DSM-5 says Enuresis may still be intentional? Does that include some of us?

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Plushie

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It seems when I get particularly stressed out, or have particularly bad anxiety, I get into a wave of "baby mode" and sometimes end up doing research... One of the things that I thought was interesting was that in the Diagnostic and Statistical Manual of Mental Disorders (the book that determines everything psychologists would consider a disorder) says that the criteria for Enuresis is the following:
A. Repeated voiding of urine into bed or clothes, whether involuntary or intentional.
B. The behavior is clinically significant as manifested by either a frequency of at least twice a
week for at least 3 consecutive months
or the presence of clinically significant distress or
impairment in social, academic (occupational), or other important areas of functioning.
C. Chronological age is at least 5 years (or equivalent developmental level).
D. The behavior is not attributable to the physiological effects of a substance (e.g., a di*
uretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina
bifida, a seizure disorder).
Specify
whether:
Nocturnal only:
Passage of urine only during nighttime sleep.
Diurnal only:
Passage of urine during waking hours.
Nocturnal and diurnal:
A combination of the two subtypes above.
........
The prevalence of enuresis is 5%-10% among 5-year-olds, 3%-5% among 10-year-olds,
and around 1% among individuals 15 years or older

So for me, I've had periods of my life where I've intentionally wet the bed (diapers) a couple times a week, mostly intentionally for an extended period of time (I say mostly because after a while of getting used to it I tend to "forget" sometimes lol).

So do you think that can mean for those of us that do/did it on purpose, we are/were clinically "enuretic" (a bedwetter/daywetter)? Just something that ponders my mind...There doesn't seem to be an ending for age either, just a minimum age. And what about the day wetting/incontinence? Although that one I believe already defined us as "functionally" incontinent somewhere before... Things that cross my mind. lol
 
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Milko

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hmm.. maybe. Interesting read anyway.
 

arcituthis

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Yeah. Enuresis itself is not a diagnosis but a symptom of something else. I would assume that this definition is in there to standardize the definition throughout the rest of the DSM when looking for mental disorders associated with it.
 
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I'm pretty sure that the information at the bottom of that article is way off.
 

Fascinating

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So I have probably wet my diaper or clothes 2+ times a week for the past 18 months so I probably have the combination kind day and night.
 

bohemian85

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I'm pretty sure that the information at the bottom of that article is way off.

definitely agree with you on that Merp. If that was the case, then why so many adult diapers/ nappies even now on supermarket shelves? Sure they might be pull-up's or shaped pads but I don't remember seeing them until recent years.

To the OP - clinical classification here is an interesting one... I do get the feeling that it could be referring to children who wet intentionally for various reasons such as feeling a lack of attention when a new sibling arrives etc. I believe that is very common. At the same time, I guess it could be argued that if you do wet yourself regularly, deliberately or not, then you are a bed/ day wetter by definition, although if discussed with a medical professional who can give that diagnosis, then it would be assumed that it was involuntary or the discussion should not be happening in the first place :)
 

Plushie

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Yeah. Enuresis itself is not a diagnosis but a symptom of something else. I would assume that this definition is in there to standardize the definition throughout the rest of the DSM when looking for mental disorders associated with it.

I don't know... I found the book here: http://www.terapiacognitiva.eu/dwl/dsm5/DSM-5.pdf
and on page 355 (390 if you load the PDF) it falls under "Elimination Disorders" as the first entry... So I believe it considers it a "disorder" on it's own.

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I'm pretty sure that the information at the bottom of that article is way off.

That part was on pg 391... but I agree, that's quite different than expected. But again, since it's including those of us that intentionally do it - can it be encapsulating ABDL reasons as well? Or making assumptions based on statistical data that may be skewed if it weren't examining the greater populace and only the limited groups of people that had some other disorder they were being treated for. (perhaps these rates of enuresis are in people who have other problems they see more often at a facility?) Or maybe it's from different countries altogether? I don't know. Who knows where they got that data... However, if we fall under that banner, that should alter the numbers a bit.

