Revision of DSM-5 (15)

I wonder if they will make any changes in the paraphilia department?

http://www.nytimes.com/2010/02/10/health/10psych...

I think they are still open for comments on http://www.dsm5.org/Pages/Default.aspx ...

edited to correct link.

Edited Thu 11 Feb 10, 7:52 PM by uniquemoon

Mmaybe it would be better to save your comments till they update the ICD 10 which is prodominantly used for classifying mental disorders in the uk.

~* Raku wa ku no tané; ku wa raku no tané. *~

http://en.wikipedia.org/wiki/Sadism_and_masochis...

My, what sharp teeth I have.

De DSM IV is, apart from it being 'mercain, basically meant as a classification system, but is frequently misused as a diagnostical tool.

So, the removal of certain items in the sections F64 and F65 from ICD-10 are IMO of paramount importance, cause they are in fact the basis that makes it possible for the DSM IV to use them within a classification-system.

(Btw not everything within those sections; pedophilia but paradoxically also gender disorders will still be seen as a disorder, and regarding gender disorders that would be good, cause that makes treatment and transgendering possible).

As the last revised version of the DSM now states, there is sort of a blurry line. Currently in the DSM-IV-TR, Sexual Sadism isn't a disorder. UNLESS it is non-consensual and/or causes significant (personal or social) distress for the individual. The "causing distress" part is questionable (is the distress the cause of the disorder, or is it merely a consequence of stigma-related stress on the individual), and I don't really have a clear-cut opinion on that part.

Edited 12 Feb 10, 2:28 PM by othyim

I think it depends on the Psychiatrist actually.... it does clealry stipulate that some kink should be considered normal behaviour and only to considered it as a disorder if the individual can not get gratification any other way.

Picking your nose is in there too, just to add a little prospective.

I suppose its there siply because of the sexual nature of the errrrr 'disorder'.

~* Raku wa ku no tané; ku wa raku no tané. *~

Edited 12 Feb 10, 2:16 PM by Diablos_patience

errr...

I thought the D in DSM stood for "Diagnostic'...?

'Twosies beats onesies, but nothing beats three...'

Wiki: "It initially evolved out of systems for collecting census and psychiatric hospital statistics, and from a manual developed by the US Army."

Listing things for that reason as a basis (looking for census) is different than developping a scientific diagnostical tool.

Edited 12 Feb 10, 2:43 PM by othyim

Thats the same way the icd-10 is used here, the diagnosis is made by the the way the person presents and based upon the psychiatrists knowledge... then its recorded for statistical purposes by using the relevant code as in the icd-10 book.

~* Raku wa ku no tané; ku wa raku no tané. *~

A number of child & adolescent psychologists that I know in the UK use the DSM codes and definitions rather than ICD - is this unusual?

'Twosies beats onesies, but nothing beats three...'

On the ICD 10: "ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994."

"It is used to classify diseases and other health problems recorded on many types of health and vital records including death certificates and health records. In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States."

versus DSM IV:

"The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers."

The ICD 10 covers ALL illnesses, not just psychiatric ones, and is younger, and considdered to be more modern....

Wiki on the difference: "ICD-10 Chapter V: Mental and behavioural disorders, part of the International Classification of Diseases produced by the World Health Organization (WHO), is another commonly-used guide, more so in Europe and other parts of the world."

So yes, both systems are used side by side. Yet, it is IMO a very good development that the paraphilia as described in the sections F64 and F65 of the ICD 10 are now being considdered questionable and even invalid in at least some European countries.

For when at least some countries will no longer validate those, perhaps a Domino-effect will take place, and I sincerely hope that this will lead to the deletion of these paraphilia on the long term. Since the coding system in the DSM IV is designed to correspond with the codes used in the ICD, both publications will sort of be forced to delete them too. The two publications are not revised synchronously.

Furthermore, the revised version of the DSM is actually more liberal than the current ICD-10... (see posting above) for it tells that a lot of paraphilia arent to be seen as a disorder UNLESS..

A revision of the diagnostic criteria for several paraphilias (exhibitionism, frotteurism, pedophilia, sexual sadism and voyeurism) was done during the 1994 and 2000 revisions of the DSM, to exclude consensual activities by overall well-adjusted individuals.

Yet, Chapter V (Mental and Behavioural Disorders) of the ICD-10 still pathologizes consensual sexual preferences (F65).

Edited 12 Feb 10, 3:35 PM by othyim

Unfortunately, reading through some of the proposed revisions on affective disorders I'm somewhat disappointed; there is still the potential to say the metaphorial equivalent of "Well, it looks like a duck, swims like a duck and quacks like a duck... lets call it a dog". Arrrggg... but what do I know.

Whenever I've talked to people in the UK about formal classification criteria the conversation has started "well there's the DSM-IV and the ICD-10" then proceeded to reference only the DSM-IV. To date, I've yet to hear or speak to someone who's used the ICD-10 classifications.

The acid test is probably finding out what's used in research in the UK but I'm far to lazy to go and look up papers just now to check.

Quoting wikipedia, now that's a risky business Yeah, it may have started out as part of a statistical tool but it is certainly far more important today.

AFAIK drugs are approved against DSM-IV / ICD-10 classifications, and to prescribe a drug off-label carries a certain risk for a doctor; not sure of the details as it was given to me as an excuse against prescribing something. Assuming that is correct then it must be considered as a diagnostic tool surely? It is also used in research as criteria for selection of patients for studies.