6 ms·

DSM Disorders Disappear in Statistical Clustering of Psychiatric Symptoms (2024)

162 points by rendx 1y ago

s5300 1y ago
[dead]
gsf_emergency_2 1y ago
For nerdsnipers who would like see if DSM-IV is "better" the wiki is https://www.ncbi.nlm.nih.gov/books/NBK519711/ https://www.ncbi.nlm.nih.gov/books/NBK519711/ Going back to DSM-III TFA has a good link https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2016.15121509 https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2... >This is unproblematic as long as DSM criteria are understood to index rather than constitute psychiatric disorders. With "index" taken to mean: >a pragmatic and well-validated way to identify [a] syndrome I.e. "Do DSM Compress?"
- raverbashing 1y ago
  Here's the thing. As much as the quality of professionals vary a lot, the practical aspects of understanding DSM (or even medical issues) plays an important part This is probably exacerbated by the closure of mental institutions where you could see in person what the textbook means exactly. Trying to understand diseases just by the text (and not even considering differential diagnosis) is an exercise in frustration. And I feel more professionals lately are just "Chinesing room" it instead of having actual experience
skissane 1y ago
Another paper I like which reaches similar conclusions, but with a rather different methodology - https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/ - looking at the biological validity of the ASD-vs-ADHD-vs-OCD distinction in children and adolescents - it concludes the boundaries between the three disorders (and between the disorders and “normality”) are a poor model of what is really going on
jppope 1y ago
wow. thats mind bending right there... I'd love to see it with some additional dimensions to it. even a 3D graph would be super interesting no doubt
- oofbey 1y ago
  The raw data are in hundreds of dimensions. To visualize it meaningfully I think you’d need to run a t-SNE clustering, which would be fine in 2D. Raw PCA or anything like that which preserves the original structure probably wouldn’t show much even in 3D. But it would be fun to see the clusters more directly.
SV_BubbleTime 1y ago
That’s interesting. Aren’t there some social contagions that are listed in DSM? I would think those basically require large groups of varying symptoms.
- kennywinker 1y ago
  Not an expert, but I don’t think - and cursory googling seems to agree - there are any “social contagions” in the dsm. The concept is not exactly proven science, and it’s worth mentioning that it’s also a bit of a dogwhistle term used to undermine a lot of queer and gender identities. Fwiw I think it’s patently obvious behaviors can influence people, but in my mind they influence the avenue of expression - they don’t create disorders from scratch. So like e.g. body image would be the underlying disorder, and if it expresses as bulimia or anorexia or cutting could be somewhat “socially contagious”.
  - vasco 1y ago
    They are correct in terms of eating disorders, bulimia is socially contagious.
    - kennywinker 1y ago
      But what does that mean? Like if you spend time around someone with bulimia there’s a chance you’ll get it too? That doesn’t seem right to me. What does seem right to me is if you feel fucked up about your body and your attractiveness, how you express that can be influenced by what you see other people doing. But if you feel confident about yourself there is no amount of hanging out with people with eating disorders that will give you one…
      - vasco 1y ago
        Read up, there's plenty of literature, there's no need for something to make sense before you actually read up on it.
        1y ago
user_7832 1y ago
I'm happy to see such results be "properly" recognized. The DSM is imo helpful only as a baseline, especially in contexts where without it, doctors might have (significant) personal bias. And... this might ruffle some feathers with the "live and die by the book" crowd, but a good, perceptive doctor doesn't need the DSM to diagnose anything. I've had video calls with a doc who took maybe 5 minutes at most of hearing subjective experiences to confidently reach a conclusion. I've also had a 45 minute "by the book" DSM-based session where boxes were being ticked... and the questions were f---ing *terrible*, if you pardon my French. "Do you have trouble concentrating" is terribly vague and can always be justified either way. Not to mention, it takes maybe a few moments to "catch on" on how to answer which questions; which seems to be a terrible way of introducing bias into the answers (as also mentioned in the article). Having someone describe their personal life is in many ways much better because it cannot be a rigid yes/no question. And all this talk is without mentions of other aspects that also need addressing, like the continuous spectrum of many conditions...
- peepee1982 1y ago
