Childhood Bipolar Boom: More Cases or Misdiagnoses?


No Data Yet For So-Called Disruptive Mood Dysregulation Disorder

Although some people say that giving a youngster a diagnosis of "disruptive mood dysregulation disorder" might be less stigmatizing than bipolar disorder, Mack said there's no data yet to show if that might be the case.

"It is unknown what would be the medical or social effect of a new diagnosis like DMDD," he said. "It certainly needs to be vetted as to its utility in psychiatry's classification of disorders. We don't want to miss kids who have true bipolar disorder, and we don't want to ignore kids with severe mood problems… We just want to know what is the right diagnosis."

Revising the DSM is a years-long project that includes comment periods and intermediate changes in proposed diagnostic criteria for psychiatric disorders. APA announced earlier this month that results of field trials at 11 medical centers for two proposed diagnoses, "attenuated psychosis syndrome," which was meant to identify people at risk of psychosis, and "mixed anxiety depression disorder," which combines anxiety and depression, weren't reliable enough to put them into broader use. As a result, they will be included in a special section of the manual for conditions requiring further research before APA determines whether they should be recognized as formal disorders.

Among other conditions to be further studied are "Internet use disorder," "caffeine use disorder," and "hypersexual disorder."

The committee also recently changed some language within criteria for major depressive disorder to acknowledge that sadness, insomnia and other symptoms while grieving a significant personal loss don't in themselves constitute a mental disorder.

Field trials at pediatric medical centers demonstrated that the proposed disruptive mood dysregulation disorder diagnosis worked in clinical settings, APA said. Similarly, field trials with 322 youngsters support a controversial proposal to narrow the definition of autism spectrum disorder and excluded very few children who meet the current definition. Critics and parents, however, fear that the new definition, which eliminates Asperger's syndrome and "pervasive developmental disorder" as related conditions, would shrink the number of children eligible for medical, social and school-based services for autism spectrum disorders.

The process of revising the manual for the first time since the DSM-4 came out in 1994 "is about compromise," said Dr. Liza Gold, a clinical and forensic psychiatrist in Arlington, Va. "The question is: how do you do science by consensus?"

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