Should BDSM and Fetishes Be Included in the DSM-5?

If you’re a little lusty for leather or predisposed to prefer pain, does that spell trouble for your mental or sexual health? While plenty of the kink-inclined assert that foot fetishes and a fondness for bondage has nothing to do with your state of mental wellbeing, wellness experts have surmised that such interests may land you in the psychiatrist’s bible of diagnoses; the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

 

The DSM-5 sets the standard criteria for psychiatric diagnoses, which means it is crucial to mental health treatment. Within its pages, unusual sexual fixations, or “paraphilias,” get their own category as odd, but not necessarily signs of mental illness. However, you will be eligible for a diagnosis of a “paraphilic” disorder if you are distressed by your fetish, or if your fetish causes harm to others. Ray Blanchard, a psychiatrist at the University of Toronto and chair of the working group on sexual and gender identity disorders for the DSM-5, explained, ‘This was a way of saying it’s OK to have a benign paraphilia. That does not automatically give you a mental disorder.’

 

Still, even including the benign paraphilias in the DSM in any capacity is thought one step too far by certain psychiatrists, as other diagnoses within the DSM can cover any harm and distress caused by sexual fixations. The argument is that by giving paraphilias it’s own special mention in the DSM, people who enjoy non-mainstream but harmless sexual activities will become stigmatised – even more so than they are already. Alan Shindel, an urologist and specialist in sexual problems at the University of California, Davis Health System, noted, ‘I’ve heard people at meetings talk about “those paraphiliacs,” “those people.” I think that’s always a dangerous road to go down when you’re talking about othering people in that way.’

 

This is not the first time that the DSM’s approach to sexual preferences has caused controversy. Even though homosexuality was removed from the DSM in 1974, for the next 12 years – until 1986 – psychiatrists still had the option of declaring gay people mentally ill if their sexuality caused them distress. Today’s mental health experts have drawn parallels between the treatment of homosexuals in the 1980s and people nowadays who get aroused by bondage or unusual objects. These advocates argue that the problem is not that the shoe fetishist or BDSM practitioner has sexual preferences that are somehow wrong; rather, the real problem behind their woes is that society judges them harshly.

 

It’s not hard to understand the advocate’s point of view, especially when you consider the fact that evidence for consensual paraphilias causing harm is lacking. Shindel commented, ‘There doesn’t seem to be a lot of harm to someone having a preference that’s unusual or different from what we consider mainstream.’ He said that the DSM have made a step in the right direction by swapping out “paraphilic disorders” for “paraphilias,” but the change still leaves plenty of wiggle room for prejudiced psychologists to blame their clients’ problems on their sexual fetishes. Shindel clarified, ‘I think it’s loosely applied and not really used the way it’s supposed to be.’

 

However, those who have framed the DSM reject the parallels made by such advocates as Shindel, with experts such as Blanchard making the point that not every sexual interest is comparable to homosexuality. ‘Homosexuality preserves a lot of what is in heterosexuality,’ he said. ‘There is a capacity for pair-bond formation, there is a capacity for long-term loving relationships. … I think it’s a special case, and I’m not afraid to say that it’s a special case.’

Categories: BDSM, DSM-5, Fetishes

Caffeine Withdrawal: Latest Silly Mental Illness in DSM-5

There are multiple wellness-boosting properties in coffee, but – let’s be honest – that’s not why you drink it! Sure, studies have shown that a diet containing moderate amounts of coffee can prevent certain diseases, such as breast cancer, but the real reason people are drinking this product everyday is for the caffeine boost. You may have even heard people say that they cannot function in the morning until they’ve had their caffeine fix. However, if you’re one of these people, be warned; your mental wellbeing may be at stake.

This is according to the American Psychiatric Association, which has monitored caffeine addiction as a potential threat to people’s mental health. In fact, the association’s newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has added caffeine withdrawal as a mental illness. If you suffer from caffeine-buzz, the DSM-5 – which has been criticised for over-diagnosing conditions – states that you will experience at least five or more symptoms after drinking 250 mg of caffeine. This translates to two to three cups of brewed coffee.

So what exciting symptoms may you experience after just a few cups of coffee? The symptoms listed under “Caffeine-Related Disorders” are restlessness, nervousness, excitement, insomnia, flushed face, gastrointestinal disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, unintentional motion, and diuresis, which is a frequent need to urinate. In the DSM-5 caffeine withdrawal has been listed as a shiny new category, including symptoms such as fatigue, loss of focus and headache.