  I have had such bad experiences with psychiatrists and psychologists being contrarian and demanding filling in generic tests leading to no working solutions (aka you're depressed here's a prescription for an SSRI. Still depressed? We'll up the dose). My current psychiatrist figured out my main issues after talking to me for 15 minutes. Sent me off to a psychologist back up his assumptions before prescribing anything. Recommended therapists who specialize in the area I needed support in. The psychologist I went to was great as well (after seeing one that was a terrible). She did a lot of testing (three sittings lasting around two hours) but said the tests were really just to rule out other things. The important part were the conversations. My life improved tremendously after that.
  - 512 1y ago
    How does one find a good psychiatrist/psychologist? My experiences have ranged from "very bad" to "OK at best" and I think finding someone a bit more invested into figuring things out might help a lot.
deleted 1y ago
[deleted]
tcj_phx 1y ago
In 2022 psychiatrist Chris Palmer MD [0] published Brain Energy [1], which shares his discovery of the 70+ years of science establishing that the behavioral/mental symptoms traditionally given 'psychiatric' labels are caused by metabolic problems. When you fix the body's metabolism the symptoms go away. Dr. Palmer recommends the ketogenic diet, but not all people need this specific intervention to improve their metabolism. I think the best place to start for most people is simply eliminating their consumption of white flour, or at the least, fortified white flour [2]. Dr. Palmer tweeted about anemia and Vitamin B-12 deficiency [3]. Many patients are prescribed synthroid (T4) for their thyroid, but they often still have all the symptoms of hypothyrodism because their body doesn't activate T4 -> T3. Adding a source of T3 to patients' Synthroid treatment can make a big difference in their behavioral symptoms. I have a book by some psychiatrists who were active in the 1940's -> 1950's, which is before the first 'psychiatric' medications were released. I didn't know this book was compiled by psychiatrists when I ordered it - I thought it was going to be a general book about the pro-metabolic intervention. It's unfortunate that the prescription drug industry never figured out why some of their chemicals help with the symptoms labeled 'depression'. The MAOIs were reasonably-effective at helping acutely-depressed people out of bed. Each generation of antidepressants was less effective than the previous, until the SSRI's arrived. Now we're stuck with antidepressants that have always been known to cause people to commit suicide. At least the psychiatrists are now revisiting MAOIs as an option for people who don't respond well to the suicide pills (SSRIs). Antipsychotics are a tragedy: anti-dopamine drugs make patients feel terrible. The one exception to the anti-treatment received by psychotics is an anti-serotonin drug approved for parkinsons psychosis [4]. [0] https://www.chrispalmermd.com/ https://www.chrispalmermd.com/ https://twitter.com/ChrisPalmerMD/ https://twitter.com/ChrisPalmerMD/ [1] https://brainenergy.com/ https://brainenergy.com/ [2] Flour manufacturers tend to use the cheapest fortifications possible. For example, the type of iron used for fortification is usually simply 'iron shavings', which usually becomes rust by the time it's absorbed. [3] https://twitter.com/ChrisPalmerMD/status/1903071654328111413 https://twitter.com/ChrisPalmerMD/status/1903071654328111413 [4] https://pmc.ncbi.nlm.nih.gov/articles/PMC5819716/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5819716/
- Aurornis 1y ago
  There are countless examples of past doctors claiming that psychiatric disorders are caused by some simple dietary issue. You can find people claiming that everything can be fixed by ketogenic diets, vegan diets, carnivore diets, Vitamin B12, niacin, magnesium, fish oil, you name it. For any vitamin or diet there is someone out there making passionate claims that it solves everything. None of these hold up under actual studies. It’s the domain of wishful thinking that sadly preys upon people desperate for answers. Some times the placebo effect works for a while, but usually people just end up with a cabinet full of supplement bottles and a history of fad diets with no progress on their condition.
andoando 1y ago
Ive been saying this forever. Even with single disorder like ADHD, per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD. So if someone has 6 symptoms how do you know theyre not all independently caused? Given a large enough population it's a guarantee
- DANmode 1y ago
  The shallowly buried truth here is that ADHD, CFS, and other common conditions are not standalone random diseases, but diagnostic names for groupings of common symptoms, caused by seemingly completely unrelated stuff ranging from childhood trauma, to a staph infection or mercury leak in a tooth root.
  - thirdacc 1y ago
