1 in 5 Young Adults Have Personality Disorder, Study Finds

[Baby Nemesis]

?! Happily I missed that post or part. "Ignorant" is being kind.

I don't think anyone's said anything that extreme in reality. I think there's been a bit of misreading going on in this thread by a couple of people.

 

[Baby Nemesis]

And of course, Psychology in general invites this type of criticism in that practitioners tend to use what works and saves lives, even if the mechanism at work is not yet understood. The test is "Does it work?" not "Why does it work?" when you are out in the field.

I'm glad someone understands that.

 

[technoextreme]

I'm glad someone understands that.

Except you don't. Psychology may not understand what is going on but if you do the science correctly you know that there is an effect. It's extremely hard because of the subjectiveness of the field but it can be done.

Would you, in a state of distress as you were, refuse to listen to anything that might help you, simply because it hadn't been subject to rigorous scientific testing?

Yes because I would be falling for one of the same tricks that woo hucksters use.

 

[Big Les]

I am not part of the Church of Scientology, nor, as far as I know, is any of the two professors that speak in the videos.

Wrong. Szasz FOUNDED "CCHR" along with the CoS. In their own words (note that link goes direct to CCHR website).

I have no idea why he would align himself with such an oppressive and controlling organisation, since as far as I can see, his views coincide ONLY as far as being anti-psychiatry goes. If he applied his own standards to "auditing", "purification rundown", the RPF, and the rest of CoS's bogus circus, he would surely have just as much issue with them as he does with psychiatry. He, and anyone else wishing to reform (or even, and I disagree "globally annihilate") psychiatry, would do well to distance themselves from Scientology - at the least it gives them no credibility. At worst they support a group who would see the entire world under their money-grabbing and restrictive influence. Ironic, eh?

Dancing David - I totally agree with you, and your rant. You only have to see your own mother try to kill herself once to appreciate that despite any faults, mental healthcare is a necessary thing.

ETA - interesting BMJ letter (PDF) from an ex-CCHR person who seems to have realised what the "sponsoring organisation" was really all about.

ETA2 - and a response to a piece by Szasz from the editor of the BMJ. He favours the "it's how science advances" argument, which I find persuasive. Look at the malpractice and wrongheaded approaches (ressurectionists etc) that plagued surgery's early years.

 

[Baby Nemesis]

Except you don't. Psychology may not understand what is going on but if you do the science correctly you know that there is an effect. It's extremely hard
because of the subjectiveness of the field but it can be done.

You seem to have totally missed the point here. The point wasn't that psychologists typically throw up their hands in resignation because they can't work out why on earth something works, or that they don't see the need to bother finding out why it does. The point is that if you have an idea that proves to work with several of your distressed clients, but you're not sure why it's working, you're not going to hold off on doing it till you've investigated several analytical scientific tests to find out exactly why it's working, and whether or not strict tests have found it does.

That's not to suggest there's no need to bother. Of course a psychologist should keep up with the research and not try anything obviously risky. But being cautious to the point of nonsensicality just because something hasn't been rigorously scientifically tested is counter-productive at the least, since it might stop you helping many people over distressing situations.

OK, here's an example:

You're a fairly new therapist. Someone comes to you saying they're self-harming. They say they fairly regularly make deep cuts on their arms and legs with a razor blade, and sometimes burn themselves with a cigarette lighter instead. You know that if they get an infection, or if they cut their wrists too deeply, they could even die. You know that to tell them they have to stop self-harming while they're in therapy with you might backfire, since they'll feel control is being taken away from them, and that's one of their triggers to self-harm. Plus they might drop out of therapy.