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So I have probably wet my diaper or clothes 2+ times a week for the past 18 months so I probably have the combination kind day and night.
So you are apparently qualifying as legitimately enuretic according to that. Unless I'm missing something and I very well may be, but since this is like the Bible of mental health, there's not much room to argue. xD :sweatdrop:

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To the OP - clinical classification here is an interesting one... I do get the feeling that it could be referring to children who wet intentionally for various reasons such as feeling a lack of attention when a new sibling arrives etc. I believe that is very common. At the same time, I guess it could be argued that if you do wet yourself regularly, deliberately or not, then you are a bed/ day wetter by definition, although if discussed with a medical professional who can give that diagnosis, then it would be assumed that it was involuntary or the discussion should not be happening in the first place :)

Well, to the fact that it's referring to children, I think you are right, but this line is interesting:
Elimination Disorders all
involve the inappropriate elimination of urine or feces
and are usually first diagnosed in childhood or adolescence

So that begs the question - does that leave it open for diagnosis after adolescence? Especially since we already know Secondary Enuresis is when wetting occurs after a period without wetting... Could there only be adult onset Enuresis? I imagine there can - all I have to say is - alcoholics, lol.


Also, why would you be going to the doctor for that diagnosis if it was deliberate anyway? Like what would the purpose be? If you enjoy wetting, even if it's accidental, would you really try and "fix" that? Like even if you're staying the night in the hospital or something, would that be something you were looking to diagnose or inform - if you were still capable of not wetting?
 

arcituthis

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Ok, after looking through it, and looking at this website: http://www.webmd.com/mental-health/enuresis, it looks like a catch-all diagnosis when urinary incontinence from all other means are ruled out. I'm looking at this:
How Is Enuresis Diagnosed?

First, the doctor will take a medical history and perform a physical exam to rule out any medical disorder that may be causing the release of urine, which is called incontinence. Lab tests may also be performed, such as a urinalysis and blood work to measure blood sugar, hormones, and kidney function. Physical conditions that could result in incontinence include diabetes, an infection, or a functional or structural defect causing a blockage in the urinary tract.

You really wouldn't go to the doctor for the voluntary half and would likely go to the doctor after incontinence began affecting your life in a negative way (as it usually does).

It also makes the percentages seem more reasonable. As people age, they tend to grow out of wetting unintentionally and people that still do tend to have an underlying medical reason and no longer qualify for the diagnosis.
 

caitianx

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Many of us autistics wet the bed.
 

Zeek61

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This discussion is exactly where the problem in the DSM-V exists and is something that is controversial within the mental health profession (not specifically enuresis but I'm talking about mental health problems in general).

You have to remember that the definitions in here do clarify everything "disorders" but in actuality they aren't at all. For example, (and i can't remember the exact phrasing or details off the top of my head) there is a section in the DSM-V that lists depression that lasts more then a month and due to the loss of a close relative/pet as a "disorder". This is clearly not the case as something like that is known to be part of a normal grieving process and not a disorder at all.

So DSM-V, whilst is the go to guide for mental health practitioners, is exactly only that, a guide. It is more a way for people within the health profession to be able to talk between each other and know what they are talking about. So if someone says that a patient has Major depression they would know what that means as opposed to an emotional disturbance after losing a relative. But that brings around the question is that are these things disorders or not even if they are listed under the category of disorders. And this is the problem that the DSM has in the health profession, that it labels people who don't actually need to be labelled as they are perfectly normal.

Also, you mentioned the part about adult onset enuresis/secondary enuresis, but your definitions are slightly incorrect. Secondary enuresis is where someone begins wetting after being toilet trained and after being able to stay dry for a period of at least a year. In the extract you put in about the different criteria, it shows one of the important ones is that the age is at least older then 5 years. This is kind of the magic number when it comes to elimination disorders as most children would be toilet trained successfully by this age and aft er this age things begin to become a problem for their social/emotional/attachment wellbeing.

