Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

DSM-5

dam-5The DSM-5, the new diagnostic manual, does little to ease the learning curve regarding mental disorders. The chief objections to the DSM-V are that many human frailties, bad judgment and maladaptive habit patterns are now listed as disorders for which treatment is indicated.

The most frequently cited example is the inclusion of “caffeine withdrawal disorder” as a mental disorder, indicating that this “disorder” causes problems with both social and occupational functioning. Also, clearly by labeling it as a mental disorder, it indicates that treatment is indicated and insurance should cover such treatment.

In a contrasting example the DSM-5, the developmental disorder Asperger’s Disorder, has been incorporated into the large group called Autism Spectrum Disorder. Those with Asperger’s would be redefined/re-diagnosed or have their disorder not covered by health insurance benefits. Another concern has been that this new classification system is an attempt to define psychological problems in terms of brain function or the impact of physical disease (or injury) upon brain function.

In the DSM-5, by defining psychological problems as a disorder of brain functioning, it follows that medication would more frequently be prescribed. This would be a decision favorable to the pharmaceutical industry and to those whose income is derived in large extent from prescribing these medications. In the area of workers’ compensation, several of the new diagnoses, along with elimination of previous diagnoses, may present a problem since the existence of a physical trigger is now ever-present.

Pain Disorder (once Somatoform Pain Disorder) is now referred to as Somatic Symptom Disorder With Predominant Pain.” What has been removed is the concept that the emphasis is upon psychological causation of pain, its severity and its chronicity. Hypochondriasis (Cf. hypochondriac) has been eliminated because it is seen as a potentially derogatory term. This is now diagnosed as “Illness Anxiety Disorder” since people with anxiety regarding their health also have concurrent physical complaints. Hypochondriasis referred to a person’s continuing belief that he/she has a physical disorder despite reassurance to the contrary.

The concern of some would be that the emphasis is upon the unfounded disease and/or defect, validating rather than dealing with the patient’s obsessive preoccupation with symptoms. Conversion Disorder (once called Conversion Hysteria) referred to inexplicable weakness, paralysis, unusual movement, swallowing difficulty, speech difficulty, sensory loss etc. without physical causation. It is now called “Functional Neurological Symptom Disorder” focusing upon the neurological.

Again, the difficulty is that attention is not concurrently upon the psychological factors, events and conflicts which may be the cause of these pseudo-neurological symptoms. While new and clarified diagnostic descriptions were the goal of this long-in-development manual, from the perspective of workers’ compensation, it may have, in fact, made the determination of cause and effect more difficult.

American Psychological Association

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