Your therapy training didn't teach you any short-term strategies for stopping self-harming. But you've spoken to several clients who've managed to stop self-harming after they've been to online support groups where they've been given ideas for what they can do when they want to self-harm that might relieve the urge, who have told you how they've done it, so you know you could give this client some quick advice that just might help them cut down the risks to themselves. Things that have worked for other clients till they've dealt with the underlying causes of their desire to self-harm have included:

• taking a warm bath
• listening to music
• going for a walk
• writing in a journal
• Drawing red lines on themselves as a substitute for blood
• Drawing a picture of whatever or whoever is making them angry
• Painting something creative
• Gently massaging the bit they would normally harm, while telling themselves they're a worthwhile person who doesn't deserve to be hurt
• Doing household chores, like cleaning
• Doing some cooking
• Doing some sewing or embroidery
• Taking a pen in the fist and scribbling vigorously on thick paper.

Now, you can speculate as to why these things have worked for other clients. But you don't really know. In fact, you're quite surprised that some of them work at all. But instead of allowing this client to go on putting herself at risk by self-harming, you want to tell her about what's helped others, even though you don't know why it works. You know not everything works for everyone, and that some things might even make some people want to self-harm more, for instance if someone looks at the red lines they've drawn on themselves, and rather than it being a satisfactory substitute for blood, it makes them want to cut themselves more. But instead of not telling this client anything because you don't know if it's been scientifically tested, and some things might make her want to self-harm more or might not work for her, you decide to caution her that some things might not work, and advise that if any of them make her feel worse, to stop and try something else.

Imagine you were speaking to a therapist who had such a client. Now, what, with your insistence on the scientific method and your harsh disparagement of anecdotal evidence, would you suggest such a therapist does? Refuses to pass the information on to the client because it's only anecdotal and hasn't been scientifically tested, even though you know it's helped several people, and if the therapist doesn't pass it on, you know the client will be putting herself at risk as much as before?

Yes because I would be falling for one of the same tricks that woo hucksters use.

So anyone who tries to give someone advice on a support forum based on things that have helped them personally is using huxter's trickery to spread woo??

I don't believe your claim for a second. Let me give you a scenario:

You have schizophrenia. When you're in your delusional state, you hear frightening voices telling you people are out to get you. They torment you by telling you that everyone around you is talking about you, plotting how to hurt you. You're even more scared, because you hear a voice telling you you're damned to hell because you're so evil. It keeps telling you that till you get so scared you wonder if it's the devil and that the voices tormenting you are demons.

You go to the doctor, and he puts you on medication. This gives you some relief from the voices, but it gives you severe tremors and spasms, which are embarrassing when you're out in public and make you look crazy. Other side effects worry you. You go back to the doctor and tell him, and he changes your medication to a newer drug without the old side effects. This again helps with your voices, but you develop breathing difficulties as a side effect of this one.

One day, you strike up a conversation with someone who you find out is also schizophrenic. But they don't seem to have any of the horrible side effects from their medication that you do. You're curious.

You're desperate for a drug without side effects, or by now, for any other information you could try that might help. So you're pleased when they tell you they managed to reduce the dose of their medication, and thus their side effects, by doing various things that dull their voices, including going around with a trusted friend sometimes who they know will tell them honestly if they can hear anyone plotting harm against them, so they can tell how accurate their voices are; drowning the voices out with music for a while and then turning it down, since they've noticed that when they turn it down, the voices get quieter with it; giving their nasty voices names and imagining they're like school bullies they used to know who they can tell to go away and know they don't need to be frightened of because they're only lying; and other such things.

No, you don't call them a woo huxter. You don't disparage them because what they're telling you hasn't been scientifically tested. No. You're so pleased that something other than medication just might work for you, and that there are techniques that'll help you be reassured that your voices aren't harmful after all, that you resolve to try the techniques out, to see if with extra help dulling your voices, you might be able to get your dose of medication reduced as well, and stop worrying about where the voices are coming from and whether they're real so much.

At least, it would take an extreme form of dogmatism to resolve to reject anything that hasn't been rigorously scientifically tested as huxter's woo, after you've been terrified by your symptoms, and distressed by your medication.

