DSM-5 Proposed Revision - Non-Sucidal Self Injury

[Invert]

http://www.dsm5.org/ProposedRevision....aspx?rid=443#

So, I was looking through the DSM-5 proposals more carefully, and I found this. I don't think a behaviour counts as a mental disorder, its an unhealthy coping mechanism, but isn't itself a disorder, though may be linked to one.... and the rationale provided seems inadequate. And I have a lot to say on this personally.

But to start off with, what do you think of this proposal diagnosis? Good, bad? Pointless? Do you think it should be classed as a disorder in its own right? If so why? And what do you think of the rationale.

(I don't think its been brough up, apologies if it has)

[Brandon]

Originally Posted by Invert

http://www.dsm5.org/ProposedRevision....aspx?rid=443#

So, I was looking through the DSM-5 proposals more carefully, and I found this. I don't think a behaviour counts as a mental disorder, its an unhealthy coping mechanism, but isn't itself a disorder, though may be linked to one.... and the rationale provided seems inadequate. And I have a lot to say on this personally.

But to start off with, what do you think of this proposal diagnosis? Good, bad? Pointless? Do you think it should be classed as a disorder in its own right? If so why? And what do you think of the rationale.

It's almost 2 in the morning, so excuse me if I'm not making sense right now.

I looked up "disorder" in the dictionary, and it says that a disorder can be a disturbance in the mental health. Unless self-injury becomes socially acceptable, I think that it would be considered a disturbance because it's not a typical thing for someone to be like "oh, well...I feel sad, so I'm going to cut myself." Granted, it can be a behavior if someone were to self-injure themselves for attention, but if someone honestly feels that self-injury is the only way to deal with their problems, then I consider that a disturbing conclusion for someone's mental health and I guess consider it a disorder.

The difference between a behavior and a disorder is the amount of control you have over something; you can choose to behave well at a fine restaurant, but you can't choose to have PTSD once you have it. If someone feels that they have no control or at least no rationalization that there's better ways to deal with issues, then I'd consider that a disorder. However, if someone were to start self-injuring themselves through rationality and ends up developing an addiction/habit to self-injury, then I believe that it's a behavior.

Hopefully that's what you're asking because, again, I'm procrastinating on sleep.

[~Mr. Self Destruct~]

I think this is a worthwhile proposal.
I've known several people with self-harm issues, but have not done so to an extent as to suggest suicidal ideation or intent.

[Kate*]

If I end up getting into school I will be taught to diagnose people out of this version of the book and this isn't the only proposal that I have a problem with. I think it should be included in there, but I don't think it needs to be diagnosed as it's own problem, at the same time, there are other maladaptive coping mechanisms that are classified as disorders like substance abuse and eating disorders, unless they find physical differences in the brain as with addicts vs. non-addicts I don't think they should bother.

[OMFG!You'reActuallySmart!]

According to this proposal, if someone gives themselves 1 ear piercing over 5 days, they would fulfill the criteria for having this disorder. I think it over-complicates treatment because a symptom is now a separate disorder. For example, if someone was diagnosed with trichotillomania, they would also have the diagnosis of non-suicidal self-injury. I think this would cause immense confusion if someone was diagnosed with trichotillomania but not non-suicidal self-injury, which the DSM-V allows by creating it as a separate disorder. Also, the non-suicidal self-injury disorder emphasizes treating the individual but nowhere does it even attempt to identify the motivation for the self-harm. To me, this seems rather self-defeating because how can you treat a symptom common to a multitude of disorders without regard to the origin. Thus, treatment of this disorder is completely dependent on other related disorders, which to me makes it more suitable as a symptom.

Originally Posted by Kate*

If I end up getting into school I will be taught to diagnose people out of this version of the book and this isn't the only proposal that I have a problem with. I think it should be included in there, but I don't think it needs to be diagnosed as it's own problem, at the same time, there are other maladaptive coping mechanisms that are classified as disorders like substance abuse and eating disorders, unless they find physical differences in the brain as with addicts vs. non-addicts I don't think they should bother.

