Diagnostic Inflation Research Articles

Criteria for the establishment of a new behavioural addiction •

When does repeated behaviour constitute behavioural addiction? There has been considerable debate about non-substance-related addictions and how to determine when impaired control over a behaviour is addiction. There are public health benefits to identifying new behavioural addictions if intervention can improve outcomes. However, criteria for establishing new behavioural addictions must guard against diagnostic inflation and the pathologizing of normal problems of living. Criteria should include clinical relevance (Criterion 1), alignment with addiction phenomenology (Criterion 2) and theory (Criterion 3), and taxonomic plausibility (Criterion 4). Against such criteria, evidence does not yet support classification of pornography-use and buying-shopping disorders as addictions.

A MEDICALIZAÇÃO DA VIDA ATRAVÉS DA INFLAÇÃO DIAGNÓSTICA: é possível reverter esse quadro?

O texto é fruto da resenha do livro "Voltando ao normal" do Dr. Allen Frances, que delineia como foi possível a grande inflação diagnóstica que vivemos no mundo atual e busca refletir sobre as possibilidades de enfrentar e reverter este quadro.

"Diagnostic inflation" will not resolve taxonomical problems in the study of addictive online behaviours. •.

This article suggests that the type of Internet-enabled device should not be prioritised when conceptualizing diagnostic categories of addictive online behaviours. The diagnostic distinction between “predominantly mobile” and “predominantly non-mobile” forms of Internet use disorders (IUD) is not empirically based, may not be clinically useful and may lead to “diagnostic inflation.” Problems with the concepts of smartphone use disorder and IUD on which the proposed distinction is largely based call for their re-examination. Future proposals for the taxonomy of addictive behaviours may not need to be based on online/offline and mobile/non-mobile dichotomies.

Infância e medicalização da vida: uma análise sobre a produção diagnóstica e seus nexos com os processos de escolarização

Nas últimas décadas tem ocorrido uma ampliação dos diagnósticos referentes aos transtornos e deficiências, principalmente no que tange ao público infantil. Esse aumento associa-se a modificações de critérios diagnósticos, ao avanço da produção diagnóstica no contexto escolar e à influência de interesses associados aos conglomerados da produção farmacológica descritos por estudiosos dessa temática. Este artigo se propõe a analisar a medicalização da vida infantil e a produção diagnóstica que se vincula aos processos de escolarização. Para tanto, apresenta-se um breve histórico a respeito da constituição do DSM, em sintonia com o debate acadêmico contemporâneo. Busca-se discutir como os engendramentos desse manual contribuem com a produção do que se compreende por inflação diagnóstica. A análise considera o processo de medicalização da vida no contexto infantil, com base em procedimentos que tendem a reduzir os fenômenos humanos a manifestações comportamentais que poderiam ser codificadas em dinâmicas que reafirmam o sujeito como centro da falta a ser corrigida.

Activity-based funding in mental health: a disastrous path.

On the basis of the experience of the Netherlands, this critical commentary will argue why activity-based funding (ABF) in mental health care is a disastrous path that Australia should not take. ABF leads to an exponential growth in health care spending as it encourages diagnostic inflation and overproductivity. It also leads to fraud and an increased bureaucracy that goes hand in hand with demoralisation among health workers. And finally, the increasing treatment claims leads to the reintroduction of productivity limitations, waiting lists and ultimately austerity measures in order to halt the untamed growth of spending.

As artes adivinhatórias e a psiquiatria do futuro

Psychiatry is studied as “divinatory art” engaged in predicting the future. It is intended to mark the management of life as a biopolitical enterprise linked to contemporary psychiatry. Therefore, the Diagnostic and Statistical Manual of Mental Disorders – Fifht Edition (DSM-5), edited by American Psychiatric Association (APA), is analyzed focusing the discussion about the notion of risk, establishing primary prevention a major goal of the psychiatric field. This reflects the reintroduction of dimensional axis into the categorical model adopted by DSM that produces a diagnostic inflation, and denotes the discontents of contemporary psychiatry front of their scope and limits.