 

[Ivor the Engineer]

<snip>

...giving their nasty voices names and imagining they're like school bullies they used to know who they can tell to go away and know they don't need to be frightened of because they're only lying; and other such things.

My mother's next door neighbour appears to do something very similar, except I don't think she has given the voices she hears names. She just yells and curses at that them.

Very, very loudly.

Usually between the hours 10pm to 6am.

 

[Baby Nemesis]

Ah. Perhaps she could do with advice from someone on a support group who could suggest a better way of dealing with them, ... like writing down her responses instead, perhaps.

ETA: Disclaimer: Of course medication is the best first-line defence against schizophrenic symptoms, if she can be persuaded to seek medical help.

 

[Dancing David]

I think it means the procedures for diagnosing mental illnesses suck.

Brave words. How much do you really know about assessment and diagnosis?

I mean really Ivor, are you a trained professional (as I was), do you really know anything about it? Should I judge the training and professionalism of a class of engineers based upon the multiple anecdotes of people who fake engineering reports and the like?

What would be the rate of false diagnosis based upon false presentation for any medical condition?

I think you are ignorant on the subject and just full of bombast.

So why don't you magic up something from your 'hard science' , I was very accurate in my assessments, I had done many of them. Over 400 at one job and 300 at another. Not including crisis line work and domestic violence screenings.

I think it should matter because I believe it is important to be able to correctly identify people with specific mental illnesses from those who are well,

Excuse me! Where is your data, I call you out again!

What data do you have that there are any, much less a specific high proportion of people who are getting treatment for mental illness who are well?

Your anti-medicine bias is showing and I call you on it.


Where is your data Ivor? is it from this century? Or is it just a product of you pretending to know about something you don't?

What is the rate of presentation for back pain in medication seeking?

What would your magic engineering bag of tricks do about it?

I can fake deer prints in the forest that does not mean that deer don't exist. If you went to a mental health center you would find that
Most people are reluctant to seek treatment for mental health. and your ignorance is rather typical of the medieval stigma associated with mental health treatment.

So where is your data?

or have different mental illnesses, before applying labels and handing out medication.

Oh great, so a doctor with limited information, history and resources, talking to an individual without a trained knowledge of what they are experiencing is supposed to let people suffer from symptoms because you have some archaic impression of what you think mental health treatment should be?

You are a bigot and prejudiced, you are stuck in some sort of moral blaming of people with a medical condition.

So you want doctors to do what instead? Let people kill themselves, loose employment, housing and social support because of your anti-medicine bias/

[b[What evidence do you have that people are being treated for mental illness who are well?[/b]


For your lack of information (called ignorance), do you think that doctors are less of a professional than you are, do you think mental health professionals are less professional than you are?

The presentation of an individual with highly negative schizophrenia and depression are going to be very similar. Often people in the early phases of schizophrenia look a lot like people with mania. the patients themselves have no clue about what they are going through.

So what would doctor Ivor do, besides make empty pronouncements based upon ignorance?

What would you do, you have a twenty five years old woman, two children, estranged from her spouse, and she reports that she is sleeping four hours every other day. She reports that she is about to be homeless and loose custody of her children. the clinician who did the assessment says that she has symptoms of mania, hypomania, depression and mild psychosis. her level of functioning is sufficient to prevent harm to herself and her children. She is unable to work due to flight of ideas and inattention. She has no family support.

What are you going to do?

"I am sorry mam, since I have no means of a definitive blood test to determine why you have these symptoms, I am discharging you to your house."

Well Dr. Ivor? What is your recommendation?

No, I'm denying the existence of sensitive and specific diagnostic tests for mental illnesses.

okay, so what are you going to do about it?

Discharge that women without any palliative relief, without any way to manage her symptoms?

 

[Baby Nemesis]

David, I think you're being over-emotional and thus unnecessarily defensive. No one's attacking you, and you're reading far more into things people have said than you should be doing. You're not going to persuade anyone of anything by being abusive. Perhaps you should go away and calm down for a while.

