Troublesome friendship or a relational disorder? By Karen S. Peterson, USA TODAY Sept. 8, 2002 http://www.usatoday.com/news/health/2002-09-08-relationship_x.htm There is just a chance that if in the future you and your spatting spouse go to a marital therapist, your relationship may be diagnosed as a "relational disorder," a proposed new form of mental illness. [Fred A. Baughman Jr., MD:
Or if you get along well with one of your kids but cross swords constantly with another, a psychotherapist just might slap the entire family with the same label indicating a psychiatric disorder. The American Psychiatric Association is considering adding "relational disorders" to the list of mental illnesses they publish in their Diagnostic and Statistical Manual (DSM). It spells out the symptoms and behaviors that constitute various types of mental and emotional disturbances. The book is used by most mental health professionals to diagnose patients. If the change takes place, this would be the first time the DSM defines a mental disorder involving two or more people in a relationship, rather than a problem involving just one individual. The concept relies on the belief that relationship problems cause genuine illnesses of both of body and mind. Both should be diagnosed and treated. [Fred A. Baughman Jr., MD:
And it is the relationship itself causing the problem, not the people involved in it. "When couples go to counseling, trying to communicate, neither member is the 'sick' one," says Michael First, associate professor of clinical psychiatry at Columbia University. "It is the relationship that needs to be worked on." Recognizing a relational disorder could prevent a divorce down the line, or the possibility of child or spouse abuse, he says. [Fred A. Baughman Jr., MD:
Changing what is defined as a mental disorder is a long process. The fifth edition of the DSM won't be out until 2010, but some leading psychiatrists are circulating a white paper now urging research on the change. First is the lead author. Study co-author David Reiss of George Washington University says the research supporting relational therapy has advanced enough that it warrants inclusion in the medically based DSM. "We have a better sense about how to characterize and measure these relationships." Although most folks have some rocky relationships, Reiss says only the most dysfunctional would be diagnosed. But the question remains for many professionals: Why should a relationship problem be called a mental illness? "Suppose you treat a child with poor school attendance, who is performing below expectations and exhibiting symptoms (such as acting out). It does not take a rocket scientist to figure out the real trouble is probably with the parents," says Ronald Fox, past president of the American Psychological Association. "You treat the parents and the kid gets better. But where is the mental illness?" He says the DSM already defines too many problems as mental illnesses. "We pathologize everything under the sun. But the DSM is the coin of the realm. It is the water we swim in as clinicians." [Fred A. Baughman Jr., MD:
The DSM is not must reading for the public, but it is for mental health experts. It is put out by psychiatrists, who are seen by many as the top of the food chain of mental health practitioners. They are physicians and can prescribe drugs such as antidepressants, while some other specialists cannot. The book is used by many types of psychotherapists to make a diagnosis that an insurance company will accept, if the company covers mental health at all. Experts note even generous companies may not cotton to the idea of coverage for a relationship instead of an individual. Listing relational disorders in the DSM would officially recognize what specialists, such as marriage and family therapists, have already been doing for years. Instead of dealing with just one individual, they look at the dynamics among various members of the entire family. "The fact they want to put this in the code book gives family systems therapists some recognition," says Terry Hargrave, a family therapist with West Texas A&M University in Canyon, Texas. Hargrave has mixed feelings about the proposed addition to the DSM. "Family therapists don't like the idea of diagnosing people," of giving them a label that they can carry for a lifetime, he says. He also says there is a risk of "making everything a medical problem." [Fred A. Baughman Jr., MD:
The psychiatric profession is based on a "medical model" and increasingly sees connections between mental disorders and brain chemistry. [Fred A. Baughman Jr., MD:
Psychiatrists often favor using drugs to help correct problems, as well as some talk therapy. [Fred A. Baughman Jr., MD:
First says he does not see drugs as part of a treatment program for a relational disorder. Entire families are not at risk for being put on antidepressants, for example. Couples or family therapy might be the treatment of choice. But finding a good therapist could be a problem. Many psychiatrists and other mental health professionals are not well trained to deal with family dynamics, says Michael Bowers of the American Association for Marriage and Family Therapy. Some critics suggest the label could be spun out of control to include other categories of relationships, such as those between employers and employees. First doesn't see that happening and says the profession is not considering it. He is not trying to say everybody is sick, First says. "The challenge is to reliably distinguish between the bumps, the ups and downs that normal relationships go through, and relational disorders where treatment could help. If we cannot, we will not go there." Recognize bad bonds: *Persistent and painful patterns of feelings, behavior and perceptions involving two or more partners in an important personal relationship. *Always involve two or more individuals. The bond is disordered, not the individuals. *Serious behavioral disturbances that can lead to major impairments in physical and psychological health. [Fred A. Baughman Jr., MD:
[Fred A. Baughman Jr., MD:
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