As far as i am aware the definition they stated that it is usually diagnosed in childhood/adolescence is pretty accurate. This is because as an adult these sorts of things don't actually happen. This diagnosis of enuresis (as someone previously mentioned) is more used for the psychological issues that arise in children. A new sibling comes along and the older child starts to wet themselves for attention. Or another thing that happens is that the younger child is "babied' by their parents (as in treated in a way that someone that age isn't usually treated and ends up causing development issues) longer then they should be and emotionally develop an abnormal attachment with their parents. In this circumstance, the child will think that when their parents want them to "grow up" that means losing the attachment they have and they end up going through a period of regression. This can include things like wetting themselves intentionally.

That is why this definition exists. It is more for the children who are doing it intentionally as part of an attention seeking behaviour. That is why there is no mention of adult-onset type behaviour. This is because as adults we try to get attention in different ways and wetting ones-self is more of an embarrassment type behaviour (which would probably be classified under the more sexual paraphilias that relate to the enjoyment of intense embarrassment.
 

Tetra

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I am incontinent due to spinal injury as well as other physical health problems.at the same time I am the son of a very noted Psychologist who when the DSM 5 was being voted on described it as "garbage" because many things changed in definition and severity based on the " in disorders" of the age we live in based on Doctors "feelings" about disorders rather than an science.

Peace

Tetra
 

dogboy

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I could be wrong, but I think there are those who either wet the bed or themselves for reasons other than infantalism, not necessarily liking diapers, or regressing to infancy, etc. If you saw the movie "Girl Interrupted", there was a girl who had smeared her feces all over her body. My wife and I have adult friends who adopted two girls with extreme emotional and mental problems as they were sexually abused and removed from the birth homes. One girl when a teenager, started defecating her pants. There are people who seem to do the things we might do, but do them for more deep seated psychological reasons.
 
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I could be wrong, but I think there are those who either wet the bed or themselves for reasons other than infantalism, not necessarily liking diapers, or regressing to infancy, etc. If you saw the movie "Girl Interrupted", there was a girl who had smeared her feces all over her body. My wife and I have adult friends who adopted two girls with extreme emotional and mental problems as they were sexually abused and removed from the birth homes. One girl when a teenager, started defecating her pants. There are people who seem to do the things we might do, but do them for more deep seated psychological reasons.

That's probably the best explanation of it, I think. I don't really think ABDL falls into the same category as the description in the DSM-5, even though technically we are wetting intentionally and some of us certainly do so more than twice a week consistently.

If you want to argue it on their own definition, the DSM-5 requires that there's no secondary cause present. I think "gains sexual or emotional pleasure from intentional wetting" could very well be a secondary cause.
 

Plushie

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Also, you mentioned the part about adult onset enuresis/secondary enuresis, but your definitions are slightly incorrect. Secondary enuresis is where someone begins wetting after being toilet trained and after being able to stay dry for a period of at least a year.
I didn't specify a period of time, because some say a year and some places say several month's. The DSM-V says " a 'secondary' type, in which the disturbance develops after a period of established urinary continence."... So as I said: " when wetting occurs after a period without wetting"...It can be a recurrence in an individual such as a relapse, or it could outright be a new unexpected problem...

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That is why this definition exists. It is more for the children who are doing it intentionally as part of an attention seeking behaviour. That is why there is no mention of adult-onset type behaviour. This is because as adults we try to get attention in different ways and wetting ones-self is more of an embarrassment type behaviour (which would probably be classified under the more sexual paraphilias that relate to the enjoyment of intense embarrassment.

Yes, I agree that's why there isn't really a mention of it, but I'm sure the "usually" part leaves it open-ended for the possibility to make sure they don't miss a really rare case. Add to that what if the adult has the mentality of an 8 year old who might do such things - how does that impact the scenario. He's over 8 years old in mental age, and therefor could meet that criteria too if he's wetting to act out.
 

