DMDD

I want to shed a little light on a brand new diagnosis for children that just came out in the newest edition of the Diagnostic and Statistical Manual (DSM-V) that mental health professionals use to help diagnose mental disorders.

Before I do that, though, I want to explain something about the DSM, and about mental disorders in general.  This time, before this edition of the DSM came out, different committees met to discuss different aspects of the manual.  Their jobs were to decide if the way things were diagnosed was accurate and basically what should be left in or taken out or changed.   The DSM is a very useful tool that mental health professionals use all the time; it's the way they know the difference between schizophrenia and schizotypal disorder; it's how they can determine if a person is suffering from antisocial personality disorder or if they have narcissistic tendencies.  That being said, the DSM is not the word of God, and should never be taken as gospel truth.  In other words, if you have an active, brilliant mind:  question everything.  Don't just blindly accept.

The diagnosis of Disruptive Mood Dysregulation Disorder was added to the most recent edition of the DSM.  This diagnosis was intended to describe children between the ages of 6 and 18 who experience rages, tantrums, and outbursts of severe types, and who also are frequently irritable over a period of months, but who do not meet the criteria for bipolar disorder or psychosis.  Logan was diagnosed with this after one of his stays at the hospital.

Mood disorders, in general, are sometimes hard to diagnose because their symptoms overlap. The DMDD diagnosis received some criticism from professionals for being too vague; because it is a relatively new diagnosis, researchers haven't had a lot of time to study it or draw conclusions about it.  Some psychological studies can take years to complete, especially when children are involved, because researchers want to know the background of the child, they want to take a family history, and they want to follow up with the child when they're older, to see if they still exhibit any of these symptoms or had problems with adjustment. Part of the reason this diagnosis was included in the fifth edition was so it would replace the diagnosis of "childhood bipolar disorder".

Why am I writing about this tonight?  Some people have asked me how Logan is doing; some want to know what exactly is going on with him.  Logan has a diagnosis of autism and intellectual and developmental disability, and general anxiety.  So imagine, for a moment, someone who wants to communicate, but can't, someone who is especially sensitive to external stimuli, like lights, noise, and touch, someone who really wants to socialize but cannot do it (asking him to do this is like asking a lion to graze with a bunch of sheep; the lion may be hungry, and if we humanize him a little bit, the lion might want to blend in, but there is no way that he can, and his nature won't let him), and imagine someone who becomes extremely anxious any time his schedule is changed or something unknown is thrown at him during the day.  That's a lot for one person to deal with.  Now throw in a mood disorder.

What this means is that all of Logan's frustrations, anxieties, loneliness, happiness, anger, rage...cannot be dealt with by him in the same way the rest of us deal with those emotions.  His disorder is a dysregulation.  He cannot regulate it.  His brain will not allow him to do so.  It's not a matter of choice, and it's not a mis-behavior on his part.  He is trapped in a wicked soup that his own brain concocts for him.  Sometimes, it's too much, and he can't control himself.  This is why we are choosing to place him in a group home.  Living here, with us, while he's battling all of this, plus dealing with being 12, is too much for us to physically, emotionally, and mentally handle.  It's too much for him to handle.  The chaos of family life, surrounded by siblings who surpass him even at the age of four, create so much frustration for him that he cannot contain it.  

Now take him out of this environment.  Put him in an environment with other children like him. With caregivers who are professionally trained to deal with these disorders.  With a schedule that does not change by the hour based on the needs of different family members.  Suddenly, he's relieved.  It may not be the ideal situation, for any of us. We are all struggling with it.  But it's what he needs.  One day, things may change, and he may be able to come home again.  But right now, during this time, this is where he needs to be.  And I think he is so brave.  He knows that he is different.  But he wakes up and he fights, every single day.  I have seen him do it.

I also write about this because I think that everyone needs to have a greater awareness of each other.  In your lifetime, you will deal with a mental disorder.  It may not be yours, but it will be a family member's, or  friend's, or a co-worker's.  You will be exposed to it.  You may meet someone and wonder why they are so eccentric, or why their mood seems to shift abruptly, or fail to understand why they take so many pills at lunchtime.  You may meet someone and wonder why they're so fat (some SSRI's (selective serotonin reuptake inhibitors) cause weight gain and enhance appetite), or you may have a friend who continues to cancel at the last minute on social engagements.  It looks rude from the outside, right?  But you cannot know that they desperately want to be there, but they are sitting on the couch at home, wrapped in a blanket, because they are too anxious to set foot outside the door.  

I'm thankful for Logan.  If I had to do this all over again with him, I would.  Without question.  I don't like the person I was before I had him. He taught me about a different world, and I never want to go back to not knowing.  Greater compassion, greater kindness, greater love.  He is my greatest teacher.