Diagnosis According to the DSM-IV

A Review and Reflection on a Videotape Series

Released by Washington University School of Medicine

And The Malcolm Bliss Mental Health Center

By Karen Rigdon

Becky, a junior at a rural high school and a piano student of mine, was three minutes into the third quarter of a girls home basketball game when she suddenly could not play anymore. She felt as though she was having a heart attack and she was nauseous and short of breath. Becky was rushed to an emergency room at a local hospital and frightened all around her as she screamed, Im having a heart attackplease help me! After an extensive medical workup, the doctor told Becky and her family that she had a panic attack  not a heart attack.

Educators at all levels have accepted the fact that each group of students may include a percentage of those who are challenged with panic disorder, ADHD, fetal alcohol effect or syndrome, and emotional, behavioral or brain disorders. Any random group of learners may also include individuals that have been diagnosed with bipolar disorder, clinical depression, schizophrenia or other mental illnesses that require treatment. It is to the benefit of educators to possess, at least, a general understanding of the behaviors, characteristics and symptoms of the most common disorders and mental illnesses. Certainly the classroom atmosphere is altered by these particular students who may or may not be diagnosed or receiving treatment and medication.

Psychiatrists and psychologists use guidelines in the DSM-IV to diagnose their clients. A set of three videotapes, Diagnosis According to the DSM-IV, will be the source for my summary. It was filmed using obliging clients in dialogue with their psychiatrist or psychologist. Each client is interviewed for ten to twenty minutes and taped. Then a group of six mental health experts discusses the taped interview and the supporting evidence for the particular diagnosis.

The case studies on the videotape series include clients with panic disorder, bipolar disorder, anorexia nervosa, major depressive disorder, obsessive compulsive disorder, schizophrenia, amnestic disorder, antisocial personality disorder and alcohol dependence. Each interview and follow-up roundtable discussion familiarizes the viewer with the criteria for the diagnosis of each client and the predominant symptoms of each mental illness or disorder. It was intriguing watching real patients talking candidly about their problems in their own words. The skill of the clinicians was equally fascinating as they elicited the pertinent details from the clients and pieced them together in an organized manner to make their diagnoses.

I was particularly interested in the case study of Chuck  a diagnosed obsessive-compulsive. Chuck described himself as a checker. It takes him two hours to get out of the house each time he leaves because he has to check the stove, windows, the animal cages etc. Once he has checked everything he has to back and check everything again and again to appease his intrusive worrisome thoughts.

My mother-in-law is a Chuck. Her intrusive thoughts bring about time consuming behavior in the area of cleanliness. When she comes home she takes off her shoes and brings them to the kitchen to be completely wiped down with wet paper towels. All of her clothes are then gone over with a masking tape roller to remove lint, dust and hair. If spots have gotten on the clothing it is most distressing to her. Her husband is often vehemently scolded for even the tiniest soiling of a garment. Laundry takes many hours to do because the wash cycle is stopped several times to straighten out the clothes. When my mother-in-law and father-in-law come to visit I know that the dresser drawers must be wiped out and television screens scrubbed clean. The family has learned to be patient but my house is never clean enough for my mother-in-law to be comfortable and satisfied. I try to love her anyway.

Anorexia Nervosa, binge eating / purging type, was also addressed in this video series. This serious disorder is more common in girls and women than in men and has become more prevalent in our society today due to a growing obsession with body image and weight. Maria Huarte, the 1998-1999 International Falls Rotary exchange student from Argentina, told me that eating disorders are rampant among teenage girls in her country. Short skirts, crop tops and thong bikinis are the fashions of choice for young Argentinean girls and they will do anything to stay thin. Maria said that many clinics that treat bulimia and anorexia have sprung up over the years in Argentina to deal with the growing problem.

Dr. Jeffery Hardwig, a psychiatrist in International Falls, treats many school age children as well as adults for mental health problems. Hardwig says that ADHD, attention deficit hyperactivity disorder, is the disorder that is most common in our communitys youth population. When ADHD is inherited it shows no gender favoritism. Ritalin is the still drug of choice for ADHD management. Oppositional defiance disorder and conduct disorder are also major problems in our school age children. Dr. Hardwig further consults with students who have clinical depression and different types of anxiety and adjustment disorders. Adjustment disorders are prevalent with children in tough situations who have problems coping with situations such as a divorce in the family, being constantly teased at school or being unpopular. Hardwigs OCD clients are mostly young girls who have repetitive bad thoughts of a sexual or violent nature. In addition, they may wash their hands or change clothes many times during the day.

I asked Dr. Hardwig about the benefits of educators knowing about a childs mental / emotional challenges. He responded, If you understand a problem you are less likely to make it worse for yourself and that person. You will respond in a way that wont hurt that person. Hardwig enforced that teachers who recognize problems in students should report their observations to the childs parents so that further evaluation could be obtained.

One of the seven habits of highly effective people, according to author Stephen Covey, is to seek to understand others before you attempt to be understood. For example, when one is aware that a clinically depressed person will often cry a lot, have no sense of purpose, feel a sense of worthlessness and have trouble even getting out of bed in the morning, it is much easier to be empathetic.

Whether you dealing with an obsessive-compulsive mother-in-law or an alcohol dependent teenager in your classroom, your knowledge of their predicament will hopefully lead you away from judgement and negative reactive behavior to empathy, understanding, patience and improved communication and interpersonal skills.

-- Anonymous, February 03, 1999