    I don't think ADHD in particular is caused by unrelated stuff. The heritability findings are pretty strong. > A study of 894 ADHD probands and 1135 of their siblings aged 5–17 years old found a ninefold increased risk of ADHD in siblings of ADHD probands compared with siblings of controls [2]. Adoption studies suggest that the familial factors of ADHD are attributable to genetic factors rather than shared environmental factors [3, 4] with the most recent one reporting rates of ADHD to be greater among biological relatives of non-adopted ADHD children than adoptive relatives of adopted ADHD children. The adoptive relatives had a risk for ADHD like the risk in relatives of control children [4]. > Twin studies rely on the difference between the within-pair similarities of monozygotic (MZ) twin pairs, who are genetically identical, and dizygotic (DZ) twin pairs, who share, on average, 50% of their segregating genes. The mean heritability across 37 twin studies of ADHD or measures of inattentiveness and hyperactivity is 74% (Fig. 1). A similar heritability estimate of around 80% was seen in a study of MZ and DZ twins, full siblings, and maternal and paternal half-siblings [5]. The heritability is similar in males and females and for the inattentive and hyperactive-impulsive components of ADHD [6,7,8]. https://www.nature.com/articles/s41380-018-0070-0 https://www.nature.com/articles/s41380-018-0070-0
    - 1y ago
oofbey 1y ago
The paper described makes a statistically rigorous attempt to recover common psychiatric diagnoses (like major depressive disorder MDD) from raw unbiased data about people’s experiences. And seems to conclude that the Venn diagram for common presentations of these conditions doesn’t line up well with the official diagnoses. Not that the conditions don’t exist. But that we are grouping together distinct conditions under the same name. They give examples of anhedonia and suicidality as distinct clusters in their data even though both would be considered MDD under the DSM. To me this begs the question of whether the DSM authors might actually know something real and useful that the data don’t show. For example that anhedonia often progresses to suicidality even though the two might not coexist in the same person often. (Doesn’t sound right to me, but that’s how I read the article.) I think it’s plausible that the direct implication of this research is actually wrong. The obvious conclusion is that the DSM is full of it and doesn’t match real people’s experiences. But I suspect it might be that the DSM captures useful correlations and progressions that this method didn’t collect. Perhaps because the data here are from a single point in time, not a progression.
- bawolff 1y ago
  Even still, wouldn't youvwant to separate X & Y are the same thing from X eventually progresses to Y. I think the most obvious conclusion is not that the DSM is bunk, but that some of things it groups together might be better to group separately. The real question of course is which grouping corresponds better to the group responding the same way to a similar intervention. After all the point diagnosing is to put people into groups so we can learn from the patterns of similar people to figure out better treatments.
  - oofbey 1y ago
    Fair point. I agree. If there’s structure in people, the DSM should capture it. MDD phase 1,2,3 would be a useful update.
- rusk 1y ago
  To me the conclusion is that the DSM is out of date. Not the document, or specific iteration itself but the mindset driving it. When DSM was simpler and we didn’t know as much about mental illness, then what DSM was trying to achieve wasn’t such a tall order, and it was a useful diagnostic companion. However it seems to me it’s gone from being merely useful to being considered canon, and through successive iterations has tried to fill those boots to the point where people are calling out the DSM as being entirely flawed when in fact what is going on is it’s just stepping out of its bounds.
Wendycutler06 1y ago
[dead]
dboreham 1y ago
The DSM exists to satisfy US medical insurance industry which requires the patient be diagnosed with a specific "condition" before they will pay for anything.
- oofbey 1y ago
  That’s one reason. Another less cynical reason is to ensure professionals mean the same thing when they use specific words. Brains are complicated, of course. Making predictions about how one person will react to medication based on their experiences is very difficult. Being able to collect data and group it consistently makes this prediction task much easier. “We known that many people who answer these questions with these answers improve after taking this medicine.” That’s genuinely useful, needs the DSM or something like it, and has nothing to do with insurance.
- halayli 1y ago
  you've checkboxed two fallacies with one stone: motivated reasoning, and attribution of malice. I am defending reasoning and logic here, not insurance industry. what you said might be true but you need to back up your claims.
moi2388 1y ago
This is a good start, but it still clusters based on symptoms It’s like going to the doctor and getting an HIV diagnosis because you’ve got a runny nose.
- SiempreViernes 1y ago
  That's how all diagnosis starts, what did you expect?
  - moi2388 1y ago
    Start. But in psychology, it’s the end of it. With actual doctors, they will take blood work, perform tests to find the actual virus, bacteria or other cause. They find the cause, not just a list of symptoms. Psychology and psychiatry is only now starting to actually research causes.
- perlgeek 1y ago
