Dangerously Behind the Curve: Why the DSM-5 Needs to Be Dumped

The “bible” for mental health clinicians in assigning diagnoses is the Diagnostic and Statistical Manual of Mental Disorders (DSM).  The DSM, currently in its fifth iteration, places mental illness diagnoses into separate categories largely separate from one another. 

It’s difficult to quickly describe just how impactful and serious these diagnoses can be.  The stigma associated with receiving an MI diagnosis can cause a person to lose their job, upend their social life, cost them custody of their children, and many other consequences.  Medications often prescribed for mental illnesses have significant side effects such as heart problems and weight gain/loss just to name a couple.

This is why I was so dismayed as I began to learn that there are serious flaws both in the DSM itself and also how it is used.  I’m writing this today specifically as a warning to anyone receiving an MI diagnosis that they shouldn’t simply accept it at face value, and here’s why…

Many of us, including myself, have received multiple mental illness diagnoses which have similar or overlapping symptoms.  It’s not uncommon to receive many different diagnoses when presenting the exact same symptoms simply based on the subjectivity of the clinician.

I’ve been hospitalized for a couple of mental health emergencies and have received serious diagnoses, such as bi-polar disorder, after being examined by various psychiatrists for no more than ten minutes each time… only to have those diagnoses wiped out later on after more extensive analysis by another doctor. 

The confusion this caused me critically compounded and exacerbated the psychological challenges I faced, thereby significantly hindering my recovery.  I’m unfortunately not even close to being alone in suffering from the problems of validity and reliability in diagnosing mental health problems… and I have to tell you that this really pisses me off.

Experiences such as mine are why many practicing clinicians have questioned the DSM’s methodology for decades.  More recently, there has been an explosion of knowledge regarding brain functions due to advances in genetics research capabilities and scanning technology, such as Functional Magnetic Resonance Imaging.  This fresh data simply do not support the DSM’s categorization of mental health diagnoses into stand-alone silo-like categories.

This has spawned a clinical movement of sorts toward viewing mental health disorders in a dimensional sense along a spectrum according to shared characteristics of risk factors, prevailing symptoms, and consequences.  These clinicians are thinking outside the categorical boxes set up within the DSM in favor of grouping similar disorders along a continuum according to various impacts on the brain. 

Think along the lines of the now fairly well-known Autism spectrum.  If a person is higher-functioning on the spectrum then they’re considered to have Asperger’s syndrome instead of having full-blown Autism.  The fact is, however, that this is a common misconception as these are not truly dichotomous diagnoses in which there are clear lines of demarcation.  They are simply different ways to describe the severity of the essentially the same condition much like there are varying degrees of ankle sprains.

This makes sense to me.  My conditions fit the newer paradigm much better than the DSM-5 methodology.  There’s so much overlap regarding the symptoms of Complex PTSD, Social Anxiety Disorder, Panic Disorder with Agoraphobia, ADHD, Bi-Polar Disorder, and Dysthymia, … all of which I have been diagnosed with at one point or another.   I think (hope?) being “over-diagnosed” in this way will eventually be avoidable with this new theory of dimensionality. 

In spite of the new and relatively unbiased scientific research data, this is amazingly still quite controversial and not close to widely accepted in the mental health community.  I admit that I naturally tend towards innovative thinking and prefer to ride the leading edge of new science when it has been developed using sound research and discovery practices, so maybe these tendencies - not to mention my own absurd and discouraging diagnostic experiences - bias me towards the novel dimensional approach.  

I strongly suggest you read this article in Nature, not to mention the many links I’ve provided above, to get a more in depth explanation of dimensionality versus categorical methodologies.  Then you can make your own educated decision.

You are primarily responsible for your health, mental and otherwise.  Scrutinize any diagnosis you receive, be directly involved in decisions of which treatments you receive, and don’t be afraid to question what you’re told by your therapist or psychiatrist.  If they recoil at your probing or outright dismiss your inquiries, find someone else to treat you.  Therapy and recovery shouldn’t be a one-way street.  Be your own strongest advocate and keep in mind that good clinicians will actually support and encourage your involvement.

A Quest to Help Others Recover From Child Abuse

It's trite, I know, but this really is the first day of the rest of my life.  It’s another chance to shirk the negative consequences of yesterday, learn from those mistakes, and start from this very moment to generate my own positives.  Sharing my story will absolutely benefit me as a cathartic release, and I may just be able to reach and help one or two others at the same time.

Today I've decided to just jump head first into this blog and post a little bit of the writing I've been doing as part of my recovery.  A harrowing childhood of abuse left me with a variety of physical and emotional scars, the results of which have been the downward spiral of my life to its current nadir.

Right now I have no steady income, no permanent home, have virtually no money, and I lost the few close friends I had because of divorce and the subsequent self-imposed social isolation of the past couple of years.  I’ve also recently lost my girlfriend who essentially broke things off with me just recently because she couldn’t bear all of the stressors with which I have to deal.  There wasn’t any problem between us at all.  In fact, we were a great match for each other, but the timing couldn’t have been worse.  She had to bail to save her emotional self from bearing the weight of my problems… that’s how sweet she was.

This is just some of what Complex PTSD does to a person, but these challenges can all be temporary if I lock down and continue the difficult recovery work I started over two years ago.  I know, I know… two years of therapy and I’m just now at my nadir?!  The first 3-4 months were spent dancing around the issues, the next 7-8 months were spent pulling out all of the dark demons down inside of me, and since then I’ve gone from one false recovery to another.  Let me back up for a moment, however.