Psychiatrie et psychanalyse : le divorce est-il consommé ? À propos des « troubles bipolaires »

Background Following the publication of the proceedings from the conference on bipolar disorders and psychoanalysis organized in March 2012 in Paris, the authors propose deepening the discussion regarding the diagnosis and treatment of bipolar disorders given recent advances in the scientific understanding of this disease and its etiology. It could be argued that the term “bipolar” has become a source of confusion for the medical community and the general public alike. As Jean Delay emphasized, mood is by nature bipolar and is “a fundamental affective disposition, rich with all the emotional and instinctual aspects, which gives each of our moods a pleasant or unpleasant tone, oscillating between the two extremes of pleasure and pain.” While the pathophysiology of the bipolar disorder is now much better known and understood, the “extended bipolar spectrum” as a nosological concept may be ill-defined in that certain personality disorders or neurotic problems may be mis-diagnosed within this spectrum. In many cases, this may inhibit further medical exploration as well as lead to inappropriate therapeutic management. Moreover, this is a troublesome development in that the bipolar disorder has seen a significant diagnostic inflation over the past 20 years, most noticeably in the United States but as well as in Europe. Within the context of modern science and current medical understanding, the authors reflect on the role of psychoanalysis as a potential therapeutic treatment for this disorder?

Essentials of Psychiatric Diagnosis (Revised Edition)

Essentials of Psychiatric Diagnosis (Revised Edition)

Childhood ADHD: a stepped diagnosis approach.

Since publication of DSM-IV in 1994, the prevalence of parent-reported diagnosed attentiondeficit/hyperactivity disorder (ADHD) has tripled to more than 10% of children. Although it is hard to know for sure whether ADHD is overdiagnosed, underdiagnosed, or misdiagnosed, it is argued that ADHD is especially prone to diagnostic inflation and overdiagnosis. Therefore, we propose a model of stepped diagnosis for childhood ADHD, which may reduce overdiagnosis without risking undertreatment. Calling attention to stepped diagnosis and formalizing the steps may improve its application in clinical practice.

Schoolchildren, governmentality and national e-safety policy discourse

The introduction of widespread school Internet access in industrialised countries has been accompanied by the materialisation of what can be labelled as a national school e-safety agenda. Drawing upon Foucault's notions of discourse and governmentality, this paper explores how e-safety policy documents serve to constrain the conceptual environment, seeking to determine and limit individuals' thoughts on this matter. Analysing UK and US government texts, it is argued that four main themes arise that subvert critical, informed debate about children online. Namely, the discursive construction of e-kids, the muting of schoolchildren's voices, the responsibilisation of students and ‘diagnostic inflation’ through realist risk discourses. These issues can be interpreted as an attempt to engender control through particular strategies of governmentality. While recognising that students may resist such attempts at control, it is concluded that the issue of children's digital rights need to be more prominent in e-safety policies.

Considération critique sur l’extension de la bipolarité, psychopathologie des mouvements d’humeur et de l’euphorie morbide

ObjectivesFrom manic-depressive psychosis to bipolar spectrum, today's psychiatry allows us to observe a widening of bipolar criteria. This article aims at studying this evolution, its consequences with a critical look and the psychopathology of mood changes and morbid euphoria. MethodsAll of our considerations refer to current data on bipolar disorders (review with Medline and Science Direct) compared with studies from classical psychiatrists (Kraepelin, Ey) and various authors inspired by psychoanalysis (Freud, Racamier) and phenomenology (Binswanger, Tellenbach, Tatossian). ResultsMany contemporary authors encourage clinicians to detect bipolar disorders from symptoms, early signs and attenuated or atypical expressions. The concept of a widened spectrum is supposed to be closer to clinical reality and it would be an opportunity to diagnose this disease and its deleterious consequences better and thus to set up an appropriate therapy at an early stage. Other authors, on the other hand, deplore a dilution of bipolar disorders together with harmful diagnostic inflation around a concept that has become too heterogeneous to be effective, that subjugates or interferes with other pathologic entities in an excessive manner and abandoning a psychopathological approach. In this view, we shall analyze the nosographic shifts of bipolar disorders throughout the history of psychiatry, from manic-depressive psychosis to bipolar disorder and spectrum. We shall then scrutinize the autonomy and limitations related to bipolar disorders as opposed to normality, confusing clinical presentations and other major mental diseases: Psychosis, depression, pathological personality, anxiety, impulse-control, attention deficit-hyperactivity, addiction and psycho-organic disorders. This work shall first introduce a discussion on the concept of bipolar disorders for children, and then through the case of some historical figures. Then we will deal with the contemporary social factors that are currently furthering the extension of this diagnosis. Last, this article sheds a light on psychopathological specificities of mania – the cornerstone in bipolar disorders – mood changes and morbid euphoria. ConclusionWe think that classic psychiatry, phenomenology and psychoanalysis would act as a guiding light through this debate and could help the clinician in this daily practice. Mood variations require a careful clinical observation and a rigorous set of interpretation, before being specified too excessively or hastily as a symptom of a real bipolarity.