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One thing to consider with the DSM is the definition of a disorder. It must be something negatively impacting a person's life enough to require treatment. People who enjoy wearing and using diapers do not have a disorder. Incontinent people have a medical condition instead of a psychological disorder. Before diagnosing a disorder, medical conditions must be ruled out.

I would not be concerned that the book recognizes Enuresis as a possible psychological disorder and lists it as possibly being intentional. Both are true and accurate. The doctor must be aware of these possibilities in order to treat children. The question is how bad must the problem be before the child or adult is seeing a psychiatrist to possibly receive this diagnosis? Not sure about you, but, as may times as my bed got wet, I never saw a doctor for it. Personally, I learned to use diapers as an adult so I would not wake up multiple times to pee. Instead of a disorder, my intentional use of diapers improved my life.

The disturbing part about the DSM and psychiatry in general is when mistakes are made. The wrong diagnosis, medication, or treatment can make things worse. I have personally seen this a few times in my own life with medical issues. Even a good doctor tried a medication that did not work for me. These things happen. No matter how good the guidelines are, someone will use them to a wrong conclusion. Doctors are doing the best they can.
 

Zeek61

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I didn't specify a period of time, because some say a year and some places say several month's. The DSM-V says " a 'secondary' type, in which the disturbance develops after a period of established urinary continence."... So as I said: " when wetting occurs after a period without wetting"...It can be a recurrence in an individual such as a relapse, or it could outright be a new unexpected problem...

The important part i mentioned is the section about being toilet trained AND being able to stay dry for a year. This is so as to avoid classing a relapse as secondary enuresis when in fact it is just a relapse. This is a pretty important distinction to make as the causes of the two and management of the two are very different. Primary enuresis (or relapse) is usually treated with alarms/medication to help concentrate the urine at night depending upon the severity. true secondary enuresis is pretty much caused by some emotional/psychological cause and requires a significant amount of counselling.

Note here that if someone was previously a bedwetter and became dry in mid teens. If that person was to say go out drinking on the town when they are older and wet the bed then this isn't secondary enuresis (even though technically it fits the definition). This is simply a relapse which is due to alcohol (or if other agents are used whatever the causative agent is). Basically, secondary enuresis is most typically a cause of psychological distress/emotional problems. And that is what it is pretty much reserved for.

Yes, I agree that's why there isn't really a mention of it, but I'm sure the "usually" part leaves it open-ended for the possibility to make sure they don't miss a really rare case. Add to that what if the adult has the mentality of an 8 year old who might do such things - how does that impact the scenario. He's over 8 years old in mental age, and therefor could meet that criteria too if he's wetting to act out.

I get what you are trying to say here. But that is the things about the DSM-V. That person wouldn't get this diagnosis simply because they "fit" that definition when something else is actually going on. That isn't how the DSM-V works. Otherwise there would be people out there who would end up with a diagnosis of half the entire DSM in one go. In a situation such as that most people look at what is called a global assessment of Function (GAF) score. This assess how the person is with global functioning and is a scale from 100 (a perfectly normal human being - which i might add, none of us are at all - to 1 -> which basically means you are a vegetable incapable of doing anything (including hygiene) for yourself.

This is one part where the DSM-IV and the DSM-V differs (and where a lot of the psychiatrists opinions of the standards differ. in DSM-IV there was a diagnosis system that was called an AXIS system. It basically looked at each part of separately (i.e. intellectual disability, psychological and mood disorder and medical disorders) and listed them all in such a way that you could see all the issues of the patient. In DSM-V this was removed and instead, the manual lists all the different impairments under disorders so that they can be listed if the patient has them. So in example you provided above, about an adult with the mind of an 8 year old, that diagnosis of mental impairment would be listed first and then anything else relevant or that was explainable on its own would be listed afterwards. In other words, the behaviour is explainable by the impact on intellectual functioning and is not an isolated issue. If that was a purely isolated issue of the person wetting themselves with no other reason for it then this definition is used. But if the person was severely depressed and didn't get out of bed, not to shower, not to go to the bathroom and wet themselves/the bed and was an 25 year old and never had this kind of behaviour before. Then in this case the diagnosis of enuresis is not relevant. That is because the more likely reason for the behaviour is the depression. And treating that issue resolves the behaviour. If you were to only treat the enuresis and ignore the signs of depression then that wouldn't actually solve the behaviour (and the person would be likely to revert to it).

