Mood Swings and ODD

Article excerpt

I needed an intellectual oasis to deal with the anguish and frustration triggered by the monumental amount of misleading information that was included in the well-written article "Not all mood swings are bipolar disorder" (Current Psychiatry, February 2011, p. 38-52). Fortunately, a commentary by Dr. Irene Abramovich ("Breaking the box," Comments & Controversies, Current Psychiatry, February 2011, p. 59) appeared as a therapeutic elixir. I believe that the "mood swings" article is filled with examples of how dangerous "cookbook" medicine can be.

Dr. Kowatch and colleagues use an expression that can be applied to the so-called diagnoses oppositional defiant disorder (ODD) and conduct disorder (CD): "Mood swings are analogous to a fever in pediatrics- - they indicate something potentially is wrong with the patient, but they are not diagnostic as an isolated symptom." A similar concept was my position in a debate titled "Childhood conduct disorder and oppositional-defiant disorders are common manifestations of bipolar disorder" in which I argued that ODD and CD are behavioral expressions of genuine diagnoses. (1) Besides bipolar disorder, I also have seen obsessive-compulsive disorder, social anxiety disorder, and even sexual abuse labeled as "ODD" because the child refuses to be around people (such as a classroom) or is distracted by intrusive thoughts or flashbacks and turns hostile when reproached in front of the class.

In my view, Dr. Kowatch and colleagues give undeserved credit to the behavioral scales (the "cookbooks" of psychiatry) to make diagnoses and seem to miss warning signs in patients' family history, ie, "history of depression and anxiety" (many times this translates as agitated/dysphoric mania) and "drinking problems," which frequently is found in undiagnosed bipolar spectrum patients who use alcohol to "shoot down" racing thoughts that interfere with normal sleep.

From January 2010 to February 2011, I reviewed charts and interviewed patients and families of 1,654 patients with diagnoses of attention-deficit/hyperactivity disorder co-morbid with ODD, bipolar disorder, generalized anxiety disorder, and even 2 diagnoses that are not allowed by DSM rules: autism and mental retardation. …