Diagnostic Inflation: A Matter for Nurses!

Diagnostic Inflation: A Matter for Nurses!

Ethical Considerations in the Development and Application of Mental and Behavioral Nosologies: Lessons from DSM-5

We are not likely to find a diagnostic system as “unethical,” per se, but rather find that it creates ethical concerns in its formulation and application. There is an increased risk of misuse and misunderstanding of the DSM-5 particularly when applied to forensic assessment because of documented problems with reliability and validity. For example, when field tested, the American Psychiatric Association reported diagnostic category kappa levels as acceptable that were far below the standard level of acceptability. The DSM-5 does not offer sensitivity and specificity levels and thus psychologists must keep this in mind when using or teaching this manual. Also, especially in light of concerns about diagnostic inflation, we recommend that psychologists exercise caution when using the DSM-5 in forensic assessments, including civil and criminal cases. Alternatives to the DSM-5, such as the International Classification of Diseases and the Psychodynamic Diagnostic Manual are reviewed.

The past, present and future of psychiatric diagnosis

The past, present and future of psychiatric diagnosis

The New Crisis in Confidence in Psychiatric Diagnosis

The New Crisis in Confidence in Psychiatric Diagnosis

APA Approves Final DSM-5, Due in May After 6-Year Revision

The American Psychiatric Association has finalized its restructuring of the Diagnostic and Statistical Manual of Mental Disorders, clearing the way for publication of the fifth edition of the DSM in May 2013 and cementing some controversial changes. On Dec. 1, the APA's Board of Trustees approved the final diagnostic criteria, which had been developed by a task force of clinicians and researchers over the last 6 years. The document now will undergo final editing before being published by American Psychiatric Publishing. “We have sought to be very conservative in our approach to revising DSM-5,” Dr. David J. Kupfer, chair of the DSM-5 Task Force, said in a statement. “Our work has been aimed at more accurately defining mental disorders that have a real impact on people's lives, not expanding the scope of psychiatry.” One change that drew the ire of critics is the removal of the bereavement exclusion. Under the DSM-IV, the exclusion was used to describe people who experienced depressive symptoms lasting less than 2 months after the death of a loved one. Instead, the text of the DSM-5 will include notes clarifying the differences between grief and depression. The APA said the change is intended to reflect the recognition that bereavement is a significant psychological stressor that can precipitate a major depressive episode after the death of a loved one. But during the drafting of the DSM-5, the proposal was ridiculed by some opponents who said that removing the exclusion could lead clinicians to diagnose major depressive disorder in people experiencing brief periods of normal grief. Another proposal that was especially controversial during drafting of DSM-5 was the plan to create a new diagnosis of attenuated psychosis syndrome. To qualify for the new diagnosis, patients would need to have relatively intact reality testing but exhibit delusions, delusional ideas, hallucinations, or disorganized speech at least once a week for the past month. The idea was to describe a condition with the recent onset of modest, psychotic-like symptoms and clinically relevant distress and disability. But after field tests failed to garner enough cases to adequately test the reliability of the diagnosis, the DSM-5's Psychotic Disorders Work Group opted to put the new diagnosis in an appendix for diagnoses in need of research. In comments made before the APA board's approval of the new draft, Donna Rockwell, Psy.D., a clinical psychologist and a member of the executive board of the Society for Humanistic Psychology, said the concern with the attenuated psychosis syndrome proposal was that it was so sweeping that it could attach an inaccurate diagnosis to people who were simply “quirky.” Dr. Allen J. Frances, who chaired the DSM-IV task force and is a professor emeritus at Duke University, also in earlier comments, said that several proposals in the pending DSM-5 would take the idea of early diagnosis too far, essentially pathologizing normal behavior. For instance, he said the manual would elevate “temper tantrums” to disruptive mood dysregulation disorder. Diagnostic inflation and excessive use of psychotropic medications already are rampant, Dr. Frances said, and broadening the diagnostic criteria in the DSM will only worsen that trend. The DSM-5 also will include some new disorders, including excoriation (skin picking) disorder and hoarding disorder. Binge eating disorder will be moved out of the DSM-IV's Appendix B, used for diagnoses requiring further study, and into the main manual. Posttraumatic stress disorder (PTSD) will be made part of a new chapter on Trauma- and Stressor-Related Disorders in the DSM-5. There will be a greater focus on the behavioral symptoms associated with PTSD, according to the APA. Many areas will remain relatively unchanged. The categorical model and criteria for the 10 personality disorders in the DSM-IV will remain the same in the new manual. However, to encourage further study on how personality disorders can be diagnosed, the DSM-5 will include a separate section with new trait-specific methodology.