OK, I've got something, from a professional therapist. No, not a Human Givens one this time, although they do claim that it's far more sensible to treat distressing symptoms individually than to slap a diagnosis on someone and then treat them according to expectations of them based on what you'd expect from someone with that diagnosis. Sounds sensible to me.

No, here's a word or two from another therapist, called Matthew Selekman. From a book about treating people who self-harm called Living on the Razor's Edge. He first discusses a few myths about teenagers who self-harm that therapists and others often hold:

... "Self-Harming Adolescents Are Borderlines"

The intimidating and repulsive nature of adolescents' deliberate brutalization of their bodies by burning or cutting themselves with sharp objects often leads therapists to gravitate toward an equally nightmarish diagnostic label for them: borderline personality disorder (Caplan, 1995; Lennan, 1996; Kutchins & Kirk, 1997). Therapists who frequently use this diagnosis with self-harming clients are probably clinically informed by the adult borderline personality disorder literature, which indicates that self-mutilation and other forms of impulsive behavior are considered major diagnostic features of borderline clients (Linehan, 1993; Kernberg, 1975; Masterson, 1981). However, as indicated by leading authorities in the area of self-injury and as can be seen by the case examples described in this book, adolescent self-harming clients do not engage in this behavior because of an underlying personality disorder (Conterio & Lader, 1998; Alderman, 1997). There are a multitude of reasons why adolescents engage in self-harming behavior. Brown (2000) contends that the borderline personality disorder diagnosis is often assigned to clients who "create discomfort for the powerful [therapists]" (p. 302). Not only is the borderline label one of the most stigmatizing labels an adolescent can be given, but it also is inaccurate: According to DSM-IV, a client must be at least 18 years old to receive this diagnosis!

"Most Self-Harming Adolescents Have Been Sexually or Physically Abused"

More often than not, therapists who are referred self-harming adolescents tend to formulate diagnostic impressions and entertain possible labels for their new clients based on the available intake information, such as drawing the immediate conclusion that there must be a history of sexual or physical abuse in the clients' backgrounds (Brown, 2000; Caplan, 1995; Dawes, 1994; Gergen & McNamee, 2000; Raskin & Lewandowski, 2000). ... At all costs, therapists must avoid being privileged "experts" and editing their clients' stories. I have worked with far too many adolescents who, pushed by their previous therapists to "work through" their past traumatic experiences, ended up increasing their self-destructive behaviors or tried to kill themselves. ...

 

[Ivor the Engineer]

Here's an interesting article:

http://ajp.psychiatryonline.org/cgi/reprint/160/1/4.pdf

Objective: The meaning of the terms “validity” and “utility” as they apply to psychiatric diagnoses is examined.

Method: The authors discuss the concepts of validity, utility, and disease; review assumptions that have been made about mental disorders as disease entities; and examine the evidence that mental disorders are separated from one another and from normality by natural boundaries (zones of rarity).

Results: Despite historical and recent assumptions to the contrary, there is little evidence that most currently recognized mental disorders are separated by natural boundaries. Researchers are increasingly assuming that variation in symptoms is continuous and are therefore questioning the validity of contemporary classifications.

Conclusions: It is important to distinguish between validity and utility in considering psychiatric diagnoses. Diagnostic categories defined by their syndromes should be regarded as valid only if they have been shown to be discrete entities with natural boundaries that separate them from other disorders. Although most diagnostic concepts have not been shown to be valid in this sense, many possess high utility by virtue of the information about outcome, treatment response, and etiology that they convey. They are therefore invaluable working concepts for clinicians.

 

[Dancing David]

David, I think you're being over-emotional and thus unnecessarily defensive. No one's attacking you, and you're reading far more into things people have said than you should be doing. You're not going to persuade anyone of anything by being abusive. Perhaps you should go away and calm down for a while.

I am not baiting you , nor will I respond to your posts. You are off base still. If Ivor continues to play his anti-medicine games, I will call him on it.

