Will ‘Disruptive Mood Disregulation Disorder’ proposed for inclusion in DMS5 be the next child mental health epidemic?

By Dr Martin Whitely

The central characteristics of ‘Disruptive Mood Disregulation Disorder’ proposed for inclusion in DSM5 are childhood “irritability” and “temper outbursts” occurring, ”on average, three or more times per week”.[1] Disruptive Mood Disregulation Disorder represents a disturbing evolution of the absurd and dangerous practice of diagnosing children, even very young children, with ‘Juvenile Bipolar Disorder’.  Although not an official psychiatric disorder Juvenile Bipolar Disorder was enthusiastically and successfully promoted by disgraced Harvard University Professor of Psychiatry, Joseph Biederman.

Biederman, who was also Director of the Johnson & Johnson Centre for Paediatric Psych-Pathology research at Massachusetts Hospital and according to the New York Times is the “the world’s most prominent advocate of diagnosing bipolar disorder in even the youngest children and of using antipsychotic medicines to treat the disease”.[2] He is largely responsible for the enormous growth in US antipsychotic prescribing rates to children including Johnson & Johnson’s very profitable antipsychotic Risperidone (brand name Risperidal).  In April Johnson & Johnson were fined US$1.2Billion by an Arkansas court for making misleading claims about the safety of Risperidal. This followed similar outcomes in other US states.[3]

In 2011, US congressional investigations led by Iowan Senator Charles E. Grassley exposed that Biederman received at least US$1.6m in undisclosed fees from drug-makers from 2000 to 2007 and only revealed a tiny fraction of this income to Harvard University.[4] The New York Times reports “court documents dating over several years that Dr. Biederman wants sealed showed that he told the drug-giant Johnson & Johnson that planned studies of its medicines in children would yield results benefiting the company”.[5]

Taking and not disclosing drug company money and planning beneficial research results is reprehensible behaviour. Harvard University’s decision to effectively give Biederman little more than a rap on the knuckles brings discredit to one of the world’s most prestigious universities.[6] Perhaps Harvard was motivated more by the funding that Biederman and his cronies attract to the university than by the damage they bring to the university’s reputation. Harvard’s failure to take strong ethical action against Biederman has meant that his influence, although waning, is still considerable.

Thankfully Juvenile Bipolar Disorder is not officially recognised as a diagnosable condition in the current DSM (DSMIV). Supporters lobbied to have it included in the DSMIV, however the DSMIV development committee “found scientific support unconvincing and refused to do so”.[7] Regardless, hundreds of thousands, possibly millions, of children have been diagnosed with the unofficial disorder and treated with anti-psychotics like Johnson & Johnson’s Risperidal.[8] These medications “can cause serious complications – major weight gain, obesity, diabetes, cardio vascular disease and possibly shortened life expectancy.  Sudden death has occurred in a few cases where excessive doses and/or multiple drugs were given to very young children.”[9]

The proposal to include Disruptive Mood Disregulation Disorder is in part a reaction to criticisms of the use of anti-psychotics for Juvenile Bipolar Disorder.  The authors of DSM5 are proposing Disruptive Mood Disregulation Disorder as an alternative to the diagnosis of Juvenile Bipolar Disorder, using the rationale that this will help curb anti-psychotic prescribing rates to children.  In effect, they are proposing a “juvenile bipolar light” disorder.

Given the unrestrained enthusiasm for prescribing psychotropics ‘off label’ to children exhibited by many clinicians, particularly paediatricians, the opposite is likely to occur.[10] The inevitable outcome is that more children will be diagnosed and experience tells us the more children diagnosed with a ‘psychiatric disorder’, the more children are subjected to the cheap and convenient practice of speculative ‘off label’ prescribing.

The only sensible course of action for the American Psychiatric Association is to reject out-of-hand the notion of Juvenile Bipolar Disorder or any lighter version thereof including Disruptive Mood Disregulation Disorder.  Failure to do so will drag the American Psychiatric Association into another epidemic of childhood drugging for which, unlike ADHD, they currently bear no responsibility.

 

[1] For a full description of the proposed diagnostic criteria see http://www.dsm5.org/proposedrevision/pages/proposedrevision.aspx?rid=397

[2] New York Times Topic Page for Professor Joseph Biederman available at http://topics.nytimes.com/topics/reference/timestopics/people/b/joseph_biederman/index.html]

[3] Companies belittled risks of Risperdal, slapped with huge fine, Los Angeles Times 11 April 2012. Michael Muskal available at http://articles.latimes.com/2012/apr/11/nation/la-na-nn-risperdal-arkansas-20120411

[4] New York Times Topic Page for Professor Joseph Biederman available at http://topics.nytimes.com/topics/reference/timestopics/people/b/joseph_biederman/index.html

[5] New York Times Topic Page for Professor Joseph Biederman available at http://topics.nytimes.com/topics/reference/timestopics/people/b/joseph_biederman/index.html

[6] For more detail see http://speedupsitstill.com/world-leading-adhd-%e2%80%98expert%e2%80%99-harvard-professor-joseph-biederman-sanctioned-hidden-drug-company-money-allegations

[7] Dr Allen Frances, Huffington Post, The false epidemic of Childhood Bipolar Disorder available at http://www.huffingtonpost.com/allen-frances/children-bipolar-disorder_b_1213028.html

[8] There are no reliable estimates of child prescribing patient numbers. In the U.S. outpatient office visits for children and adolescents with bipolar disorder increased 40-fold from 20,000 in 1994–95 to 800,000 in 2002–03. http://www.thedailybeast.com/newsweek/2011/06/19/mommy-am-i-really-bipolar.html