The perils of diagnostic inflation

People shopping for a psychiatric disorder, or psychiatrists looking to expand their scope of practice and billing codes, will need look no further than the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-V ), critics say. Revisions to the long overdue

Diagnostic Inflation

There have been a striking diagnostic inflation and a corresponding increase in the use of psychotropic drugs during the past 30 years. DSM-5, scheduled to appear in May 2013, proposes another grand expansion of mental illness. In this article, we will review the causes of diagnostic exuberance and associated medical treatment. We will then suggest a method of stepped care combined with stepped diagnosis, which may reduce overdiagnosis without risking undertreatment of those who really need help. The goal is to control diagnostic inflation, to reduce the harms and costs of unnecessary treatment, and to save psychiatry from overdiagnosis and ridicule.

Diagnostic Inflation of The Knee Joint

THE roentgenogram is a diagnostic aid of great value in bone and joint diseases. It reveals and confirms such pathologic changes as clinical medicine is often unable to visualize. In the early years of roentgenographic experience, one was unable to make a diagnosis from X-ray evidence alone. As a result of careful observation and study, however, the radiologist is frequently able to diagnose lesions without the contribution of clinical evidence. With the refinement of instruments added to careful study, the possibilities of diagnosis have become boundless. There are still a large number of conditions where the X-ray findings are exceedingly limited, among which the knee joint figures very conspicuously. This limitation is not due to the fact that the roentgenogram does not reveal the existing pathology, but may be attributed to the lack of our own knowledge in X-ray interpretation of soft tissue changes. Clinical medicine helps to pave the way for X-ray interpretation, but without surgical aid confirming the actual presence of pathology, the existence even of gastric ulcer would not have been as well known as it is to-day. A sufficient number of knees have not been operated upon in obscure conditions to correlate the pathology with the X-ray findings. The hazy outlines and shadows, therefore, mean nothing. We are still unable to disclose, in a large percentage of cases, the presence of a torn cartilage; or to disclose or interpret with a great degree of accuracy the existence of changes in the synovial membranes. In this paper we will deal with derangements of the knee joint which, under ordinary circumstances, present negative findings in the roentgenogram. Soft tissue structures do not readily cast a shadow unless considerable change has taken place, or some medium is introduced into the tissues to outline these structures. Liquids injected into a joint for diagnostic purposes are too irritating, often leading to adhesions, and are absorbed too slowly. Gaseous substances are preferable and therefore oxygen and carbon dioxide should be employed. Carbon dioxide has been used in our series of cases because it is very readily absorbed, producing very little irritation. One must be familiar with the pathology which takes place as a result of internal derangements of the knee and determine if the roentgenogram reveals these changes. The knee joint differs from all other joints in the body in that it is purely a hinge joint, permitting only a small amount of rotation, and that only when the knee assumes the position midway between flexion and extension. This position is often called the “danger zone,” because, when the joint is in this position, injuries take place which are of more serious consequence, namely, displacements and tears of the semilunar cartilages. The anatomical structures which as a rule show no changes in the roentgenogram are the synovial membrane, fat pad and the semilunar cartilages.