This study is 12 years old but still relevant enough, however, as you can imagine there is indeed a problem with directionality since you cannot ethically make someone into a drug addict for scientific research.

[dr2005]

Originally Posted by The Man And XX Master

According to this proposal, if someone gives themselves 1 ear piercing over 5 days, they would fulfill the criteria for having this disorder.

The proposal specifically excludes body piercings, under the auspices of "socially sanctioned" purposes. Paragraph A, third line.

Originally Posted by The Man And XX Master

I think it over-complicates treatment because a symptom is now a separate disorder. For example, if someone was diagnosed with trichotillomania, they would also have the diagnosis of non-suicidal self-injury. I think this would cause immense confusion if someone was diagnosed with trichotillomania but not non-suicidal self-injury, which the DSM-V allows by creating it as a separate disorder.

I see what you mean; there is potential crossover to some extent. However, I would say it is very unlikely it would cause the confusion as suggested, simply because the diagnosing physician could say, with justification, that such behaviour better fits the definition of trichotillomania rather than non-suicidal self-injury. The way it is worded to me suggests it covers behaviour not previously accounted for by other disorders - for instance, the last sentence excluding picking wounds and nail biting excludes disorders such as onychophagia and dermatillomania from the remit of non-suicidal self-injury. The same would presumably apply for trichotillomania, especially given the wording of paragraph D.

Originally Posted by The Man And XX Master

Also, the non-suicidal self-injury disorder emphasizes treating the individual but nowhere does it even attempt to identify the motivation for the self-harm. To me, this seems rather self-defeating because how can you treat a symptom common to a multitude of disorders without regard to the origin. Thus, treatment of this disorder is completely dependent on other related disorders, which to me makes it more suitable as a symptom.

Paragraph B seems to me to cover the motivation side, especially in sections 1 and 4.

Anyway, my view on it is if it does serve as a useful diagnosis in terms of helping patients and physicians remedy self-harm then fair enough. Sometimes it can be swept under the carpet in terms of treatment unless it readily points to a more established disorder, if only for scarcity of resources rather than a desire to ignore it. At the same time, if it distracts from more serious underlying issues then it may not be such a good idea. The only way to find out is to try it in the field really - if all else fails, it can be removed from DSM-6.

[Dez]

I agree that it can be included but not as an actual diagnosis.

[OMFG!You'reActuallySmart!]

Originally Posted by dr2005

The proposal specifically excludes body piercings, under the auspices of "socially sanctioned" purposes. Paragraph A, third line.

Paragraph A third line states "for purposes not socially sanctioned" with the example of body piercing so it includes rather than excludes it.

Originally Posted by dr2005

Paragraph B seems to me to cover the motivation side, especially in sections 1 and 4.

Not really since Paragraph B states at least 2 of the 4 sections need to be present, thus sections 1 and 4 cannot cover the motivational aspect in all individuals. For such individuals, sections 2 and 3 fail to account for any motivational side.

[dr2005]

Originally Posted by The Man And XX Master

Paragraph A third line states "for purposes not socially sanctioned" with the example of body piercing so it includes rather than excludes it.

I read that as treating such practices as "socially sanctioned", as that appears to be the most logical interpretation of it. Such practices are socially acceptable, after all. It's poor drafting in any event.

Originally Posted by The Man And XX Master

Not really since Paragraph B states at least 2 of the 4 sections need to be present, thus sections 1 and 4 cannot cover the motivational aspect in all individuals. For such individuals, sections 2 and 3 fail to account for any motivational side.

