Here's another expert weighing in onthe new language about postpartum depression in the DSM-V: Susan Stone, LCSW. Susan ischair of the President's Advisory Council of Postpartum Support International.
It takes years (generally) for clinical observation to find representation in the DSM. The basis for making such change requires compelling research, clinical oversight and the agreement of multiple committee members, each with his own perspective and experience. It is a necessarily lengthy and thoughtful process. While the gap between clinical reality and DSM validation may be frustrating at times, the extension of the postpartum onset specifier [to 6 months] is highly significant.
If included, this could help increase access to insurance coverage to mental health services in pregnancy and the postpartum. Liability issues resulting from denial of benefits becomes a more strongly mitigating factor in coverage decisions when the DSM acknowledges and validates the proposed extension. In addition, extending the specifier justifies the research community's ever-widening investigation of perinatal mood disorder incidence and initiation, encouraging funding. These are major gifts which will pave the way for future DSM modifications.
In reading through the language [of Dr. Ian Jones], I did not feel that the writer was denying the existence of pregnancy-related disorders, butcalling for further research. Because the incidence of depression among women is close to the statistics for antenatal and postpartum depression, specific determination of the biopsychosocial characteristics unique to perinatal mood disturbances is needed to justify its entry as a separate group of disorders. Research focused on these determinations will help inform prevention and treatment!
Great insight Susan! Thanks!
Interesting…I like her point about the close numbers in incidences of depression in general among women and of ppd, etc. I do remember feeling like my prenatal depression and ppd didn't have a whole lot to do with hormonal changes, necessarily, and had a whole lot more to do with my background with an abusive mother and my fears about being a mother, plus lack of sleep, plus a stressful new life circumstance when I had little social support. I remember feeling annoyed when people wanted to attribute my depression primarily to hormones or the state of being pregnant or post-partum when I was pretty sure it had a whole lot more to do with factors that had previously caused a lot of depression for me anyway. That's not to say that hormones didn't play a role, or didn't enhance my depression, but I felt like often people missed the other factors causing my depression, factors that I really needed help with. That being said, it still seems obvious that for many people hormones/other things unique to pregnancy or to the post-partum period play a huge role and it's a really good thing that ppd and other perinatal mood disorders are being listed as separate categories so that women can get the best treatment available.
I'm sorry if this has come up before and I'm repeating the question (and thus the needed response)………
Does anyone know about the applications of the DSM in other Western countries? I mean, if they're more progressive and in-sync w/understanding perinatal mood disorders, and applying them in circumstances requiring the legal system (i.e. when it becomes a legal case), how does the DSM apply?
And not to disqualify a man's intellectual input, but why is a classification of a women's mood disorder (particularly one that CANNOT be applied to the opposite gender–maternal mood disorder) in the possession of a male-dominated profession and discretion??!?!?!
I understand there are professional women in the field and on the panel who have been contributing to this section of the major over-haul, but REALLY(?) how can a MAN (and to referring to Brook Shields' retort to Tom Cruise) know what it's like to experience/suffer from any of these maternal mood disorders?
That's a great question Josie. I will ask
if the DSM is used outside of the US for
diagnosis.
In terms of the male vs. female question, I
know some amazing specialists in PPD
treatment who are men and understand these
illnesses just as well as a female physician, and are AWESOME treating physicians whose patients love them, so I don't have any concerns there. I do think we tend to have
more women specialists in this field, and
that's probably because women understand the "motherhood" thing better. I wouldn't count all men out, though.
Thank you, Katherine for your response. I just wanted to clarify that I wasn't trying to convey a "count men out" approach. I don know of some great ones in the field. My question goes back to the DSM and who IS and ISN't in control of this pychiatric classification system. I think it's odd that it's taken so long to get from a 4-6 week status to an "updated" (and I am being facetious here, given that range is SO yesterday and antiquidated, but..) to a 4-6 month defined range. Men, not women, came to that consensus…and it's going into the "updated" holy grail book of psychiatric disorders.