Monday, December 3, 2012


Get Your Midnight Book Release Costume Ready!

The term "gender identity disorder", for children and adults who strongly believe they were born the wrong gender, is being replaced with "gender dysphoria" to remove the stigma attached to the word "disorder". Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual decades ago.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by psychiatrists in the US and other countries. The changes were approved on Saturday.

The DSM-V will most notably eliminate Asperger's syndrome in favor of a wider net for "autism spectrum disorder," add hoarding and binge-eating disorders (binge-eating was there but kinda in the index before, or something), remove the bereavement exception for major depression, and probably about six thousand other things that make more sense if you have a background in the field.

Share opinions if you've got 'em, present and future shrinks! And tell us they're going to jazz up that cover art.

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Huh. I've always said gender dysmorphia. Is my face red! Anyways, great news, even if it's more of a semantic matter - the psychiatric community still has MILES AND MILES to go in treating transgender individuals humanely.

Springtime for Voldemort

@hallelujah Gender dysmorphia has been accepted for awhile in more trans-friendly circles, it's just that they update the official book about once a millenia. (Or twenty years, which is basically the same.)


This is one of the very best post I've ever seen! @y

Heat Signature

I'm actually pretty excited for the new DSM, although I'll try to get it used since new ones cost like, $1000 and I am a poor social worker.


Wait, if you're still worked up over the loss of a loved one after two weeks, that's not... normal? My grandmother was clearly down and having a somewhat harder time being functional after my grandfather died rather suddenly, but I dunno, after a good 45 years of marriage, two weeks seems a little short for a mourning period. It's been awhile since I studied the Kubler-Ross stages but I don't think the depression one had a two-week limit.

(Honestly, as sad and miserable as I felt in the wake of my grandfather's death, it was nothing like the worst bouts of depression I had. At least there was a concrete reason for how I felt, rather than a general sense that my life & I were awful.)


@Poubelle Whether it's normal or expected or not doesn't have much to do with whether someone shows symptoms of major depression and could benefit from treatment associated with major depression. The uphill battle the DSM faces is removing the stigma associated with various mental and cognitive conditions. Of course it's normal to be depressed while you're grieving—still depression. That's their thinking, anyway.


@Emby Yeah, the "you'll get over it eventually" crowd is totally going to be swayed by the idea that depression and grief are one and the same. So helpful!

Look, there's a point, death of a loved one or no, where you probably do need professional help. If the change is to make diagnosis of the severe cases easier (especially if it's to get insurance to maybe help out), great. But bereavement that goes on for more than two weeks, on it's own--I'm not sure how clinical intervention (especially if it involves medication) is exactly helpful. It's actually healthy to have that sort of connection with other people that losing them is a Big Deal. Death is natural and part of the cycle of life, yada yada (except, of course, when it isn't--if it's too soon or too violent or too nonsensical)--but it's also major life change, and there's a very good reason cultures across the board have such specific ways of dealing with it.


@Poubelle The point of the DSM isn't to make recommendations for treatment, though, it's to characterize mental states and conditions. It's not intended to pathologize (though, of course, that can unfortunately happen). Saying that someone can become depressed in the wake of the loss of a loved one, at least by the strict DSM definition, isn't the same as saying it's unhealthy.


@Emby I should note, though, that the efforts to move away from pathologizing mental states is a rather recent development that began in earnest in DSM-IV and is still a work in progress.


@Emby Yeah, exactly. It's normal and natural to break your leg when you fall down the stairs. You still might want to get it looked after.


@queenofbithynia I understand everyone's points here but the "two weeks" part does seem callously conservative and almost like a typo that should actually say "two years" or something. But that's coming from someone who still tears up looking at pictures of my pet that died four years ago,


So complicated!

If you are depressed, a doctor might write down "Major Depression". This might make treatments available to you that aren't otherwise, a good thing. But you aren't really sick, you are in a crappy situation. Your doctor might understand that now, but your next doctor might understand you through the lens of "Major Depression" and now it isn't about helping you deal with your surroundings but about fixing you. That can become a much larger problem when it happens to a lot of people.

