DSM-5

Response to a classmate's post regarding the benefits and concerns of using the DSM for diagnostics in counseling

I decided I will start a new category of Substack posts called: Masters Research. Since starting grad school for Counseling a month ago, my creative and intellectual equity has been funneled exclusively into the writing of discussion papers and responses to classmates, on various topics pertaining to mental health. In an effort to (1) continue making consistent contributions to my Substack, and (2) infuse the tedium and exhaustive nature of graduate school with purpose and meaning, I will begin publishing my work here. And see if that works.

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Hi Jamie!

Thank you for sharing so openly about your experience with mental health diagnostics and the DSM-5. Learning more about your origin story allows me better to understand my own experience in the mental health system. You are doing an excellent job maintaining a high level of professionalism while practicing self-disclosure. Developing these skills will undoubtedly serve your future clients, as it already serves your readers!

I recognize myself in your mention of “selective admissions” in the context of therapeutic relationships. I appreciate you mentioning this, as withholding information during intake sessions has had detrimental effects on my health and well-being. I wish every test or assessment had to account for possible withholding of information. However, this would make diagnosis impossible. How can we ever know how much of the truth we are getting? 

After the birth of my second child, I went to see a psychiatrist for a Vyvanse prescription (I couldn’t cope with the stress of life and was having trouble concentrating; also, undisclosed, I wanted to lose the baby weight). Two of the questions my psychiatrist asked were whether I ever restricted my food intake or had any history of eating disorders. I said “no” to both questions, knowing that a “yes” would have gotten in the way of a prescription. I was prescribed the stimulant because I crafted the diagnosis to fit what I wanted. Not what I needed. I dread to think how commonplace this is. Towards the end of our professional relationship, she commented on my weight loss and confronted me about having an eating disorder. I told her the truth, which was “yes.” And she reminded me that she would never have prescribed the medication if she had known about this conveniently excluded aspect of my medical history. 

My next point of concurrence with your post has less to do with the DSM-5 specifically and more to do with the cons of diagnosing with the DSM. I see what you’re saying about the proliferation of newly named disorders reflective of standard life stresses and widespread concerns regarding the overmedicalization of mental health disorders. For example, “Binge Eating Disorder” is characterized by “excessive eating, loss of control over the amount of food and manner of eating, inability to change behavior, continuing behavior despite negative consequences, increased impulsiveness and emotional imbalance.” (Bąk-Sosnowska, 2017). If you look closely, there are minimal differential criteria between BED and Bulimia Nervosa in the DSM. 

In 2015, the FDA approved Vyvanse as a viable treatment for Binge Eating Disorder (BED). In 2017, I approved Vyvanse as my viable course of treatment for overeating and wanting to lose weight without the hassle of working towards a goal. Being prescribed this medication (even though I manipulated my diagnosis) was dangerous and nearly induced psychosis. It also bypassed any root problems at the causation of my overeating that needed to be addressed (such as trauma, abuse, low self-esteem, and poor coping skills). Thinking we treat the whole person by slapping a bandaid on surface-level symptoms is like investing in failure. Therefore, I would argue that treating BED with stimulants is to miss an opportunity to teach self-efficacy. Most everyone I know has overeaten at some point and regretted it. But that doesn’t mean we all need a prescription for Vyvanse. This case supports the concern listed in the book, that “The overdiagnosis and medicalization of mental disorders has the potential to support harmful and unnecessary treatment” (Nystul, 2018, p.203).

As a counterpoint, Prolonged Grief Disorder, the newest addition to the DSM-5, struck a chord that made me think otherwise. I have a friend who lost a sister a year ago. This friend still experiences debilitating emotions regularly over the loss, and is doing a tremendous job honoring her grief and holding space for it, even though the world tells her its been long enough, and she should get over it. I wonder what the introduction of this diagnosis might provide for her in the way of treatment. Or if it’s even ethical to quantify or qualify grief. “The inclusion of the diagnostic criteria for prolonged grief disorder in DSM-5-TR allows clinicians to use a common standard to differentiate between normal grief and this persistent, enduring, and disabling grief” (Nystul, 2018). It makes me question whether this proliferation is all dismissable, or if there might be some credibility in adding new diagnoses, especially if insurance would pay for it precisely because it’s included in the DSM-5.

I appreciate you giving me the opportunity to look at both sides of this coin! Thank you, Jamie!

References:

Appelbaum, P., & Yousif, L. (2022, May). Prolonged Grief Disorder. American Psychiatric Association. https://www.psychiatry.org/patients-families/ prolonged-grief-disorder

Bąk-Sosnowska, M. (2017). Differential criteria for binge eating disorder and food addiction in the context of causes and treatment of obesity.

Psychiatria Polska, 51(2), 247–259. https://doi.org/10.12740/pp/onlinefirst/62824

Nystul, M. S. (2018). Introduction to counseling: An art and science perspective (6th ed.). Cognella, Academic Publishing