![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
Differential diagnosis
Jul. 30th, 2009 11:27 pmIf 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.
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.
