8 ms·

I think the same is true for all the psychiatric disorders, but people talk about diagnosing and "having" these disorders as if they're definite things. I don'

I think the same is true for all the psychiatric disorders, but people talk about diagnosing and "having" these disorders as if they're definite things. I don't understand for example why ADHD is any more real than any other collection of seemingly related symptoms one might conjure up. Just going by the criteria of the DSM, its logically possible for two people to be diagnosed while sharing only 3 of the 9 symptoms. And if one someone without ADHD can have 5/9 symptoms, and someone with ADHD can have the first 6 symptoms, and another can have the last 6, and another 1,3,5,7,8,9 of the symptoms, it says to me these symptoms can arise out of completely independent causes. So might it be possible someone meeting the clinical definition of ADHD can have just happen to have 6 independently caused symptoms? Thats not to say I don't think people truly have physical issues, but there is nothing at all to say any two people who "have" depression or ADHD are anything at all alike.

_yb2s 2y ago
All of the symptoms of ADHD are different areas of executive control. I would argue that all people with ADHD generally also show all of the symptoms, but which are severe enough to cause a diagnosis varies- often due to external factors, like which aspects of executive control are most critical for a particular individual. People also have varying success and abilities at compensation. For example, I don’t misplace objects as often as a lot of people with ADHD, but that it just because I did it so much as a kid, I developed systems to deal with it- like the habit of anxiously accounting for everything I’m supposed to have on me every time I stand from a seated position. You might say I don’t even have that symptom, yet I can’t stand up and walk without checking everything in my pockets like most people can.
- bragr 2y ago
  Your comment made me realize I totally do this. I at least frisk my pockets every time I stand.
  - afarviral 2y ago
    I think thats andoando's point, people do things fairly unconsciously so symptoms which align them with a particular diagnosis can be absent for a multitude of reasons. In your case you developed an unconscious habit of frisking your pockets as part of developing a coping strategy. It may be coping with "ADHD" or coping with being a flawed human as we all are.
- andoando 2y ago
  >All of the symptoms of ADHD are different areas of executive control. I am not sure what you mean. Isn't "executive control" involved in almost every behavior? Why are the criteria used in ADHD diagnosis any more indicative of executive control than some other set of criteria I can come up with? Is being bored of people talking a sign of lack of control or a lack of interest? >I would argue that all people with ADHD generally also show all of the symptoms, All people show all the symptoms. Who has never lost their keys, day dreamed during a conversation, loses focuses in an activity, forget small details, etc. >yet I can’t stand up and walk without checking everything in my pockets like most people can. How do you know what most people do? I think checking your pockets is a fairly common normal behavior. Different people have different adaptations to solving this problem of making sure they have what they need when they go out. Some people may have developed the discipline from a young age for example of placing things at the same place everytime. Some people may be more risk tolerant or care free, so they may not devote so much attention to the consequences of losing things. Some people may be clean freaks, so they encounter where their things are more often as they clean, and having a clean space, are also able to find things more easily. Some people, in some circumstances may become anxious, overly excited, etc before going out, and lose track of these things. There's a million reasons for why someone does these things. These are all things that may even change by environment! I think the ADHD diagnosis can be harmful in that it makes people attribute all their behaviors to "Adhd" and makes them believe they are incapable of being changed. And this is all contingent on even trusting that you actually do forget things more often than most, which again I don't know why people are so sure about, and Im even more confused as to how a physician assesses this to be true.
  - afarviral 2y ago
    As someone formerly diagnosed with ADHD I tend to agree with you, but I thought there were studies which found specific genes and brain structures common to many people diagnosed with ADHD, I need to look in to this. On symptoms alone the overlap between trauma-noise and ADHD means someone with C-PTSD may share the symptoms of ADHD and vice versa but psychologists need only be aware of the conditions which are often confused and find criteria to rule one or the other out. There's no doubt that many of disorders/conditions in the DSM need more work to make them as helpful as they can possibly be, and for the world to recognize that they are clusters of symptoms not true things with firm borders (unless they turn out to be through neuro-science). Once certain issues become recurrent/troublesome enough to seek a diagnosis I only hope the DSM aligns people to something which is helpful, whether it be pharmicological or developing coping strategies. Some may find it invalidating for their DSM diagnosis to be questioned but it's not an attack on the validity of their problems, only on what the labels are referring to.
JohnMakin 2y ago
> I think the same is true for all the psychiatric disorders, but people talk about diagnosing and "having" these disorders as if they're definite things. This kind of reasoning is completely faulty and rampant in discussions that usually hold a fair amount of stigma towards people experiencing mental health conditions (it’s also extremely insulting fyi). I can have a headache, and there may be an unknown biological mechanism, but that doesn’t mean I’m not experiencing a headache.
