passerine: Picture of Sparrow from Dykes to Watch For (Default)
[personal profile] passerine
If I could rewrite the DSM, I'd have the current Axis IV (environmental conditions) be the most important section. I'd also put a lot more emphasis on differential diagnosis (yes, there's some, but there needs to be more).

Some selected points:

- A young person who is LGBTQ, avoiding school due to bullying related to being LGBTQ, and not getting along with heterosexist parents does not have Oppositional Defiant Disorder, most likely.

- Likewise, someone who is enduring constant harassment/bullying/stalking may well develop PTSD as a result, but trying to claim that the victim is paranoid/delusional or has a personality disorder? Um, no. Can we say "blaming the victim"?

- CULTURAL COMPETENCY, PEOPLE. "Magical thinking" consistent with a person's culture and subculture is NOT a symptom of mental illness. Active involvement in a religious community is one of the 40 developmental assets or "protective factors" against various problems in adolescence and early adulthood. (There are reasons this particular fail is so common. They merit their own post later.)

- Postpartum depression is very easy to both overdiagnose and underdiagnose because so many symptoms of depressive episodes are just part of life when you have recently given birth and have a newborn baby. (Lack of sleep - check. Fatigue - check. Weight changes - check. It wouldn't be difficult to also have loss of interest/pleasure in formerly enjoyed activities and difficulty concentrating in the immediate recovery-from-childbirth period. OTOH, it's easy to accept this as "normal" and not help someone who is in need of help.)

- Being an adoptee (and thus "obviously" having "issues around abandonment") is not grounds to change diagnosis from Bipolar II to Borderline Personality Disorder. Yes, I know the diagnostic criteria are similar on the surface but seriously, what? Oh, and insert rant here about the practice of using BPD as a slur diagnosis for "intelligent and self-aware patient that I don't want to deal with."

- Screen for hypothyroidism before you put someone with "treatment-resistant depression" on lithium to augment an SSRI, plzkthnx.

Date: 2009-07-31 03:37 pm (UTC)
From: [personal profile] corinthian
Psych and psych diagnosis always give me a tough time — because on one hand, it is a battle to give a more concrete set of symptoms, to be MORE scientific, to be more like "A + B => C" because people don't believe in it. But on the other, it is also a discipline which is highly dependent on far more variables than just cause and effect and as much as I appreciate some people's idealism coughskinnercough there is a large amount of variety that needs to be taken account. It's like. . . it's very hard for people to find faith in psychological diagnosis and psychology in general, I find. And most often people use differential diagnosis or lack of "concrete" proof (well, if a person suffers from PTSD shouldn't they ALWAYS be ____) or whatnot and it's frustrating -- but equally frustrating to be on the other side as well.

Which is a tl;dr which has NOTHING TO DO with your post, really, because I agree with a lot of these points. It's like. . . a the lines between overdiganosing children and ignoring their problems and so forth and so on.

Being an adoptee (and thus "obviously" having "issues around abandonment") is not grounds to change diagnosis from Bipolar II to Borderline Personality Disorder. Yes, I know the diagnostic criteria are similar on the surface but seriously, what? Oh, and insert rant here about the practice of using BPD as a slur diagnosis for "intelligent and self-aware patient that I don't want to deal with."

Haaau hauuu I have some FEELINGS!!11 on the subject but nothing concrete but ajksdba.

Date: 2009-08-02 01:12 am (UTC)
phoenixsong: An orange bird with red, orange and yellow wings outstretched, in front of a red heart. (Default)
From: [personal profile] phoenixsong
Being an adoptee (and thus "obviously" having "issues around abandonment") is not grounds to change diagnosis from Bipolar II to Borderline Personality Disorder. Yes, I know the diagnostic criteria are similar on the surface but seriously, what? Oh, and insert rant here about the practice of using BPD as a slur diagnosis for "intelligent and self-aware patient that I don't want to deal with."

Haaau hauuu I have some FEELINGS!!11 on the subject but nothing concrete but ajksdba.


Ohyes. Having to explain to my therapist, up-front, that yes, I am adopted, but no, my issues with my parents are not directly related to being adopted but due to the fact that they are absolutely crazy. (Or as it turns out, due to my having GAD and most of my immediate adoptive family having OCD. Yeah, no wonder most of my childhood made no sense until my mom and I finally compared psych notes last summer!)

Date: 2009-08-02 01:21 am (UTC)
From: [personal profile] corinthian
SOB yes. like. I have attachment issues, yes! But . . . I also grew up with a pretty emotionally volatile and slightly disturbed sibling who had severe learning disabilities and my parents ended up getting divorced because they couldn't stand each other! So. I DON'T KNOW.

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