According to Dr. Charles O’Brien, who chairs the Substance-Related Disorder Work Group for the DSM-5, ‘Caffeine is a drug, a mild stimulant, which is used by almost everybody on a daily basis, but it does have a letdown afterwards. If you drink a lot of coffee, at least two or three [eight ounce] cup at a time, there will be a rebound or withdrawal effect.’ However, several experts are critical of the DSM-5′s inclusion of caffeine withdrawal as a mental illness, stating that as caffeine withdrawal does not lead to long-term consequences that consistently disrupt work and social relationships, it does not work in the same way as other mental illnesses.

Categories: caffeine withdrawal, DSM-5, mental illness

The P6 Framework: How to Improve Employee Mental Health

The challenges of employee mental illness are undeniable. Not only does mental illness affect your employees’ wellbeing, but corporate wellness can suffer as a result of increases in absenteeism, a decline in workplace productivity, and even risk of litigation. This is why you need to establish a psychologically healthy workplace, as outlined in the new standard on Psychological Health and Safety in the Workplace.

 

If you’re operating a psychologically healthy workplace, this means that you are actively seeking to prevent harm to employee psychological health (which includes negligent, reckless or intentional ways) and promote their psychological wellness. At an Employee Assistance Programme Association of Toronto event last week, Krista Hiddema, co-founder of e2r Solutions, commented, ‘While today we are talking about a voluntary standard, I’m personally of the view that it will become a legislative standard.’

 

But is it really that serious a problem? According to Hiddema, the recent release of the DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) has heightened the impact that employee mental illness will have on employers, as the DSM-5 has expanded what falls under psychological illness to include bereavement, for example. According to Hiddema, ‘Claims could go up because of new definitions of psychological illness,’ and this idea of ‘everything is an illness’ will become a little frustrating for employers.

 

There’s a moral element to establishing a psychologically healthy workplace, as looking after your employee’s psychological wellbeing is a key element of being a responsible employer. Hiddema explained, ‘A huge portion of our lives and self-esteem comes from our workplace and how we’re treated in the workplace.’ Plus, there’s a legal factor at play here: a report by the Vancouver Board of Trade noted that, since 2004, there has been a 700% increase in the number of court-awarded settlements due to mental injury in the workplace.

 

While you’re not obliged to do anything for your employee’s mental health, Hiddema urged, ‘Being proactive and getting ready now will reduce litigation and you’re getting ahead of the curve.’ The P6 framework can help you do exactly that, based on a six-step process of policy, planning, promotion, prevention, process and persistence. Hiddema explained that the framework is ‘an extension on what your organisation’s likely already doing, and because this is a voluntary standard, there’s nothing stopping you from doing just P1 [policy] and P6 [persistence].’ She added, ‘Just because you can’t do everything, doesn’t mean you shouldn’t do anything.’

Categories: DSM-5, employee mental health, P6 Framework

Are New Pills the Answer for Women with a Low Libido?

Last month, the New York Times Magazine published a story touting two new pills in the pipeline to boost a woman’s low libido. The article made it seem as though this was an imminent possibility, and so sex therapists’ phones have been ringing off the hook ever since; from patients desperate for heightened sexual wellness.

However, this excitement for, well, more excitement may have been premature. According to Lorri Brotto, a psychologist at the University of British Columbia who was quoted in the article, ‘My patients who read the story have been asking me about these drugs, but the study data so far have found that the pills aren’t effective for everyone with low desire – only a subgroup of women.’ These pills tend to enhance your sexual wellbeing if you have trouble experiencing sexual pleasure due to a lack of sensation, rather than simply a lack of desire.

Each of the two new experimental drugs – Lybrido and Lybridos – have been tested in about 200 women, and so will both need to be tested in longer studies containing 1,000 or more women to even be considered for approval by the US Food and Drug Administration. Even if the drugs were to gain FDA approval, they would be indicated only for women with a psychiatric condition, such as the newly named sexual interest/arousal disorder. The DSM-5 recently categorised this condition to reflect not just a lack of interest in sex but also difficulties with the mechanics of it.