  It's like going to the doctor and getting a runny nose diagnosis because you've got a runny nose. In the end, a diagnosis only helps the patient if it enables a treatment, hopefully an effective one. If you have a cluster of symptoms with two possible causes, and there is no difference in the care for the patient, what's the point of further differential diagnosis?
ryanjshaw 1y ago
Important to note the various limitations of this approach: > It relies only on self-reported symptoms, and features requiring clinician observation are missing; symptoms are decontextualized (e.g., insomnia due to substance withdrawal isn’t differentiated from insomnia due to anxiety); all symptoms were assessed using a 12-month time scale, even though different symptom patterns exist at different time scales. In particular, I’m not sure how this would identify somebody with the traditional schizophrenia + anosognosia combo, which requires another person to help diagnose.
TeeMassive 1y ago
Every time I read a part of the DSM-V, as a layman, I'm flabbergasted how vague and redundant and arbitrary symptoms and diagnostics are made (e.g. "if 6 out of 10 then..."). It just seems that on its face, while psychiatry has improved and began doing more good than harm since deinstitutionalization, it still lacks the rigor found in other applied scientific fields such as cardiology and oncology for example. This study is a very good step in the right direction. The other direction is more quantitative methods such as measuring the brain waves response to a retinal laser flash to detect mental disorders (look it up, it's real)
mwidell 1y ago
Could it be that everything we call mental illness is just natural variation of people's psyche, at the ends of the bell curve? Many of the mental illnesses are of course bad, but in an evolutionary perspective it makes sense that we have these variations in a population, to optimise adaptation.
- AlecSchueler 1y ago
  What do you mean by "natural variation?" A great many of mental health issues develop as a result of trauma. You could say that a broken leg is a natural variation of a leg, as it happens naturally as the result of physical trauma, but does that help you understand it or treat it better?
  - mwidell 1y ago
    I mean natural variation as in genes. Trauma often triggers mental health problems, but there usually needs to be genetic susceptibility as a foundation for it to happen.
    - Fraterkes 1y ago
      I mean, sickle cell is arguably a "natural genetic variation" but we very much treat it like a disease.
Danjoe4 1y ago
Psychiatry is loosely based on science and 90% of the drugs they prescribe are net harmful
TeMPOraL 1y ago
I really like the approach, this is exactly what statistical tools are for. I like it all the way up to the very end, where I feel this report drops the ball, in trying to derive a hierarchy from the results. Hierarchies don't exist. Nothing in nature is organized in trees (data structures), not even actual trees (the other kind). Organization, relationships, form directed graphs (or the continuous domain equivalent). Hierarchies are deceptively simple because they planarize, meaning you can draw them on paper without crossing lines, or introducing indirect references. But that's often as deceiving as it is helpful. Think of the "tree of life" - there is no one tree of life, its shape depends on which aspects of phenotype or genotype you select and organize around. Think of corporations and governments - you can either accept there's a lot of "dotted lines" in the org chart, turning it into a dense DAG, or never understand why people do what they do. And so here, it's also quite apparent there are correlations cutting across the proposed hierarchy, clearly visible even on Figure 2 - the one that urges us to disregard the left-to-right ordering of the constructs. I mean, the researchers are likely perfectly aware of this. My worry is that 90%+ of the insight of the proposed model will get lost in final planarization into a hierarchy that gets into the next DSM.
dr_dshiv 1y ago
This is very much in line with the research-alternative to DSM— the so-called RDoC — which takes a clustering vs category approach: https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/about-rdoc https://www.nimh.nih.gov/research/research-funded-by-nimh/rd...
nraynaud 1y ago
I'm very happy that they are trying to re-classify the DSM, it's probably the sign of a maturing medical field. Let's also hope that re-clustering will help with the reproduction crisis.
angelarudolphs7 1y ago
My husband has Parkinson’s disease, adding PD-5 to his nighttime Parkinson’s meds has completely changed his sleep issues. He slept all day and up all night, we had to hire care nurses. Now using this PD-5 medicine for the last four months and a normal routine he sleeps almost completely through the night and may get up once to use the restroom. It’s improved so much we were able to let go of the night nurses. This medicine also helps a ton with memory. we got the treatment from www. limitlesshealthcenter. com I am absolutely confident that this program offers a viable solution. I hope someone find this helpful, We feel very fortunate to have learned about pd-5.

