A common criticism of modern psychiatry is that it contrives “psychiatric disorders” for the purposes of commercializing treatments. “Caffeine intoxication disorder” and “disorder of written expression” sound like serious afflictions, and yes they can be found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). But what exactly about caffeine withdrawal and poor writing skills warrants a psychiatric diagnosis?
As the final word on mental illness, anything listed in the DSM takes on near-indisputable authority. Entries are officiated through peer consensus and become tools in not only diagnosing mental health and prescribing treatment, but resolving court cases, acquiring insurance and personalizing education. This becomes problematic not in the least because the “diseases” don’t have to be — and in fact nearly always aren’t — grounded in verifiable physical evidence. They come from an experiential consensus by psychiatric professionals who have a mandate to tell people what is wrong with them, assuming something is wrong. The most sinister embodiment of this logic rests in the DSM’s “noncompliance with treatment disorder”: you have a disorder in rejecting treatment for your disorder.
Many have attacked the latest DSM’s authors with acerbic accusations of corruption, ties to big pharma and financial conflicts of interest. But just as likely are the more innocuous intellectual conflicts of interest: Could a natural side effect of psychiatry simply be that its practitioners, fixated on their models and theories of human behaviour, often overstep practical boundaries when evolving diagnostic standards? Either way, it appears to be a problem.
Check out these four somewhat unusual but actual and diagnosable disorders, according to the American Psychiatric Association.
4. Oppositional defiant disorder (ODD)
Symptoms of ODD in children include refusing to comply with requests, deliberate annoyance of others, arguing, and frequent loss of temper. According to the APA, the exact cause of ODD is unknown, but ‘a combination of biological, psychological and environmental factors’ likely contribute. Researchers have found positive reinforcement to be the most effective treatment.
Beyond the scope of positive reinforcement (which some might say is simply “good parenting”), the APA endorses treating the basic symptoms of, well, being a child as it were, through options like individual psychotherapy, cognitive behavioural therapy and social skills training. When a child is recommended for personal therapy, doors to drug regimens open.
But let’s give some sort of benefit of the doubt here: ODD, of course, would only concern kids who act out “too much”, right? Well if you consult the psychiatric Bible, it states simply that the so-called symptoms last a minimum of 6 months. This sort of ambiguity —much like the consensus for the DSM manual itself — leaves room for disastrous interpretations. It could easily convince a parent that their child’s regular bouts of immature behaviour, what some might call the very characteristics of childhood, signal a mental disorder, and may lead many to be believe that professional intervention and possibly medicating their kids is needed to overcome it.
3. Binge eating disorder (BED)
Do you enjoy eating food? So do we. Do you ever find yourself eating lots of food and then thinking to yourself, “I shouldn’t have eaten so much food?” Apparently, we have a problem.
Binge eating disorder didn’t exist until the fifth edition of the DSM published last year. It describes “recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances”, often in the absence of actual hunger and accompanied by feelings of guilt. It almost sounds like a plausible eating disorder, the kind you might associate with the serious disorders of bulimia and obesity… Except the diagnostic criteria for problematic binge eating is once a week over a period of three months.
Under this criteria, about 6% of the US population qualifies. But is the manual aware that, for example, having a weekly “cheat day” is so common it’s a popular dieting technique? Or that feeling bad after over-indulging in anything is practically a law of physics? The inclusion of BED in DSM-5 was so absurd that even Allen Frances, a leading psychiatrist who oversaw the formulation of the fourth DSM, called it “egregious” in his LA Times article warning of the manual’s dangers.
2. Minor neurocognitive disorder
As of last year, growing old and forgetting more things is a certifiably abnormal condition of the brain. If “mild decline” in your cognitive function has been noted by a family member or physician, you qualify.
Including minor neurocognitive disorder in DSM-5 means countless people not at particular risk of dementia might encounter unnecessary panic at some stage in the natural aging process. Moreover, without any proven effective treatment for either this “condition” or dementia itself, a diagnoses merely promotes anxieties and lures people into arguably needless dependency on psychiatric evaluation.
1. Disruptive mood dysregulation disorder
Children’s tendencies towards unpredictable behaviour leaves them especially vulnerable to airy psychiatric evaluations. Hence they’re the targets of the most diagnostic overkill. Over the last two decades, cases of attention deficit disorder have increased by 3 times, autistic disorder by 20, and childhood Bipolar Disorder by an astonishing 40 times. This has provoked fears that American children are overmedicated, a trend which doesn’t seem to be slowing down.
Disruptive mood dysregulation disorder turns temper tantrums into a psychiatric problem: The generous criteria, temper outbursts 3 or more times a week, will exacerbate the already excessive prescribing of medicine for children. Supposedly based on limited research, its inclusion was met with much controversy even among psychiatrists, and it could very well become the new ADD.