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I would also suggest that if the subjective anxiety were preventing me from accomplishing my wants that it would be at the level of a pathology. For example, I have no desire to go up on scaffolding, but if I were an agoraphobe who was missing my child's wedding because I could not bring myself to go into public, I believe that condition would be interfering with my wants.
Clearly, I do believe that there are some conditions where subjective distress is indicative of a disorder. However, I also fervently believe that both psychologists and psychiatrists are likely to over diagnose people, turning normal variation into illness. Normal and average are not the same thing, and they should not be treated as such by mental health professionals. I believe that simple phobias are probably the best candidate for being excluded from the DSM. Specific phobias rarely meaningfully impact quality of life. For example, I have a friend who has a rodent phobia. She does not find rodents simply distasteful; she is irrationally scared of them. If she sees a rodent, she runs and screams, she has been known to lose bladder control when around rodents, and she avoids scenarios where seeing a rodent is likely. For example, she rides horses, and when she saw rodent horses at her stable she purchased traps and rodent-proof feed containers, and avoided the feed room until other people could reassure her that the rodents had been trapped and killed and that no new droppings had appeared for some time. There is no doubt that her fear of rodents impacts her daily activities in some way. However, her fear of rodents does not prevent her from engaging in activities she enjoys. Furthermore, her fear of rodents, like most phobias, is an extreme version of a rational fear; humans naturally fear rodents because they carry disease and are associated with illness. While I do not feel that a single specific phobia should be enough to qualify for a pathology, I do think it is important to note that I would change diagnostic criteria for generalized anxiety to disorder to include people who suffer from a sufficient number of specific phobias to prevent them from being able to be functional.
If I were to create a disorder for the DSM, it would not be an anxiety disorder. I have some familiarity with the field of domestic violence and am aware that whether or not to include being an abuser as a diagnostic area on the DSM is a subject of significant debate. I believe that it should be included on the DSM for several reasons. First, when looking at whether a person with a diagnosed mental illness should be committed for involuntary treatment, the general standard is danger to self or others. Obviously, a person who commits domestic violence presents a danger to others, suggesting that their behavior is not only impairing personal functionality, but also their ability to function in relationships with others. People who commit domestic violence often experience significant distress as a result of their behavior: they may lose interpersonal relationships, lose contact with their children, be subject to criminal prosecution, and experience job loss as a result of their behaviors. Family violence disorders are oftentimes cyclical and failure to intervene and treat may result in another generation manifesting the same behavior. This is an area where the behavior is well within the boundaries of the normal range of behavior; it is prevalent in society. Moreover, it may even be a behavior that was, at least historically, positively adaptive in some manner, but is no longer adaptive in modern society. Finally, it is very resistant to treatment, suggesting that it is more than a chosen behavior. The main argument against including family violence as a disorder in the DSM is that by pathologizing family violence there is a fear that one is providing an abuser with an excuse to perpetuate the violence. However, if pathologizing the violence provides means for forced commitment, treatment, and medication of family violence offenders, greatly reducing the risk of harm to others, that "excuse" seems like an acceptable compromise.[continue]
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