162 points by rendx 1y ago

[dead]

For nerdsnipers who would like see if DSM-IV is "better" the wiki is https://www.ncbi.nlm.nih.gov/books/NBK519711/ https://www.ncbi.nlm.nih.gov/books/NBK519711/ Going back to DSM-III TFA has a good link https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2016.15121509 https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2... >This is unproblematic as long as DSM criteria are understood to index rather than constitute psychiatric disorders. With "index" taken to mean: >a pragmatic and well-validated way to identify [a] syndrome I.e. "Do DSM Compress?"

raverbashing 1y ago
Here's the thing. As much as the quality of professionals vary a lot, the practical aspects of understanding DSM (or even medical issues) plays an important part This is probably exacerbated by the closure of mental institutions where you could see in person what the textbook means exactly. Trying to understand diseases just by the text (and not even considering differential diagnosis) is an exercise in frustration. And I feel more professionals lately are just "Chinesing room" it instead of having actual experience

skissane 1y ago

Another paper I like which reaches similar conclusions, but with a rather different methodology - https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/ - looking at the biological validity of the ASD-vs-ADHD-vs-OCD distinction in children and adolescents - it concludes the boundaries between the three disorders (and between the disorders and “normality”) are a poor model of what is really going on

jppope 1y ago

wow. thats mind bending right there... I'd love to see it with some additional dimensions to it. even a 3D graph would be super interesting no doubt

oofbey 1y ago
The raw data are in hundreds of dimensions. To visualize it meaningfully I think you’d need to run a t-SNE clustering, which would be fine in 2D. Raw PCA or anything like that which preserves the original structure probably wouldn’t show much even in 3D. But it would be fun to see the clusters more directly.

SV_BubbleTime 1y ago

That’s interesting. Aren’t there some social contagions that are listed in DSM? I would think those basically require large groups of varying symptoms.

kennywinker 1y ago
Not an expert, but I don’t think - and cursory googling seems to agree - there are any “social contagions” in the dsm. The concept is not exactly proven science, and it’s worth mentioning that it’s also a bit of a dogwhistle term used to undermine a lot of queer and gender identities. Fwiw I think it’s patently obvious behaviors can influence people, but in my mind they influence the avenue of expression - they don’t create disorders from scratch. So like e.g. body image would be the underlying disorder, and if it expresses as bulimia or anorexia or cutting could be somewhat “socially contagious”.
- vasco 1y ago
  They are correct in terms of eating disorders, bulimia is socially contagious.
  - kennywinker 1y ago
    But what does that mean? Like if you spend time around someone with bulimia there’s a chance you’ll get it too? That doesn’t seem right to me. What does seem right to me is if you feel fucked up about your body and your attractiveness, how you express that can be influenced by what you see other people doing. But if you feel confident about yourself there is no amount of hanging out with people with eating disorders that will give you one…
    - vasco 1y ago
      Read up, there's plenty of literature, there's no need for something to make sense before you actually read up on it.
      - 1y ago

user_7832 1y ago

I'm happy to see such results be "properly" recognized. The DSM is imo helpful only as a baseline, especially in contexts where without it, doctors might have (significant) personal bias. And... this might ruffle some feathers with the "live and die by the book" crowd, but a good, perceptive doctor doesn't need the DSM to diagnose anything. I've had video calls with a doc who took maybe 5 minutes at most of hearing subjective experiences to confidently reach a conclusion. I've also had a 45 minute "by the book" DSM-based session where boxes were being ticked... and the questions were f---ing *terrible*, if you pardon my French. "Do you have trouble concentrating" is terribly vague and can always be justified either way. Not to mention, it takes maybe a few moments to "catch on" on how to answer which questions; which seems to be a terrible way of introducing bias into the answers (as also mentioned in the article). Having someone describe their personal life is in many ways much better because it cannot be a rigid yes/no question. And all this talk is without mentions of other aspects that also need addressing, like the continuous spectrum of many conditions...