No, but if either 1 or 4 are present that covers the motivation. Besides, it seems rather commonplace to look into the motivation for such behaviour in the course of treating disorders anyway - the criteria for a major depressive episode, for example, do not specifically look at the motivation yet this would be covered in treatment via CBT etc. As such, I'm not entirely sure why this needs to be expressed in the diagnostic criteria as it seems to me that a motivation for doing it is a given. I recognise as a given my knowledge of this is not on the same level as yours, so if you can clarify that would be appreciated.

[OMFG!You'reActuallySmart!]

Originally Posted by dr2005

I read that as treating such practices as "socially sanctioned", as that appears to be the most logical interpretation of it. Such practices are socially acceptable, after all. It's poor drafting in any event.

The writing was rather obscure in that area so after re-reading your previous post and the poorly written draft, I'm not sure if my interpretation is correct.

Originally Posted by dr2005

No, but if either 1 or 4 are present that covers the motivation. Besides, it seems rather commonplace to look into the motivation for such behaviour in the course of treating disorders anyway - the criteria for a major depressive episode, for example, do not specifically look at the motivation yet this would be covered in treatment via CBT etc. As such, I'm not entirely sure why this needs to be expressed in the diagnostic criteria as it seems to me that a motivation for doing it is a given. I recognise as a given my knowledge of this is not on the same level as yours, so if you can clarify that would be appreciated.

The motivation can separate whether a behaviour qualifies as a disorder or whether it is sub-threshold. For example, if I were to slash my arms because I had an auditory hallucination that "told" me to do so, that motivation is not covered by any section in criterion B, hence, I would not have this particular disorder. On the other hand, if I were depressed and slashed my arms, then I would have this disorder. The overall behaviour is the same and by specifying motivation, one can differentiate between "disordered" or "non-disordered".

You're absolutely right, the motivation would arise in treatment. In most cases though, the psychiatrist uses a 5-axes diagnostic scheme (technically they only need to use 2 axes but it gives insufficient detail for treatment). The last axis is called the global assessment of functioning scale (GAF scale) rated from 0 to 100, where 0 represents such overall poor function the person is a danger to themselves and/or others. If I'm treating someone who slashed their arms because they were depressed, it will lower their GAF score but not as much as someone who acts on the hallucinations they experience as it indicates they are out of touch with reality.

Unlike previous DSM versions, the proposed DSM-V is meant to include scales for judging severity, although this particular disorder does not have one. For disorders that do have one, knowing the motivation is crucial. Additionally, other disorders may have specifiers, which are added details to the diagnosis to give a more accurate picture of the patient. This can be seen at the bottom of the page where it lists proposed sub-categories.

[udontno]

I think that something in there needs to be mentioned about it, but I'm not sure that it should be an actual disorder. It's definitely a problem... but self harm is usually related to some underlying problem. People don't cut themselves because they are happy... there tends to be something like depression going on as well.

[Total Light Storm]

I think it shouldn't be added, it seems as though adding this would cause a bunch of confusion
with physicians and other people due to the fact that quite a few are already not educated enough about the topic of SH and this could be a quick diagnosis for someone with other issues.
Also, the following quote confuses me a bit and I would like some clarification as to what it is saying:
[quote=[FONT=Arial]1. Negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act.[quote]
Would that statement disclude people with other disorders or mental health issues such as depression or anxiety disorders? I am wondering because it says negative feelings such as depression, how would they determine the amount of time the person felt depressed and whether or not they get depressed and then SH or if the person has depression that needs to be dealt with?
What would be the length of the immediate time period that is discussed here?
Overall, I just have this feeling in me that some doctors will take the ability to diagnose some one as having non-suicidal Self-Injury as a way to not have to take the time and work required to help the person deal with the issues involved whether they are uncomfortable with those issues or feel they would be overwhelmed, I just think that is a possibility somewhere.[/font]

[Kate*]

That's why I don't think it deserves it's own diagnosis, I think it's mostly done as a result of something else. Technically someone who was self harming as a coping mechanism to deal with some kind of distress would be diagnosed with this as well as any other disorder (depression anxiety etc.) for which they fit the criteria.