- andoando 2y ago
  As I said "Thats not to say I don't think people truly have physical issues". I have diagnosed ADHD, and I take mental health very seriously. I have zero such prejudice. By "definite" things I mean, singular, physical causes which can be pointed to.
  - JohnMakin 2y ago
    I understand that you believe this, I am merely pointing out that the type of reasoning you’re using is typically seen in the type of psychiatric gatekeeping used in discussions that are laden with stigma against people experiencing mental conditions.
    - akoboldfrying 2y ago
      > I am merely pointing out that the type of reasoning you’re using is typically seen in the type of psychiatric gatekeeping You called this reasoning "completely faulty" in your previous comment, which clearly goes well beyond that. What you are actually trying to do is stigmatise a valid form of reasoning, by association.
    - elefanten 2y ago
      “I understand that you believe” …that questioning diagnostic clarity is associated with some nebulous conversational or clinical scenarios that make you uncomfortable. But sticking your head in the epistemological sand and chastising people for being “extremely insulting” (based on your own extrapolated associations with their position) is extremely …condescending argument-by-assertion. I have skin in the game on this one and in my own experience sloppy diagnostics have caused way more suffering than stigma. I was nodding along with gp’s entire point. Your confidently dismissive chastisement is what feels out of line.
jaggederest 2y ago
ADHD in particular is located to very specific areas in the brain. Primarily the dorsolateral prefrontal cortex and areas in the cingulate cortex. We can see neuroanatomy differences on scans, which, while not specific or sensitive enough for diagnosis, are definitely real physical changes in the brain, and they're pretty consistent across diagnosed vs baseline. There are lots of psychiatric disorders where that doesn't take place, but developmental neuropsychiatric disorders don't fall under that "are they even alike at all" kind of umbrella. In some kind of awful alternate universe we could pretty reliably induce them with gamma knife surgery, for example. Depression is much easier to argue that it's a less specific symptom of a larger constellation, with lots of causes and lots of manifestations.
- andoando 2y ago
  Can you point me to a study showing these brain scans being different from those with diagnosed ADHD and not? The evidence would furthermore have to show that this difference is apparent not just from adhd vs non adhd but adhd vs anxiety, depression etc. And lastly, are these changes perhaps an affect of taking stimulants? And how significant are these results? Are we talking about a few percent difference? Are 10% of diagnoses ADHD shown to have statistically significant differences, 20, 50, 90? Depending on the figure, my criticism of the diagnostic criteria remains. Because if it is a low figure like 10%, that means 90% of the diagnoses aren't supported by any scientific evidence. From what I've been told, including professionals this evidence does not exist. I've also seen studies which indicate that psychiatric evaluations are entirely inconsistent across physicians.
  - jaggederest 2y ago
    > The morphometric findings predicted an ADHD diagnosis correctly up to 83% of all cases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391018/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391018/ It's not good enough for diagnosis - you want to hit 95+% accuracy for diagnostic. And MRIs are extremely expensive compared to 2-3 outpatient psychology appointments. But it's real.
    - 2y ago
h0l0cube 2y ago
Behavioral biology is still a nascent field. Finding concrete biomarkers is the holy grail if diagnosis, but behavioral observation is the best we’ve got, and it so happens that certain traits tend to cluster, so the DSM and the like have resorted to shorthands. When biological mechanisms can be teased out, then we might see finer grained diagnoses and treatments.
joyeuse6701 2y ago
The symptoms tend to appear together, just like many datasets it is not some perfect line or cluster of symptoms that always appear together at the same time for everyone. Sure, maybe some statistical analysis will reveal that some symptoms should belong in the classification of adhd and others shouldn’t, but given the near infinite possible symptoms a person may exhibit, it’s interesting that there are a few that seem to appear often. It’s not just ADHD. Consider OCD, while there are several sub types and triggers, many of the traits and rituals are very similar (repetitive washing, locking of doors, uncomfortably violent ideation) so much so that it’s clear they are related. And if you’re a familiar of these people, you will experience their condition undoubtedly, when compared to a neurotypical.
- kaba0 2y ago
  It’s pretty easy to show that while on one scatter plot questionnaire results of depressed people may tend to form a cluster of points, typical medication is only working in half of the cases, ergo if we add one more dimension than we could separate it into at least two clusters with probably widely different physical explanation.
- andoando 2y ago
  Based on what data can you say these symptoms tend to come together though? This is a whole another problem with the diagnosis. A human being is making subjective judgements based on the self reporting of another human being. Most of the dsm is stuff like "is often inattentive in conversations", "often misplaces things". How often is "often"? How do you know on average how many times people misplace things? I have no issues with this at all if we just admit its not really a science and were just trying to treat patients