Brotto, who helped develop the new definition, explained, ‘This change was based on a fair bit of research showing that sexual fantasies aren’t necessarily a good indicator of a woman’s level of desire.’ She noted that while a desire-boosting drug may offer real solutions for problems that are likely physiological, more women may have sexual health problems which may not be fixable with a pill. Brotto commented, ‘Some experts see monogamy as the ultimate killer of desire. Distance, intrigue, mystery, and romance all dramatically decline as two people become more familiar and secure.’

An important element that can heighten a woman’s sex drive is being present in those moments of foreplay. Brotto suggested ‘Their minds may be elsewhere during sex; thinking that it’s just something they want to get over with.’ Brotto teaches her clients to tune into their bodies using mindfulness exercises, such as eating a raisin slowly: ‘I guide them through noticing its texture, shape, and smell, how it feels resting on their lips or sitting in their mouth, and how it tastes.’

Categories: DSM-5, female libido, Pills

Is Depression Only a Mental Disorder Because of Our Culture?

Last weekend, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders – DSM-5 – was published. The DSM-5 describes the symptoms of a vast range of mental illnesses and is intended as a guide to diagnosis, but the committee has been accused of continually expanding the categories of mental illness, resulting in “diagnostic inflation”.

 

Moreover, the US National Institute for Mental Health (NIMH) dislikes the DSM’s symptom-based approach, asserting that laboratory tests for biomarkers are the only rational way to diagnose mental illness. Arguably, the categorisation of mental illness based on symptoms can be useful, but it’s important to remember that those diagnostic categories are cultural constructions, not global certainties. For example, susto, or fright sickness, of Latin America, and what people in India call the dhat syndrome – in which men experience fatigue, anxiety and guilt – is a well-documented example of a psychological culture-bound syndrome.

 

Professor Christopher Dowrick put forward in a recent editorial in the British Journal of General Practice, that depression could be a western culture-bound syndrome, rather than a universal disorder. He noted that psychiatrists constantly shift the diagnostic goalposts, and this lack of consensus as to what constitutes depression supports his case. Professor Dowrick explained, ‘In western anglophone societies we have developed an ethic of happiness, in which aberrations … are assumed to indicate illness.’

 

But it’s not just depression, but pre-menstrual syndrome (PMS) that wellness experts have argued is a Western culture-bound syndrome. Thomas S Johnson claimed, in 1987, that PMS symptoms are an expression of ‘conflicting societal expectations’ on women, while a 2012 meta-analysis of published research failed to find evidence that negative mood correlates to the pre-menstrual phase of the menstrual cycle.

 

However, Dr Rachel Cooper, author of Classifying Madness, comments, ‘I think the distinction between “biological” and “social” causes can get tricky. Lots of human practices that are clearly culturally patterned – child-rearing practices, diet, and sleep patterns, for example – affect our biology. You could have cases where a “core” biological disturbance is expressed differently in different cultures. Some have suggested that this might be the case with western-style depression and Chinese neurasthenia.’

Categories: culture, DSM-5, PMS

Is Your Normal Behaviour a Sign of a Mental Disorder?

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has sparked major controversy, with critics arguing that it’s ridiculous that aspects of your normal behaviour, such as checking Twitter a little too often, will be signs of poor mental wellness, and even a new mental disorder.

According to writer and broadcaster Jon Ronson, whose bestselling book, The Psychopath Test, has helped to bring the DSM to the attention of a UK audience, attitudes to the DSM have changed. He explained, ‘When DSM first came out people were really excited. There was something alluring about it because people loved nothing more than mental health checklists. It was also a change from the pseudoscience that had gone before.’ And now? ‘They feel that there is an ivory tower elite trying to turn normal human behaviour into disorders and they don’t want to be told what they are feeling isn’t normal.’

As a previous member of this elite, former chairman of the work party for DSM-IV, Dr Allen Frances, is not looking forward to the new edition of the DSM, as it threatens to unleash what he has called a ‘diagnosis hyperinflation’ by ‘greatly expanding the number of people considered mentally ill, and reduces the ranks of the normal’. Dr Frances elucidates, ‘Grief becomes Major Depressive Disorder; worrying about being sick is Somatic Symptom Disorder; temper tantrums are Disruptive Mood Dysregulation Disorder; gluttony is Binge Eating Disorder; and soon almost everyone will have Attention Deficit Disorder.’