peepee1982 1y ago
I have had such bad experiences with psychiatrists and psychologists being contrarian and demanding filling in generic tests leading to no working solutions (aka you're depressed here's a prescription for an SSRI. Still depressed? We'll up the dose). My current psychiatrist figured out my main issues after talking to me for 15 minutes. Sent me off to a psychologist back up his assumptions before prescribing anything. Recommended therapists who specialize in the area I needed support in. The psychologist I went to was great as well (after seeing one that was a terrible). She did a lot of testing (three sittings lasting around two hours) but said the tests were really just to rule out other things. The important part were the conversations. My life improved tremendously after that.
- 512 1y ago
  How does one find a good psychiatrist/psychologist? My experiences have ranged from "very bad" to "OK at best" and I think finding someone a bit more invested into figuring things out might help a lot.

deleted 1y ago

[deleted]

tcj_phx 1y ago

In 2022 psychiatrist Chris Palmer MD [0] published Brain Energy [1], which shares his discovery of the 70+ years of science establishing that the behavioral/mental symptoms traditionally given 'psychiatric' labels are caused by metabolic problems. When you fix the body's metabolism the symptoms go away. Dr. Palmer recommends the ketogenic diet, but not all people need this specific intervention to improve their metabolism. I think the best place to start for most people is simply eliminating their consumption of white flour, or at the least, fortified white flour [2]. Dr. Palmer tweeted about anemia and Vitamin B-12 deficiency [3]. Many patients are prescribed synthroid (T4) for their thyroid, but they often still have all the symptoms of hypothyrodism because their body doesn't activate T4 -> T3. Adding a source of T3 to patients' Synthroid treatment can make a big difference in their behavioral symptoms. I have a book by some psychiatrists who were active in the 1940's -> 1950's, which is before the first 'psychiatric' medications were released. I didn't know this book was compiled by psychiatrists when I ordered it - I thought it was going to be a general book about the pro-metabolic intervention. It's unfortunate that the prescription drug industry never figured out why some of their chemicals help with the symptoms labeled 'depression'. The MAOIs were reasonably-effective at helping acutely-depressed people out of bed. Each generation of antidepressants was less effective than the previous, until the SSRI's arrived. Now we're stuck with antidepressants that have always been known to cause people to commit suicide. At least the psychiatrists are now revisiting MAOIs as an option for people who don't respond well to the suicide pills (SSRIs). Antipsychotics are a tragedy: anti-dopamine drugs make patients feel terrible. The one exception to the anti-treatment received by psychotics is an anti-serotonin drug approved for parkinsons psychosis [4]. [0] https://www.chrispalmermd.com/ https://www.chrispalmermd.com/ https://twitter.com/ChrisPalmerMD/ https://twitter.com/ChrisPalmerMD/ [1] https://brainenergy.com/ https://brainenergy.com/ [2] Flour manufacturers tend to use the cheapest fortifications possible. For example, the type of iron used for fortification is usually simply 'iron shavings', which usually becomes rust by the time it's absorbed. [3] https://twitter.com/ChrisPalmerMD/status/1903071654328111413 https://twitter.com/ChrisPalmerMD/status/1903071654328111413 [4] https://pmc.ncbi.nlm.nih.gov/articles/PMC5819716/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5819716/

Aurornis 1y ago
There are countless examples of past doctors claiming that psychiatric disorders are caused by some simple dietary issue. You can find people claiming that everything can be fixed by ketogenic diets, vegan diets, carnivore diets, Vitamin B12, niacin, magnesium, fish oil, you name it. For any vitamin or diet there is someone out there making passionate claims that it solves everything. None of these hold up under actual studies. It’s the domain of wishful thinking that sadly preys upon people desperate for answers. Some times the placebo effect works for a while, but usually people just end up with a cabinet full of supplement bottles and a history of fad diets with no progress on their condition.

andoando 1y ago

Ive been saying this forever. Even with single disorder like ADHD, per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD. So if someone has 6 symptoms how do you know theyre not all independently caused? Given a large enough population it's a guarantee

