Revisions of the DSM-V Related to Bipolar Disorder in Children
The Pediatric Bipolar conference in March ended with a discussion led by Ellen Leibenluft and Danny Pine of the NIMH about possible changes in the diagnostic criteria for childhood onset bipolar disorder being considered for the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which will be finalized in the next few years. There has been an increase in the diagnosis of bipolar disorder in children in the past decade, and many have attributed this to over-diagnosis. Controversy about the precise symptoms and thresholds for diagnosis has been prominent in the literature and in the popular press.
The major change proposed was that the syndrome of severe mood dysregulation (SMD) described by Leibenluft et al. in 2003, may be called Temper Dysregulation Disorder (TDD), and would not be considered part of the bipolar spectrum. This is in part because SMD is not associated with an increased incidence of a positive family history of bipolar illness. Part of the motivation for separating TDD from bipolar illness is to cut down on what some consider the over-diagnosis of bipolar disorder in children.
Many in the audience voiced concerns about the suggested name of the disorder (TDD), which may have pejorative and stigmatizing connotations to it. Others felt that a new diagnosis was not necessary as the syndrome is adequately described by ADHD with a severe comorbid oppositional defiant disorder (ODD) and that there are no specific treatments yet delineated for TDD. This editor has concerns that a new diagnosis will increase rather than decrease diagnostic controversy about childhood onset bipolar disorder, and that the differentiation of BP NOS (not otherwise specified) and TDD from each other may be particularly problematic.
Leibenluft and Pine indicated that they are continuing to solicit input on the proposed DSM-V revisions, so there is still time for a consensus to be reached that helps stimulate better recognition and treatment of these ill children and fosters more treatment-related research in this understudied area.
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