There are so many consequences of diagnosis that I wish the APA would recognize, but they put in disclaimers about how diagnoses are to be used and refuse to acknowledge that the DSM is not used in practice the same way as it is used in their clinical studies that lead up to DSM publication.


@Emby Yeah but is a broken leg still considered a fracture if you acquired it while exercising?


Yes, I agree. "Two weeks" is bizarre as a normalized mourning period for a loved one.

Also, bereavement feels different from depression -- I sincerely doubt, as well, that hte same brain chemistry is involved, given all that I've read about clinical depression -- it just doesn't seem helpful to anybody to lump them together, and it may have very bad treatment consequences & consequences for societal understandings of the grieving period.


@queenofbithynia How does the broken leg analogy work for those of us who have depression without anything like someone dying to set it off? You can't exactly go through life with a leg that hurts a lot and won't work properly and realize, hmm, maybe my leg's been broken all this time. And how does that fit with Emby's argument that it "isn't the same as saying it's unhealthy"?

@notpollyanna Yeah, the realities of actually having the diagnosis don't seem to be considered much.

I still find the two weeks idea crazy short. Maybe if it's an expected death--someone who was already very, very old, or someone with a long-term terminal illness, where you had time to accept the idea that they were dying before they actually died--I guess I could see that timeline. But two weeks? That's awful quick.

Summer Somewhere

@Poubelle I prefer to see it this way: if someone is grieving to the point where those feelings interfere with their ability to care for themselves and otherwise function on a daily basis, it's normal and healthy to seek professional help. The collection of symptoms focus on the afflicted person's ability to function, so I don't think two weeks is too short. Two weeks is a long time to have such reduced functionality, especially if feelings of worthlessness are present and suicidal ideation comes into play.

Insurance will usually only cover counseling or medication if there's a DSM diagnosis attached, so opening up the definition means that more people can get help. I don't really understand why there was a bereavement exception before because major depression can be triggered by a lot of things that are normal to be sad about - a bad relationship/breakup/divorce, unemployment, serious illness, etc.- and I don't see why this one would be different. A broken leg is a broken leg whether you got it through exercising or skydiving.

This argument seems to hinge on the idea that a diagnosis of major depression carries a stigma, and that the bereaved don't deserved to be stigmatized. I'm uncomfortable with this because the implication is that other people do deserve the stigma. The stigma surrounding mental illness is a serious problem, but it's way bigger than the DSM.


Wow, I'm pretty annoyed it hasn't been rewritten in 20 YEARS. :/


"Listen, you! I co-chaired the committee that reviewed the recommendation to revise the color of the book that regulation's in. WE KEPT IT GRAY."


@area@twitter High five for the Futurama ref.

fondue with cheddar

The color needs some work for sure, but I hope they at least change the type to something besides Arial.


I'm just going to be over here, clinging to the ICD-10 (last digital update in 2010), which has the proper diagnostic criteria for Asperger's syndrome. YOU CAN'T JUST REMOVE ONE OF THE MAJOR CRITERIA, DSM-IV-TR. Not that I'm still annoyed about that.

Insurance companies are going to have a field day with this.


@Derevkova It seems premature as for research of causes, but Aspberger's essentially seems to be fluent Autism.

Edit: I'm so glad the gender dysphoria finally happened!!


"Alcoholism is the only disease you can get yelled at for having."


@stuffisthings Dammit, Mitch, you have cancer.


@stuffisthings Yeah, although as someone who grew up with an alcoholic, I can attest that you're usually not being yelled at for simply being an alcoholic, but rather for lying (again)/breaking shit/betraying the trust of everyone around you in some spectacular way. The yelling comes when the end of a tether has been reached and when not yelling is no longer possible.

Also if someone I loved had emphysema and kept smoking themselves to death, I honestly might yell at them too. In any case, you can never know until you've been there.


