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Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7662
Experience:  35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
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Is the criteria in the DSM considered standard of care when

Resolved Question:

Is the criteria in the DSM considered standard of care when diagnosing a mental illness?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Elliott, LPCC, NCC replied 1 year ago.

Elliott Sewell, LPCC, NCC :

Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Elliott Sewell, LPCC, NCC :

Dear friend,

Elliott Sewell, LPCC, NCC :

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the the American Psychiatric Association. It establishes a common language and standardised criteria with which to classify mental disorders.

Customer: If someone doesn't meet the criteria in the DSM can they still be diagnosed with a mental illness?
Elliott Sewell, LPCC, NCC :

It is used by by therapists, researchers,psychotropic drug regulation agencies, health insurance companies, drug companies, and policy makers

Elliott Sewell, LPCC, NCC :

No. If they fall short, then they are not diagnosable.

Elliott Sewell, LPCC, NCC :

It can be said that they meet certain of the criteria, but they still cannot be diagnosed with the disorder.

Elliott Sewell, LPCC, NCC :

It is like a card game. You must hold all the cards to win.

Customer: For example I was diagnosed with bipolar disorder after experiencing a manic episode on an antidepressant. This mania started after an increase in dosage. I had never had mania before. As I understand a mania that occurs during antidepressant usage is not considered a diagnosis for bipolar. Is this true ?
Elliott Sewell, LPCC, NCC :

If a person has bipolar disorder but they are not given mood stabilisers or antipsychotic drugs or antiseizure medication because the doctor thought he or she were treating only depression. then the onset of mania symptoms might occur. This is common, and is an indication that the person treated already had bipolar disorder. If a person has bipolar depression, it looks the same as unipolar depression.

Elliott Sewell, LPCC, NCC :

So chances are that you already had bipolar disorder but the manic side was not clearly apparent to the physician. The symptoms may have been absent.

Elliott Sewell, LPCC, NCC :

This is not really a drug induced mania.

Customer: So a mania that occurs during antidepressant is considered bipolar or can it be a side effect of the antidepressant?
Elliott Sewell, LPCC, NCC :

Are you having mania now or recently, after that event?

Elliott Sewell, LPCC, NCC :

It could be a side effect of the antidepressant.

Customer: I never had a mania before and never had a mania again. Only the one time when my dosage was increased
Elliott Sewell, LPCC, NCC :

I think that longer observation should be made before jumping to that conclusion. In any event, I'm sure I wouldn't take that medication again.

Elliott Sewell, LPCC, NCC :

What was it?

Customer: Celexa
Customer: I was diagnosed 12 years ago with bipolar and I've never had another mania in that 12 years. Only that one time. But I was treated and took bipolar medication for 12 years and now I'm told I don't have bipolar.
Customer: So for 12 years I thought I had a mental illness for the rest if my life and now I'm told I have nothing
Elliott Sewell, LPCC, NCC :

I believe that if you have ever been diagnosed with bipolar before, then the next episode of depression should be categorized as Bipolar I Disorder , Most Recent Episode Depressed.

Elliott Sewell, LPCC, NCC :

According to the rules of the current DSM (DSM-IV-TR)

Elliott Sewell, LPCC, NCC :

It was evidently in remission all of that time.

Elliott Sewell, LPCC, NCC :

During my internship, by chief supervisor was a young psychiatrist diagnosed with Bipolar Disorder. He was under the care of HIS psychiatrist. He took medications daily.

Elliott Sewell, LPCC, NCC :

He was and still it a beloved psychiatrist, had been chief psychiatric resident of a major teaching hospital, and functioned wonderfully.

Elliott Sewell, LPCC, NCC :

My point is that it can be controlled, as yours was, probably just by your own ability to cope and inner strength that you possess.

Elliott Sewell, LPCC, NCC :

My psychiatric supervisor told all of his new bipolar patients, "Welcome to the club".

Elliott Sewell, LPCC, NCC :

My point is not to brand yourself as a mentally ill person, which is what DSM does. In reality, you occasionally or even rarely get some symptoms.

Elliott Sewell, LPCC, NCC :

Manage them, if need be, but don't let labels make you think that you are dysfunctional or crazy. You obviously are not.

Elliott Sewell, LPCC, NCC :

If you have depression and need medication, the safest one would probably be Paxil because of its short half-life.

Elliott Sewell, LPCC, NCC :

But it probably should be taken with a mood stabiliser as well.

Elliott Sewell, LPCC, NCC :

If you were diagnosed with bipolar 12 years ago, then the person who diagnosed you had to have thought you had mania as well, right or wrong, or would not have been able to diagnose you as bipolar.

Elliott Sewell, LPCC, NCC :

I think this may not the answer that you had hoped to hear. I am just giving you the facts, as a knowledgeable professional. Please do not shoot the messenger. I have been with you faithfully for well over half an hour, and would be most grateful if you were to give me positive feedback for my work so that JustAnswer will recognize me for my input.

Elliott Sewell, LPCC, NCC :

I do enjoy helping others to the best of my ability, and I also do this for a living. Thank you so much for your consideration.

Elliott Sewell, LPCC, NCC :

I wish you great success and if you wish to get back with me, please feel free to do so.

Elliott Sewell, LPCC, NCC :

Warm regards,

Elliott Sewell, LPCC, NCC :

Elliott Sewell, LPCC, NCC, CCMHC

Expert:  Elliott, LPCC, NCC replied 1 year ago.
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Customer: replied 1 year ago.
Just one last question. The DSM states that to be classified as mania that the mania not be substance induced. That the mania is spontaneous and not caused by drugs or antidepressants. Is this correct? Then if my mania only occurred one time while on an antidepressant then how was it a true mania?
Expert:  Elliott, LPCC, NCC replied 1 year ago.
Dear Lee,

A substance induced mood disorder can be diagnosed when it followed the ingestion of an antidepressant AND if the reaction was severe enough to "cause clinically severe distress or impairment in social, occupational, or other important areas of functioning."

Since you have had no diagnosis of bipolar disorder for 12 years, and the original diagnosis is questionable as to its validity, I would call this Substance-Induced Mood Disorder Due to Antidepressant with Manic Features.

(DSM # XXXXX)

I hope this helps.

Warm regards,

Elliott

Elliott Sewell, LPCC, NCC, CCMHC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7662
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
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