DANmode 1y ago
The shallowly buried truth here is that ADHD, CFS, and other common conditions are not standalone random diseases, but diagnostic names for groupings of common symptoms, caused by seemingly completely unrelated stuff ranging from childhood trauma, to a staph infection or mercury leak in a tooth root.
- thirdacc 1y ago
  I don't think ADHD in particular is caused by unrelated stuff. The heritability findings are pretty strong. > A study of 894 ADHD probands and 1135 of their siblings aged 5–17 years old found a ninefold increased risk of ADHD in siblings of ADHD probands compared with siblings of controls [2]. Adoption studies suggest that the familial factors of ADHD are attributable to genetic factors rather than shared environmental factors [3, 4] with the most recent one reporting rates of ADHD to be greater among biological relatives of non-adopted ADHD children than adoptive relatives of adopted ADHD children. The adoptive relatives had a risk for ADHD like the risk in relatives of control children [4]. > Twin studies rely on the difference between the within-pair similarities of monozygotic (MZ) twin pairs, who are genetically identical, and dizygotic (DZ) twin pairs, who share, on average, 50% of their segregating genes. The mean heritability across 37 twin studies of ADHD or measures of inattentiveness and hyperactivity is 74% (Fig. 1). A similar heritability estimate of around 80% was seen in a study of MZ and DZ twins, full siblings, and maternal and paternal half-siblings [5]. The heritability is similar in males and females and for the inattentive and hyperactive-impulsive components of ADHD [6,7,8]. https://www.nature.com/articles/s41380-018-0070-0 https://www.nature.com/articles/s41380-018-0070-0
  - 1y ago

oofbey 1y ago

The paper described makes a statistically rigorous attempt to recover common psychiatric diagnoses (like major depressive disorder MDD) from raw unbiased data about people’s experiences. And seems to conclude that the Venn diagram for common presentations of these conditions doesn’t line up well with the official diagnoses. Not that the conditions don’t exist. But that we are grouping together distinct conditions under the same name. They give examples of anhedonia and suicidality as distinct clusters in their data even though both would be considered MDD under the DSM. To me this begs the question of whether the DSM authors might actually know something real and useful that the data don’t show. For example that anhedonia often progresses to suicidality even though the two might not coexist in the same person often. (Doesn’t sound right to me, but that’s how I read the article.) I think it’s plausible that the direct implication of this research is actually wrong. The obvious conclusion is that the DSM is full of it and doesn’t match real people’s experiences. But I suspect it might be that the DSM captures useful correlations and progressions that this method didn’t collect. Perhaps because the data here are from a single point in time, not a progression.

bawolff 1y ago
Even still, wouldn't youvwant to separate X & Y are the same thing from X eventually progresses to Y. I think the most obvious conclusion is not that the DSM is bunk, but that some of things it groups together might be better to group separately. The real question of course is which grouping corresponds better to the group responding the same way to a similar intervention. After all the point diagnosing is to put people into groups so we can learn from the patterns of similar people to figure out better treatments.
- oofbey 1y ago
  Fair point. I agree. If there’s structure in people, the DSM should capture it. MDD phase 1,2,3 would be a useful update.
rusk 1y ago
To me the conclusion is that the DSM is out of date. Not the document, or specific iteration itself but the mindset driving it. When DSM was simpler and we didn’t know as much about mental illness, then what DSM was trying to achieve wasn’t such a tall order, and it was a useful diagnostic companion. However it seems to me it’s gone from being merely useful to being considered canon, and through successive iterations has tried to fill those boots to the point where people are calling out the DSM as being entirely flawed when in fact what is going on is it’s just stepping out of its bounds.

Wendycutler06 1y ago

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dboreham 1y ago

The DSM exists to satisfy US medical insurance industry which requires the patient be diagnosed with a specific "condition" before they will pay for anything.

oofbey 1y ago
That’s one reason. Another less cynical reason is to ensure professionals mean the same thing when they use specific words. Brains are complicated, of course. Making predictions about how one person will react to medication based on their experiences is very difficult. Being able to collect data and group it consistently makes this prediction task much easier. “We known that many people who answer these questions with these answers improve after taking this medicine.” That’s genuinely useful, needs the DSM or something like it, and has nothing to do with insurance.
halayli 1y ago
you've checkboxed two fallacies with one stone: motivated reasoning, and attribution of malice. I am defending reasoning and logic here, not insurance industry. what you said might be true but you need to back up your claims.

moi2388 1y ago

This is a good start, but it still clusters based on symptoms It’s like going to the doctor and getting an HIV diagnosis because you’ve got a runny nose.