The same is true if for example a 30 year old was involved in a motorbike accident and had spinal damage. In such a situation they would have "enuresis" because they would be involuntarily passing urine/feaces. But that isn't their diagnosis at all. The diagnosis is spinal cord damage which is causing the enuresis. So therefore he wouldn't need a psychiatrist to help him deal with that as it is a medical/surgical issue. So the overarching issue is not the enuresis in this case (even if it might be causing psychological distress), but rather the spinal cord injury.

This is why its not a simple matter of this diagnosis exists and you "fit" the definition, so you can be called that. You have to look at what the overarching issue is. And if that overarching issue explains the behaviour then that is the diagnosis that is given because treatment of that diagnosis resolves the problem. So the best way to think about the DSM (particularly the DSM-V) is a list of patient priorities that need to be treated.
 

Plushie

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" in disorders" of the age we live in based on Doctors "feelings" about disorders rather than an science.

Honestly they're inventing new disorders every day too... I could take that in the direction of ADD/ADHD and things like that, but I don't want to take the conversation off topic. Also I've heard they brand things as disorders just so they can then be medically covered in some places...but that could be hearsay.

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I could be wrong, but I think there are those who either wet the bed or themselves for reasons other than infantalism, not necessarily liking diapers, or regressing to infancy, etc. If you saw the movie "Girl Interrupted", there was a girl who had smeared her feces all over her body. My wife and I have adult friends who adopted two girls with extreme emotional and mental problems as they were sexually abused and removed from the birth homes. One girl when a teenager, started defecating her pants. There are people who seem to do the things we might do, but do them for more deep seated psychological reasons.

They must've been really damaged... That's terrible and sad... But I can imagine what you're saying, so it makes sense. But honestly, I'm sure there has to be at least some psychological reason during childhood (albeit milder) that causes us to deviate from the "normal" path - including regressive behaviour and (for some of us) sexual interests.

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If you want to argue it on their own definition, the DSM-5 requires that there's no secondary cause present. I think "gains sexual or emotional pleasure from intentional wetting" could very well be a secondary cause.

Interesting point. :)

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The question is how bad must the problem be before the child or adult is seeing a psychiatrist to possibly receive this diagnosis?

Honestly I'm thinking it would be more the parent or spouse who might be concerned. Honestly if u consistently wet your bed for fun no matter the reason, you could end up with an "intervention" of some kind. On that note - FYI I was sent to see a shrink by my mother when I was 13 when I admitted to her I liked diapers and things... Had I intentionally wet myself because of that, I may have fallen under that category not because it was causing problems for me, but perceived by others. She claimed later that she had thought that was "a cry for help" (when I was just trying to be brave and "come out" about it)...So it's not hard to imagine that scenario. I remember a long time ago (when I was maybe 13-16 years old) on a previous forum that closed down, there were a lot of others around my age that honestly thought they "could get diapers if they wet their bed on purpose enough"... So that's another reason to see this situation as a possibility.
 

Fascinating

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Yes, I'll admit that wetting the bed does not appear to be a choice but for me it is pretty much intentional. I chose to take a drink of water before bed. I chose not to empty my bladder before going to sleep. I chose to listen to wet the bed tracks. I chose to wet my padding any time I wake up needing to go. Then some night a cool breeze blows through and my bladder lets loose and I wake up drenching myself. At that point it does not feel like a choice because it is too late to change my mind. I can't quit wetting and get up and go to the restroom. I can't reason that I should let it out slowly to avoid flooding. I can't decide I am never going to wet in the bed again. Now that this behavior has become a part of me it would take a lot of hard work to change my mind. However, I have no regrets. I am happy cuddled under the covers in a dry bed with a wet disposable garment doing its job.
 
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