'Explosive Outbursts' Need a Diagnostic Home: Expert Would like to See Label Added as Modifier in the DSM-5, Perhaps to Conditions Such as ADHD

By Otto, M. Alexander | Clinical Psychiatry News, March 2011 | Go to article overview

'Explosive Outbursts' Need a Diagnostic Home: Expert Would like to See Label Added as Modifier in the DSM-5, Perhaps to Conditions Such as ADHD


Otto, M. Alexander, Clinical Psychiatry News


LOS ANGELES -- Psychiatrists need to find a better diagnostic home for children who have explosive outbursts, according to Dr. Gabrielle A. Carlson.

They happen in children with all kinds of psychiatric diagnoses, but no good diagnostic description captures the pervasiveness of the problem, said Dr. Carlson, director of child and adolescent psychiatry at Stony Brook (N.Y.) University.

In some places, explosive outbursts earn children diagnoses of bipolar disorder, though they might otherwise lack classic symptoms.

And although some explosive children meet the criteria for temper dysregulation disorder with dysphoria (TDD), a diagnosis being considered for the DSM-5 ("New Pediatric Diagnoses Proposed for DSM-5," Clinical Psychiatry News, December 2010, p. 1), TDD would exclude children with many common psychiatric problems, including autism, depression, and posttraumatic stress disorder, Dr. Carlson said at the meeting, sponsored by the American Academy of Child and Adolescent Psychiatry.

Children with these common diagnoses can have rages, too. "What about those kids?" she asked.

Intermittent explosive disorder isn't a good fit, either, because it requires the absence of other psychiatric disorders, she said.

Modifying the Problem

Finding a diagnostic home for kids with explosive anger is more than an academic concern.

It matters because "explosive outbursts are the most serious, compelling problem we have in child psychiatry," often the reason why children are institutionalized, Dr. Carlson said.

"Until we've got a good label for [the problem], we are not going to have the [Food and Drug Administration] going after the indication; we are not going to have grants from the [National Institute of Mental Health] studying it," she said.

Dr. Carlson said she believes the solution is including a "with explosive outbursts" modifier in the DSM-5 to add to comorbid conditions such as attention-deficit/hyperactivity disorder. But the idea is not likely to make it into the upcoming version of the diagnostic manual. Dr. Carlson said she has been told by those involved in the revision that such a modifier would likely go unused by clinicians.

She proposed the idea to Dr. David Shaffer, the Columbia University professor of child psychiatry who serves as head of the DSM-5 childhood disruptive disorder work group.

In an interview, Dr. Shaffer confirmed that Dr. Carlson had, indeed, proposed the idea in an e-mail. In general, modifiers "come to be seen as subsidiary or a consequence to the parent diagnosis," he said in response to Dr.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

'Explosive Outbursts' Need a Diagnostic Home: Expert Would like to See Label Added as Modifier in the DSM-5, Perhaps to Conditions Such as ADHD
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.