temper outbursts occur, on average, three or more times per week.

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).

Read more

DSM-V: Mood Disorders, Part 1

Mood disorders, including Depression and Bipolar Disorder, are tentatively slated for a number of changes in the DSM-V. You can read an overview of the proposed changes on the DSM-V web site, and follow the links to specific disorders to see the proposed diagnostic criteria and the rationale for any changes. One of the most contentious proposals involves an attempt to decrease what is perceived to be over-diagnosis (or misdiagnosis) of Bipolar Disorder in young children.  Over the past few years, a number of studies have looked at severe mood dysregulation (SMD) in children and what happens to these children as they mature — do they develop depression or Bipolar Disorder, or neither? As a result of the studies, two DSM-V work groups collaborated and proposed a new diagnosis called "Temper Dysregulation Disorder with Dysphoria" (TDD).  You can read the proposed diagnostic criteria on the DSM-V web site or here. If you are interested in this condition or the issue of childhood-onset mood disorders, you may find it helpful to read two articles that the work groups produced to explain the research and their rationale for proposing TDD as a new diagnosis:   Issues Pertinent to a Developmental Approach to Bipolar Disorder and Justification for Temper Dysregulation Disorder with Dysphoria. In subsequent posts, I will try to summarize more of the controversy and provide statements by different groups of stakeholders who are pro and con the proposal.

« Previous Page — Next Page »