SiempreViernes 1y ago
That's how all diagnosis starts, what did you expect?
- moi2388 1y ago
  Start. But in psychology, it’s the end of it. With actual doctors, they will take blood work, perform tests to find the actual virus, bacteria or other cause. They find the cause, not just a list of symptoms. Psychology and psychiatry is only now starting to actually research causes.
perlgeek 1y ago
It's like going to the doctor and getting a runny nose diagnosis because you've got a runny nose. In the end, a diagnosis only helps the patient if it enables a treatment, hopefully an effective one. If you have a cluster of symptoms with two possible causes, and there is no difference in the care for the patient, what's the point of further differential diagnosis?

ryanjshaw 1y ago

Important to note the various limitations of this approach: > It relies only on self-reported symptoms, and features requiring clinician observation are missing; symptoms are decontextualized (e.g., insomnia due to substance withdrawal isn’t differentiated from insomnia due to anxiety); all symptoms were assessed using a 12-month time scale, even though different symptom patterns exist at different time scales. In particular, I’m not sure how this would identify somebody with the traditional schizophrenia + anosognosia combo, which requires another person to help diagnose.

TeeMassive 1y ago

Every time I read a part of the DSM-V, as a layman, I'm flabbergasted how vague and redundant and arbitrary symptoms and diagnostics are made (e.g. "if 6 out of 10 then..."). It just seems that on its face, while psychiatry has improved and began doing more good than harm since deinstitutionalization, it still lacks the rigor found in other applied scientific fields such as cardiology and oncology for example. This study is a very good step in the right direction. The other direction is more quantitative methods such as measuring the brain waves response to a retinal laser flash to detect mental disorders (look it up, it's real)

mwidell 1y ago

Could it be that everything we call mental illness is just natural variation of people's psyche, at the ends of the bell curve? Many of the mental illnesses are of course bad, but in an evolutionary perspective it makes sense that we have these variations in a population, to optimise adaptation.

AlecSchueler 1y ago
What do you mean by "natural variation?" A great many of mental health issues develop as a result of trauma. You could say that a broken leg is a natural variation of a leg, as it happens naturally as the result of physical trauma, but does that help you understand it or treat it better?
- mwidell 1y ago
  I mean natural variation as in genes. Trauma often triggers mental health problems, but there usually needs to be genetic susceptibility as a foundation for it to happen.
  - Fraterkes 1y ago
    I mean, sickle cell is arguably a "natural genetic variation" but we very much treat it like a disease.

Danjoe4 1y ago

Psychiatry is loosely based on science and 90% of the drugs they prescribe are net harmful

TeMPOraL 1y ago

I really like the approach, this is exactly what statistical tools are for. I like it all the way up to the very end, where I feel this report drops the ball, in trying to derive a hierarchy from the results. Hierarchies don't exist. Nothing in nature is organized in trees (data structures), not even actual trees (the other kind). Organization, relationships, form directed graphs (or the continuous domain equivalent). Hierarchies are deceptively simple because they planarize, meaning you can draw them on paper without crossing lines, or introducing indirect references. But that's often as deceiving as it is helpful. Think of the "tree of life" - there is no one tree of life, its shape depends on which aspects of phenotype or genotype you select and organize around. Think of corporations and governments - you can either accept there's a lot of "dotted lines" in the org chart, turning it into a dense DAG, or never understand why people do what they do. And so here, it's also quite apparent there are correlations cutting across the proposed hierarchy, clearly visible even on Figure 2 - the one that urges us to disregard the left-to-right ordering of the constructs. I mean, the researchers are likely perfectly aware of this. My worry is that 90%+ of the insight of the proposed model will get lost in final planarization into a hierarchy that gets into the next DSM.

dr_dshiv 1y ago

This is very much in line with the research-alternative to DSM— the so-called RDoC — which takes a clustering vs category approach: https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/about-rdoc https://www.nimh.nih.gov/research/research-funded-by-nimh/rd...

nraynaud 1y ago

I'm very happy that they are trying to re-classify the DSM, it's probably the sign of a maturing medical field. Let's also hope that re-clustering will help with the reproduction crisis.

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