[9] Dr Allen Frances, Huffington Post, The false epidemic of Childhood Bipolar Disorder available at http://www.huffingtonpost.com/allen-frances/children-bipolar-disorder_b_1213028.html

[10] A recent study of psychiatrists in Christchurch New Zealand revealed that 96% of them prescribed antipsychotics off label. While it is unlikely that rate is replicated across the globe it is nonetheless an alarming statistic and indicates the practice is very common. M. Slezack, Psychiatry Update, 26 April 2012, 96% of psychiatrists prescribe off-label anti-psychotics  http://www.psychiatryupdate.com.au/latest-news/off-label-anti-psychotics-almost-universally-presc

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  1. Schalk’s avatar

    It seems like you also don’t get it. There is no scientific foundation for these psychiatric “diseases” and they therefore cannot be discussed within the realm of science. Akin to a child baking mud cakes cannot be discussed within the realm of gastronomy.
    So? In which realm should these issues be discussed? Surely there are people who exhibit the unwanted behavioral traits as described in the DSM? The answer?: If you cannot find a home for your theories, don’t hijack and infect SCIENCE with your perverted ideas! Find your OWN platform and display it there! (Or is psychiatry so bankrupt and without substance that it has no hope in hell to survive on it’s own merit? Does it have to attach itself to a host (science), like a parasite, for sustenance?)
    Although I appreciate your criticism of psychiatry, you do tend to debate the bogus issues! How can you prove or disprove something that does not exist! Surely the starting point should be to ask the claimant to prove his claim, something psychiatry has been unable to do.
    By continually entering into debate with bio-psychiatry about different “treatments” for bogus disease (as IF there is some scientific link), you legitimize the discussion around this invented bogus disease as if it belongs in science. You are willfully blurring the borders between objective science and pure conjecture.
    Bio-psychiatry should be exposed for what it is: Medieval sorcery and human experimentation in it’s most evil form.
    Don’t you think it is time to put things in it’s right perspective?
    What I perceive is a psychiatrist (you) that BELIEVE and concur with the diagnosis, you just differ with the “treatment”. By doing so you keep the door wide open to profit from the bogus diagnosis.
    Maybe you wish to make a categorical statement and clarify your stance?

    Reply

    1. martin’s avatar

      A few quick responses Shalk.
      First, I am not a psychiatrist, I am a politician, mental health advocate and author.
      Second, I am totally opposed to the recognition of Disruptive Mood Disorder in the DSM5 and anywhere else for that matter. I think it has the potential to be an even bigger disaster than ADHD.
      Third, sorry to dissapoint you but I am not anti-psychiatry or anti-medication. I am however opposed to bad psychiatry an the innapropriate and dangerous use of psychotropic medications. Unfortunately, both bad psychiatry and the innapropriate and dangerous use of psychotropic medications are very, very common.

      Reply

    2. Dr Joe’s avatar

      What utter rubbish! This “condition” can join Oppositional Defiance Disorder at the top of the BS chart. We all have different moods and children more so because they are still learning to manage their emotions.
      Labelling and drugging them may boost profits but damages children. No doubt this will be looked for as part of the 3y.o. screening checks.
      Keep up the good work Martin!

      Reply

    3. bjcirceleb’s avatar

      I totally agree it is useless diagnosis, and one that will do a lot more harm than good. I would however like to add, that most of this prescribing is not “off label” anymore. Resperidone the most commonly prescribed antipsychotic is now approved by the Theraputic Goods Administration for the treatment of Autism, Intellectual disability and a number of other conditions. It is of course also approved for the treatment of Bipolar. One can only guess that drug companies are already in the process of doing or at least planning research to make sure that these drugs are approved for the treatment of these conditions. Within the US Resperidone and a number of other antipsychotics are now approved for the treatment of Depression and Anxiety. If this is not the best evidence of the lies that are told about these med’s I don’t know what is. How can a drug that supposedly stops voices in the head, also make people happy, less anxious, less autistic, cure an intellectual disability, etc???

      As for the 3 y.o screening check don’t even get me started about that one. They claim it is not compulsory, but parents will loose over $700 in family tax benefits if the child is not screened. Mind you they have no such penalty for not having a child immunised. They pay bonuses for immunisations, don’t take away basic payments. And for immunisations parents can simply attend a one off counselling sessions with a GP to be told about the risks of not immunising and they then get paid, regardless of whether the child is even immunised. While I respect there are debates about immunisation I am not aware of anyone who would think that we had more evidence in regards to predicting bogus brain diseases, than we do of the benefits of immunisation. And of course the government has not provided any funding to fund any other treatments for children, so doctors are supposed to diagnose and treat these children and they have nothing in which to do it with except drugs. Of course none of this even looks at WHY a child is acting this way. Why not do a parenting check to make sure parents are actually looking after the kids, and then refer the parents to parenting services instead of labelling children and drugging them up for life.

      Reply

    4. Rog’s avatar

      When will these crooks be brought to justice? Is a person promoting unsafe drugs to children, which might result in brain damage or developmental disturbances hurting less people than Mr. Sandusky? The criminal court should prosecute this creep for neurochemical assault on children or something. That Harvard does nothing about this lowlife just shows how corrupt the universities are. It is not about finding the truth or benefit humanity, it is about cold cash. I hope the creep, Johnson & Johnson executive board, and the administration at Harvard have a room waiting for them in hell.

      Reply

    5. Anthony’s avatar

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