However, Dr David Kupfer, chair of the DSM-5 taskforce, has unsurprisingly asserted that the DSM-5 is not about redefining what is normal. He argued, ‘DSM has been periodically reviewed and revised since it was first published in 1952. The previous version of DSM was completed nearly two decades ago; since that time, there has been a wealth of new research and knowledge about mental disorders that is not reflected in the current [DSM-IV] text.’ He added that ‘at every step of development, we sought to make the process as open and inclusive as possible and did so to a level unprecedented for any area of medicine.’

 

Categories: diagnosis hyperinflation, DSM-5, normal behaviour

Experts Speak Out Against Plans to Classify Grief as Illness

Diagnosing schizophrenia and bipolar disorder is not valid or useful. This is according to the leading body representing Britain’s clinical psychologists, who say that, given a lack of scientific evidence to diagnose mental health problems as illnesses, there needs to be a “paradigm shift” in how the issues of mental health are understood.

In their statement – which has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress. In other words, they do not believe that those with mental health problems are the same as people suffering from illnesses that are treatable by doctors using drugs. According to the DCP, their statement ‘reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems’ that are used in psychiatry today.

One of the wellness experts who helped draw up the DCP’s statement was consultant clinical psychologist Dr Lucy Johnstone, who said it was unhelpful to see mental health issues as illnesses with biological causes. ‘On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse,’ she said.

But why are mental health experts saying this now? The DCP has timed their statement to come out just before the release of the fifth edition of the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 has expanded the range of mental health issues that are classified as disorders, hence the new statement. grief, temper tantrums and worrying about physical ill-health, for example, will now be classified as the mental illnesses of major depressive disorder, disruptive mood dysregulation disorder and somatic symptom disorder, respectively.

The writer Oliver James, who trained as a clinical psychologist, welcomed the DCP’s decision to speak out against psychiatric diagnosis. He stressed that we need to move away from a biomedical model of mental distress to one that examines societal and personal factors, noting, ‘We need fundamental changes in how our society is organised to give parents the best chance of meeting the needs of children and to prevent the amount of adult adversity.’

Categories: DSM-5, grief, illness

Myth Busters: Is it Possible to Classify Mental Disorders?

In a month’s time, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is due to hit psychiatrists’ and psychologists’ shelves. This is a standardised system of diagnosing mental disorders produced by the American Psychiatric Association (APA), but the DSM is not without its critics. The first edition of the DSM was published in 1952, and there have been three more since then, coming out every 15 to 20 years. However, the DSM has always had opposition, as some object to classifying mental health, as this can have several wellness complications.

The DSM-5’s primary purpose is to allow a reliable diagnosis of a mental disorder, as well as providing treatment pathways and likely outcomes for a patient’s wellbeing. Certainly, mental health is more difficult to measure than, say, heart health, but without the DSM-5 there is no other way of truly knowing whether a disease really exists. Differences of opinion are inevitable in this area, and so the DSM enables two clinicians to reach the same diagnosis for a particular patient.

As the APA has made a lot of money from the DSM “enterprise”, critics argue that the DSM is just a money-making scheme in which book royalties are the primary motivator for producing yet another edition. However, if book royalties are the primary objective, how would you explain that an estimated $25 million has already been spent on the fifth revision process? The truth is, medical experts are continually learning about the brain and mental health, and so revisiting standards and guidelines every 20 years is hardly an unnecessary step to take.

One of the main worries about the latest DSM is that more people will be diagnosed with a mental disorder. Though the total number of disorders in DSM-5 is yet to be announced, its chair David Kupfer has said the total number of disorders will not be more than in the DSM-IV: 297. Revising the DSM is an extremely rigorous process, which requires strong scientific evidence and wide expert opinion before new disorders or guidelines make the cut.

Finally, critics assert that the DSM is trying to redefine what’s normal. Yet being normal is not the same as “not having a DSM-5 diagnosis”, and having such a diagnosis is not the same as being “insane”. This has been wrongly argued by those who oppose the DSM, as many individuals, including physicians, find it difficult to accept that mental illness, not unlike physical illness, is common and most of it is not madness or insanity. The DSM is definitely not above criticism, but is probably the best manual of mental disorders that we are likely to have for some time.

Myth Busters: Is it Possible to Classify Mental Disorders?

Categories: book royalties, diagnosis, disorders, DSM-5, health, mental, mental disorder, Mental disorders, Mental Health, Myths, total number