January 31, 2012

Women Affected by New Definitions for Mental Disorders {featured news}

The current process of revising the definitions for a range of mental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), has received quite a bit of attention in the media lately, in particular for how it may include or exclude people from qualifying for covered treatment. This article sums up some of the controversy around definitions for autism (a tightening of the criteria) and depression (a widening to include grieving after bereavement), and adding other definitions that include “binge eating disorder” (out-of-control bingeing, complete with self-loathing) “premenstrual dysphoric disorder” (a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation) and “attenuated psychosis syndrome” (delusional thinking).

I was glad to see premenstrual dysphoric disorder recognized as the painful disorder it is. Women's premenstrual- and menstrual sufferings are too often silenced or belittled while in fact an estimated 75% of women suffer from premenstrual syndrome (PMS) during their childbearing years. Premenstrual dysphoric disorder (PMDD) affects between 3% and 8% of women during the years when they are having menstrual periods. Steps to ensure covered treatment for this disorder seems overdue if anything.

Since 2000, antidepressants and a form of birth control pill have been federally approved to treat PMDD. Still there are critics arguing against including PMDD in the manual, saying that it may increase "the likelihood of being treated for what is normal behavior, or close enough," an argument which yet again dismisses a female specific illness as real and worthy of proper recognition as such.

Including PMDD in the DSM has stirred passionate protests for decades. When the American Psychiatric Association considered adding the diagnostic category to the 1994 edition of the manual, "women’s health activists argued that the diagnosis pathologized the menstrual cycle and would stigmatize many women by wrongly labeling them mentally ill, and put them in jeopardy of discrimination at the workplace or in child custody battles." Opposed to which, Dr. Peter J. Schmidt, a psychiatrist with the National Institute of Mental Health, has argued that "making the diagnosis official would validate the experiences of women who have PMDD, increase the odds that health insurers would cover treatments for it, and spur additional research and development of new therapies by drug companies." Notes Dr. Susan R. Johnson, a University of Iowa obstetrician-gynecologist, "while societal stigma against mental illness is a serious problem, it is not a reason to avoid acknowledging PMDD. It would be like saying, ‘Well, let’s say there is no major depressive disorder because we don’t want people to be stigmatized as having this condition,’ even when it has a biological basis and can be treated."(A Clash of Science and Politics Over PMS)

For now, these revisions are still in play; the completed manuscript for the manual is due to the printer in December. The proposed revisions are available online at this website. In spring 2012, the website will be open for a third and final round of comments from visitors, which will then be reviewed by work groups for consideration of additional changes.

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