Unfortunately for children gender dysphoria is not really fleshed out all that well in the DSM. Many young children (and adults, tbh) do not fully understand the difference between sex and gender and so the can meet many of the criteria by not being happy with their gender roles (think: tom boys). We are putting ourselves in dangerous territory when we start medically intervene with children, like blocking puberty.

Sgt. Exposition

@sintaxis As a card carrying trans person, I understand your concern but must strongly disagree. Working with very young children is a delicate business, but trans kids who can verbalize their discomfort often feel and maintain their dysphoria from a very early age (this is not to say that everyone does or must have a childhood narrative - I don't). The alternative is Kenneth Zucker, whose methods I find horrifying.

And by the time one reaches puberty, the possibility of regret is minimal. Children are both more and less aware than adults think.

Springtime for Voldemort

I'm still pissed they didn't include C-PTSD. It's not a shocker or anything, given their wussiness towards children's rights and abuse -long live parental sovereignty -but still, I'm disappointed, and afraid that it will be another twenty years before the issue is officially revisited.


@Springtime for Voldemort I asked my professor about Complex PTSD, because I am writing twenty pages on the subject. She swore and said "Maybe next time".

Springtime for Voldemort

@Bloodrocuted Both you and your professor may have an expensive holiday cookie - one of the ones with chocolate and everything.

What's your paper on (more specifically)?


@Springtime for Voldemort You know, I have never had an expensive holiday cookie. I just think it's not really my holiday and feel they are off-bounds. I'm going to buy an expensive holiday cookie. A big box.
The C-PTSD part of my paper is specifically on the affects of physical and sexual child abuse. I research if and how C-PTSD devolves into other Cluster B and C disorders in adulthood, if and how that leads to an abuse cycle, and how to realistically stop an abuse cycle.
While I'm on Cluster B disorders, I am also going to make the point that histrionic PD is essentially narcissistic PD with sexism.
I love talking about papers. Are you also studying?

Springtime for Voldemort

@Bloodrocuted That sounds so interesting! So, how do you realistically stop the abuse cycle?

What? WHAT? Histrionic is a bunch of sexism? Get out of town!! ;)

I am! But not psychology. The Spanish Inquisition. It was entirely expected.


@Springtime for Voldemort I don't know, yet. It is presumed to be like "a lot of therapy specific to the adult PD developed", but it might be something more surprising, like "more therapy focused on C-PTSD despite the adult PD". And so on. Maybe "eating a lot of cookies-based therapy" will come into consideration.
I agree, the histrionic/narcissistic PD is almost too obvious. I want to mention it here because I think the disorder will be relevant to C-PTSD, and it is the end of the semester and we have not talked about it with details yet. I am going to write about how women and men differently present 'overt sexuality'.
So, not psychology. Do you have an interesting paper in another area of study?

Springtime for Voldemort

@Bloodrocuted If the answer is a cookie-based therapy, be sure to let me know?

Yes, I'm writing one on the Spanish Inquisition. It's not as interesting as I'd hoped, because I really didn't plan well enough for it, so instead of doing a paper on women in the Inquisition, I'm just doing THE paper on the Inquisition. Whatever. Upside: I have totally proven that that other teacher definitely did not know anything about the Inquisition, despite spending 2 weeks on it. I'm now tempted to passive-aggressively slip an anonymous note in her box, saying that her lectures might benefit from reviewing the works of (Big Author on the topic) and his updated historiography.


@Springtime for Voldemort Wow, that letter! She must be very incompetent. You could give it to her like a Christmas present... no, that would be too awful.
If you write an update on your paper this FOT, I'll look for it. I hope you do well.

Springtime for Voldemort

@Bloodrocuted Thanks, you too!


As an editor of psych books, I am grateful for the job security. Also, I agree with the commenters above who have commented on the lack of development in diagnosing disorders or otherwise abnormal psychology in children.


When my marriage was tanking, I called my psychologist mother, and said "mom, I think I might be clinically depressed".
She said, "Nonsense! You're not 'clinically depressed', your depressed because your life sucks right now. There'd be something wrong with you if you weren't depressed".

Strangely, this made me feel much better.

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