The DSM-IV is the diagnostic “Bible” of psychology. It essentially is a list of different symptoms that apply to a certain disorder or mental illness, say for example “depression” and says in effect, if the patient has 9 out of 12 of these symptoms lasting X amount of time, then their diagnosis is “Major Depression”
Unfortunately, it is hard to get a consensus of opinions from three psychologists much less hundreds about a psychological problem, and in some cases they can’t even agree on a name for a disorder.
The manual is updated periodically and it is currently in an up date process and should be out “soon.”
Also, causing more problems in diagnosing psychological and mental health issues is the fact that people have overlapping symptoms, no two people are exactly alike and there is disagreement between one mental health practitioner and the next on whether a person has X symptom or Y symptom. So in other words you may have say in a court case two PhD psychologists testifying, one for the prosecution saying that the defendant is sane, and the one hired by the defense saying he is crazy as a bessie bug.
So if your child is acting out and you take them to a psychologist for an evaluation you may be given a diagnosis that another equally qualified psychologist might say is wrong. This is quite frustrating to parents, police, teachers and other mental health professionals.
The following is a link to the Mayo Clinic website about “oppositional defiance disorder” and I think is a pretty good layman’s explanation of ODD. Keep in mind though that your child may also have other problems such as Attention Deficit Disorder, ADD, or Attention Deficit/Hyperactive Disorder. ADHD. Having one disorder or illness does not keep a person from having another one as well.
Some research now is showing that many mental illnesses and personality disorders, just like alcoholism, have a pretty heavy genetic component. That does not mean though that DNA=destiny and that if your child has a parent or grandparent with mental disorders or illness that they are doomed to also have this disorder or mental illness, but it might be a heads up to you if you start having problems with your child if they have a parent or grandparent who might have passed on some “bad” DNA..
Some mental illnesses and personality disorders do not show up until puberty or young adulthood, while other kids may be showing marked behavior problems at an early age. I have worked in psychiatric inpatient facilities with children as young as 8 or 10, that I would not have gone to sleep if that child was in my house for fear they would burn it down while I slept.
My own son, Patrick, who is officially diagnosed as Anti-social Personality Disorder (this is the DSM-IV equivalent of “Psychopath” or “sociopath.”) but prior to about 14 or 15, he was an ideal child with only one episode of serious misbehavior at age 11 but which quickly seemed to resolve itself.
My other son, Andrew, was ADHD from the day he was born, but managed to do quite well over all and is a self supporting functional adult. He required a great deal of attention and private schools for a time, but we muddled through. I did not allow him to use his ADHD diagnosis as a crutch or an excuse for bad behavior. I also chose not to medicate him with Ritalin which was the only drug available at the time. It turned him into a “zombie.”
Even if your child is diagnosed as Anti-social personality disorder that does not mean that s/he will become a serial killer as the popular media might have us believe. Many people with this disorder become doctors, lawyers, senators, judges, military generals or CEOs of Enron. They learn to function in society, though they lack a typical amount of empathy.
In my own family, my biological father would qualify as a psychopath without a doubt and I know for sure he killed at least two people, yet he was quite bright and maked the Forbes 400 richest men in America at one time in the 1970s. He was also married 6 or 7 times, estranged from all his children except one of my half brothers who is a clone of him. My son’s other grandfather was a navy chief in WWII and a career navy man, that I have no doubt would score high on the Psychopathic Check List, revised, developed by Dr. Robert Hare as the legal gold standard for distinguishing a psychopath in a court of law.
In my mother’s family, her brother I believe was a psychopath as well as a violent alcoholic and wife beater who if his crimes had been punished as they deserved, would ave spent life in prison without parole. Her maternal grandfather was also an abusive alcoholic. Unfortunately, in our family and culture and the assigned role of the women was to cover up and keep secret the evil deeds of the male offenders. Alcoholics Anonymous would call this role “enabling.” To this day, my mother plays her assigned role to the hilt by supporting my son Patrick by sending him money in prison and hiring him an attorney to try to get him out of parole, even though by so doing, her other grandsons and her only child will not speak to her as long as she does so.
I grew up not understanding the family dynamics or the assigned roles in our family drama-rama, but after I started working in mental health venues, my education slowly started to erode my denial of what the dynamics were. At first I had difficulty accepting them until eventually after I broke off all contact with Patrick, he sent an ex cell mate of his to kill me. At that point I started to truly educate myself on all forms of behavioral problems and try to find a way to heal my own wounds and to grow into an emotionally healthy adult. Better late than never.
Now that I am retired and have gained some hard won wisdom, my purpose is to help others to cope with problematic family members in a healthy way. When Patrick was arrested the first time, I felt so alone, and condemned by the psychologist that the court ordered that we attend counseling with. Patrick convinced the man that I was an abusive mother and that his main problem was his abusive home life. Then he stole my car to haul the loot he stole from our friend’s business, and when I turned him in to the law, jumped bail, stole a motorcycle and went back to Texas from the state where the family was living. He hasn’t lived in my home since then, 1989, and has only spent a total of less than 12 months on the streets as a free man. Even those months were on parole. While on parole he never made any attempt to follow the rules. Even in prison, he has made every effort to break the rules and in the first 15 years he was there was sent to solitary 19 times for serious offenses including having a knife in his cell and a cell phone.
While I kept Patrick’s crimes secret from all but my closest friends and family for decades, I have “come out of the closet” and am no longer willing to bear his shame. I raised him to the best of my ability, and though his father and I were divorced, his step father and other male family members were good role models, so he was not without good male influences or anything else a kid would have needed to succeed in life. He was blessed by God with superior intelligence and scored in the top percentile on the IQ tests, and he was given private schooling and many other advantages that other kids lack. Unfortunately, he made choices to give in to the DNA and to find his adrenaline rushes in socially unacceptable ways.
Joyce Alexander, RNP, retired