_yb2s 2y ago

All of the symptoms of ADHD are different areas of executive control. I would argue that all people with ADHD generally also show all of the symptoms, but which are severe enough to cause a diagnosis varies- often due to external factors, like which aspects of executive control are most critical for a particular individual. People also have varying success and abilities at compensation. For example, I don’t misplace objects as often as a lot of people with ADHD, but that it just because I did it so much as a kid, I developed systems to deal with it- like the habit of anxiously accounting for everything I’m supposed to have on me every time I stand from a seated position. You might say I don’t even have that symptom, yet I can’t stand up and walk without checking everything in my pockets like most people can.

bragr 2y ago
Your comment made me realize I totally do this. I at least frisk my pockets every time I stand.
- afarviral 2y ago
  I think thats andoando's point, people do things fairly unconsciously so symptoms which align them with a particular diagnosis can be absent for a multitude of reasons. In your case you developed an unconscious habit of frisking your pockets as part of developing a coping strategy. It may be coping with "ADHD" or coping with being a flawed human as we all are.
andoando 2y ago
>All of the symptoms of ADHD are different areas of executive control. I am not sure what you mean. Isn't "executive control" involved in almost every behavior? Why are the criteria used in ADHD diagnosis any more indicative of executive control than some other set of criteria I can come up with? Is being bored of people talking a sign of lack of control or a lack of interest? >I would argue that all people with ADHD generally also show all of the symptoms, All people show all the symptoms. Who has never lost their keys, day dreamed during a conversation, loses focuses in an activity, forget small details, etc. >yet I can’t stand up and walk without checking everything in my pockets like most people can. How do you know what most people do? I think checking your pockets is a fairly common normal behavior. Different people have different adaptations to solving this problem of making sure they have what they need when they go out. Some people may have developed the discipline from a young age for example of placing things at the same place everytime. Some people may be more risk tolerant or care free, so they may not devote so much attention to the consequences of losing things. Some people may be clean freaks, so they encounter where their things are more often as they clean, and having a clean space, are also able to find things more easily. Some people, in some circumstances may become anxious, overly excited, etc before going out, and lose track of these things. There's a million reasons for why someone does these things. These are all things that may even change by environment! I think the ADHD diagnosis can be harmful in that it makes people attribute all their behaviors to "Adhd" and makes them believe they are incapable of being changed. And this is all contingent on even trusting that you actually do forget things more often than most, which again I don't know why people are so sure about, and Im even more confused as to how a physician assesses this to be true.
- afarviral 2y ago
  As someone formerly diagnosed with ADHD I tend to agree with you, but I thought there were studies which found specific genes and brain structures common to many people diagnosed with ADHD, I need to look in to this. On symptoms alone the overlap between trauma-noise and ADHD means someone with C-PTSD may share the symptoms of ADHD and vice versa but psychologists need only be aware of the conditions which are often confused and find criteria to rule one or the other out. There's no doubt that many of disorders/conditions in the DSM need more work to make them as helpful as they can possibly be, and for the world to recognize that they are clusters of symptoms not true things with firm borders (unless they turn out to be through neuro-science). Once certain issues become recurrent/troublesome enough to seek a diagnosis I only hope the DSM aligns people to something which is helpful, whether it be pharmicological or developing coping strategies. Some may find it invalidating for their DSM diagnosis to be questioned but it's not an attack on the validity of their problems, only on what the labels are referring to.

