Using caution when using the DSM V

An issue I would like to address is the over reliance on the DSM V. Too many doctors in and out of the office rely on the DSM criteria for diagnosing and treating patients. When I did my time in county, I had doctors who literally looked at the DSM and check the boxes for the symptoms. This lead to my misdiagnosis. DSM-5 criteria for: Bipolar I disorder: These doctors find themselves so rushed that they cannot take the time to really think about the patient's history and circumstances. All of these play a role in mental illness and indicate the genesis of the behaviour. 

Take for example bipolar disorder. Many people will receive an incorrect diagnosis of bipolar disorder due to isolation of symptoms. The doctor will treat the patient based on what they observe in the now. During a psych eval, the doctor will question the patient about their symptoms and what they are. 

"Have you slept too much or finding yourself sleeping too little?"
"Do you find yourself feeling hopeless or down?"
"Are you more goal driven recently?"
"Have you been more sexually active in the last few weeks?"
"Do you feel unusually elated or euphoric?"
"Do you hear voices or see things that aren't there?"
There are the common barrage of questions asked during a psych intake. The patient may lie or give simple answers such as yes or no. Not often do I hear clinicians probe the issue farther such as asking "what are your living conditions, have any tragic events happened recently, or have you suffered domestic violence." "How does this affect you." 

These secondary questions can provide valuable as they might uncover other reasons for the behaviour. Even though a great deal of symptoms are best answered by a organic mental illness that comes from the brain, some of them may stem from conditions. Some conditions such as abuse or trauma lead to irrational behaviour or emotions. It has been well documented that children who suffer from abuse demonstrate erratic behaviour unrelated to mental illness. It would be termed mental disordered behaviour.  For example when I lost my child, on the outside, I displayed behaviours consistant with a mixed episode. There were moments of crying, yelling, depressive moments, and irrational thoughts. Prima facie this would present as a bipolar mixed episode with psychotic features. However, the disqualifying factors are time, isolated incidence, and lack of impairment in daily life. This reaction did not halt my life or create issues with the law. It was an isolated incident that perhaps needed talk therapy but did not necessitate hospitalization nor consevatorship. I personally believe that a small number of psych patients need to be reevaluated to ensure that their mental illness is primarily organic and not simply a one time reaction to stress or trauma. Like there is situational DV I strongly believe in situational mental illness. disorders.


For reference: DSM V criteria for bipolar I.
Characterized by the occurrence of 1 or more manic or mixed episodes

• Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and increased goal-directed activity or energy lasting ≥1 week (any duration if hospitalized), present most of the day, nearly every day

• During the mood disturbance and increased energy or activity, ≥3 (or 4 if irritable mood only) of the following:
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • Pressured speech
  • Racing thoughts or flight of ideas
  • Distractibility
  • Increased activity
  • Excess pleasurable or risky activity.
• Marked impairment not due to a substance or medical condition
• In addition, these symptoms:
  • Do not meet criteria for a mixed episode
  • Cause functional impairment, necessitate hospitalization, or there are psychotic features
  • Are not related to substance misuse
  • Are not due to a general medical condition
  • Are not caused by somatic antidepressant therapy