Physical and psychological abuse was the ever-present guillotine hovering over my youth until I was struck for the final time as a 20-year old sophomore home from college for a holiday break.  This long chapter of my life story is the single most problematic and complicated truth I have confronted, privately or not, to this day.  I was not sexually abused, however.

I bring that up immediately because the media and society in general give relatively no attention to the men who have endured repetitive significant trauma but were neither molested as boys nor maimed physically and/or psychologically as adult combatants in armed conflict.  There’s a litany of resources for men who were young sexual-abuse victims or those who developed war-related debilitating psychological challenges.  However, I’ve been quite frustrated over the comparatively few opportunities for help specifically dedicated to the untold number of men who were “only regularly abused” as kids. 

I'm in a great position to provide at least a few more resources out there for men like me.  I'm slowly and carefully constructing a multi-faceted social media presence to that very end.  I began writing months ago, have already started by dipping my toe ever so gently into Twitter (@men_helping_men), and now this blog.  I'm not too concerned with display, layout, professionalism, etc. at this point.  I'll get to all of that eventually.

It's the information that's critical to the success of my endeavor.  I'm NOT very well acquainted with manipulating social media tools.  I write this for men like myself who’ve been too “tough” to ever ask for help with the problems they don’t like to admit even having because of a past that they don’t want to discuss.

For the record, I've been diagnosed with C-PTSD, Panic Disorder with Agoraphobia, General Anxiety Disorder, and ADHD.  I'll go into greater detail in future blogs.

I hope that my writing primarily for men with C-PTSD doesn't turn anyone else off, however.  Anyone wanting a fairly expansive first-person perspective, along with helpful details and resources, should find this blog and Twitter feed very helpful (unless I fail miserably, which I don't intend to do).

Don’t come here for sappy feel-good nonsense, either.  I'm putting nothing but reality (or at least my particular version of it) into this.  Be prepared for different reads depending on the post and my mood of the day.  One day I'll be writing as though it's a scholarly article for peer-reviewed publication, and other times I'll be very laid-back in my writing style. 

It’s important for the regular guy to "get" what I'm saying, and sounding like an academic is not the way to go.  Sometimes I'll just talk about what's happening with me that day because it's been very helpful to me to hear the stories other men have.  I've learned so much from the experiences of others, and I hope to pass along this knowledge to others.  If I'm fortunate, then I will accomplish 2 things with this:

1) Other men with experiences remotely similar to my own will come across this and realize they’re not alone.  They will understand they should not be ashamed of how their adult lives have suddenly or repeatedly been twisted up, even though the actual abuse may have ended years and even decades earlier.

2) The all-important loved ones of these men will read this and begin a path toward understanding why the guys they love so dearly repeatedly act as they do or suddenly seem to have become someone else entirely.  True recovery has a much greater chance of success if they develop a sense of what he's previously endured, how those experiences currently manifest, why they are unable or unwilling to adequately express it to you, and (most importantly) that this need not be a permanent state.  Maybe this blog will initiate the early stages of repair and end with eventual enrichment of your relationships.

I AM NOT A CLINICIAN AND DO NOT PROVIDE ANY CLINICAL ADVICE TO ANYONE.  I do have a Master's-level education in Public Health (and an MBA, for whatever that’s worth here), so I've been trained on researching and understanding medical issues.  This allows me to digest a wide variety of information about childhood abuse and CPTSD, in both academic and first-hand fashions, and then reframe in ways accessible to virtually anyone.  I want to encourage people to seek the help of a psychologist, therapist, or maybe even a psychiatrist to overcome the traumas of their past.

The thing is that I'm just now lifting myself off rock bottom... so the upshot is that anyone regularly following this blog can see the ups and downs of real recovery.  You've missed much of my opening phases of recovery, but I'll reference them from time to time.

While I’m a very cognitively-oriented guy, this isn’t about thinking my own way out of having these problems.  This is about emotions which hijack my ability to function properly or at all.  I might be the smartest guy in the room most of the time, but I still won't recover unless I'm willing to confront, accept, and process those emotions effectively.

It sucks, I won't lie.  At the outset of recovery, you'll unearth some ghastly shit that will frighten you, and then you'll realize it has been there all along seeping poison into the various parts of your life.  Just realize that this is not a permanent state of being.  Once you avail yourself of the support from your loved ones, follow the guidance of a professional clinician, maybe join a group, and you'll be on a solid path to recovery and living the life you deserve.

Finally, recovery will happen only if you truly commit to the difficult work while availing yourself of every source of assistance you can find.  Since you’re still reading, I’ll make the assumptive leap your life has imploded and is completely littered with the fragmented pieces of your former world and future dreams, and you’re desperate to reassemble them immediately.

Let me disabuse you of the notion that there are any shortcuts to true recovery… believe me because I’ve tried just about all of them.  The path you’re peering down is plagued with potholes and straight up roadblocks.  Yet so many others have successfully traversed these obstacles, as I continue to do myself, so there's no reason you can't as well.

What you find on my blog is NOT a blueprint for recovery.  Everyone’s recovery path is just as unique as the person.  What you see in my recovery as it's recorded here is not something you should necessarily follow.  Maybe it's something for you to bring into your sessions with your therapist, maybe it's discussed with your partner or best friend, or perhaps it’s just some place you can go to see there’s somebody out there even more screwed up than you are!