JohnMakin 2y ago

> I think the same is true for all the psychiatric disorders, but people talk about diagnosing and "having" these disorders as if they're definite things. This kind of reasoning is completely faulty and rampant in discussions that usually hold a fair amount of stigma towards people experiencing mental health conditions (it’s also extremely insulting fyi). I can have a headache, and there may be an unknown biological mechanism, but that doesn’t mean I’m not experiencing a headache.

andoando 2y ago
As I said "Thats not to say I don't think people truly have physical issues". I have diagnosed ADHD, and I take mental health very seriously. I have zero such prejudice. By "definite" things I mean, singular, physical causes which can be pointed to.
- JohnMakin 2y ago
  I understand that you believe this, I am merely pointing out that the type of reasoning you’re using is typically seen in the type of psychiatric gatekeeping used in discussions that are laden with stigma against people experiencing mental conditions.
  - akoboldfrying 2y ago
    > I am merely pointing out that the type of reasoning you’re using is typically seen in the type of psychiatric gatekeeping You called this reasoning "completely faulty" in your previous comment, which clearly goes well beyond that. What you are actually trying to do is stigmatise a valid form of reasoning, by association.
  - elefanten 2y ago
    “I understand that you believe” …that questioning diagnostic clarity is associated with some nebulous conversational or clinical scenarios that make you uncomfortable. But sticking your head in the epistemological sand and chastising people for being “extremely insulting” (based on your own extrapolated associations with their position) is extremely …condescending argument-by-assertion. I have skin in the game on this one and in my own experience sloppy diagnostics have caused way more suffering than stigma. I was nodding along with gp’s entire point. Your confidently dismissive chastisement is what feels out of line.

jaggederest 2y ago

ADHD in particular is located to very specific areas in the brain. Primarily the dorsolateral prefrontal cortex and areas in the cingulate cortex. We can see neuroanatomy differences on scans, which, while not specific or sensitive enough for diagnosis, are definitely real physical changes in the brain, and they're pretty consistent across diagnosed vs baseline. There are lots of psychiatric disorders where that doesn't take place, but developmental neuropsychiatric disorders don't fall under that "are they even alike at all" kind of umbrella. In some kind of awful alternate universe we could pretty reliably induce them with gamma knife surgery, for example. Depression is much easier to argue that it's a less specific symptom of a larger constellation, with lots of causes and lots of manifestations.

andoando 2y ago
Can you point me to a study showing these brain scans being different from those with diagnosed ADHD and not? The evidence would furthermore have to show that this difference is apparent not just from adhd vs non adhd but adhd vs anxiety, depression etc. And lastly, are these changes perhaps an affect of taking stimulants? And how significant are these results? Are we talking about a few percent difference? Are 10% of diagnoses ADHD shown to have statistically significant differences, 20, 50, 90? Depending on the figure, my criticism of the diagnostic criteria remains. Because if it is a low figure like 10%, that means 90% of the diagnoses aren't supported by any scientific evidence. From what I've been told, including professionals this evidence does not exist. I've also seen studies which indicate that psychiatric evaluations are entirely inconsistent across physicians.
- jaggederest 2y ago
  > The morphometric findings predicted an ADHD diagnosis correctly up to 83% of all cases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391018/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391018/ It's not good enough for diagnosis - you want to hit 95+% accuracy for diagnostic. And MRIs are extremely expensive compared to 2-3 outpatient psychology appointments. But it's real.
  - 2y ago

h0l0cube 2y ago

Behavioral biology is still a nascent field. Finding concrete biomarkers is the holy grail if diagnosis, but behavioral observation is the best we’ve got, and it so happens that certain traits tend to cluster, so the DSM and the like have resorted to shorthands. When biological mechanisms can be teased out, then we might see finer grained diagnoses and treatments.

joyeuse6701 2y ago

The symptoms tend to appear together, just like many datasets it is not some perfect line or cluster of symptoms that always appear together at the same time for everyone. Sure, maybe some statistical analysis will reveal that some symptoms should belong in the classification of adhd and others shouldn’t, but given the near infinite possible symptoms a person may exhibit, it’s interesting that there are a few that seem to appear often. It’s not just ADHD. Consider OCD, while there are several sub types and triggers, many of the traits and rituals are very similar (repetitive washing, locking of doors, uncomfortably violent ideation) so much so that it’s clear they are related. And if you’re a familiar of these people, you will experience their condition undoubtedly, when compared to a neurotypical.

kaba0 2y ago
It’s pretty easy to show that while on one scatter plot questionnaire results of depressed people may tend to form a cluster of points, typical medication is only working in half of the cases, ergo if we add one more dimension than we could separate it into at least two clusters with probably widely different physical explanation.
andoando 2y ago
Based on what data can you say these symptoms tend to come together though? This is a whole another problem with the diagnosis. A human being is making subjective judgements based on the self reporting of another human being. Most of the dsm is stuff like "is often inattentive in conversations", "often misplaces things". How often is "often"? How do you know on average how many times people misplace things? I have no issues with this at all if we just admit its not really a science and were just trying to treat patients