Maybe you should learn who you are talking to before you give out such advice.

OK, I've got something, from a professional therapist. No, not a Human Givens one this time, although they do claim that it's far more sensible to treat distressing symptoms individually than to slap a diagnosis on someone and then treat them according to expectations of them based on what you'd expect from someone with that diagnosis. Sounds sensible to me.

No, here's a word or two from another therapist, called Matthew Selekman. From a book about treating people who self-harm called Living on the Razor's Edge. He first discusses a few myths about teenagers who self-harm that therapists and others often hold:

If you were open minded, then I would discuss this you, back off the matronizing attitude and I might.

Most personality disorders are incorrectly diagnosed, they have no meaning except as a short hand of behavior. They also become ways of dismissing personal and clinical accountability. Considering that 19 of the twenty borderlines I worked with had a major alcohol problem, they were misdiagnosed.

As I said. I know my way around psychosocial rehab and DBT as well. I like it, some prefer the other model.

 

[Dancing David]

Here's an interesting article:

http://ajp.psychiatryonline.org/cgi/reprint/160/1/4.pdf

Evasion noted, not relevant to your comments Ivor. The utility of the diagnosis is the only meaning is has, which if you weren't ignorant, you would already know.

So where is the data about 'well' people receiving treatment, you said it, where is it?

"correctly identify people with specific mental illnesses from those who are well" is what yous aid, so someone has suicidal ideation, they present with a plan to commit suicide, by means that are accesible to them, They appear to have a mixed presentation of florid psychosis (auditory hallucination, paranoia, intermitent aphasia), they are also presenting with florid symptoms of mania (they talk quickly, they have flight of ideas, gradiosity, they and their room mate report they have not slept for more than two hours a day in the last three weeks.)

So by your standard the doctor should do what? Just lock them up until they can determine a diagnosis? discharge them at high risk of self harm?

You present what you think they should do, your words present that you feel that should not be treated because there is not a clear cut diagnosis. So what do you think should be done?

 

[Ivor the Engineer]

Evasion noted, not relevant to your comments Ivor. The utility of the diagnosis is the only meaning is has, which if you weren't ignorant, you would already know.

So where is the data about 'well' people receiving treatment, you said it, where is it?

<snip>

I do recall a thread on another sub-forum about homosexuality being considered an mental illness in need of treatment not so long ago.

 

[luchog]

OK, let me go into more detail about what I meant. Making incautious accusations which you may discover later were erroneous will only make you look bad.

*yawn* Yet another attempt to personalize the debate when you've been shown to be wrong.

Here's some information on non-drug treatments that have been proven to help schizophrenic patients in combination with medication. There are treatments out there that can both reduce the amount of medication needed, and can help with symptoms medication doesn't help with. I'll elaborate on non-drug treatments:

Nope, wrong again. Not non-drug treatments, but treatments used alongside of drug therapy. Note that they don't eliminate drug therapy, merely miminize the necessity through environmental control, which is exactly what I said in my previous post.

In the few cases where treatment has been effective without any drugs, the chances are very high that the original diagnosis of schizophrenia was erroneous, and another disorder was involved.

And these appear to be only short-term studies; not enough lifetime studies. All forms of schizophrenia are degenerative; and the only adequately demonstrated to slow (not stop) that degeneration so far is medication.

The fact that relapses can be prevented when non-drug treatmentss are added to a medication regimen suggests that things in the environment are contributing to relapse.

Contributing, not causing. You need to get that difference straight.

"Correlation is not causation."
"Contributing doesn't mean sole cause."
"Controlled does not mean cured."
"Misdiagnoses happen."

And there's no quantification of said contribution.

Not only that, research is still investigating the possibilities that things like stress trigger off first episodes of psychosis in people with a genetic vulnerability. For instance, from an article called Raised Incidence Of Psychoses Among Migrant Groups In UK Revealed By Research:

I see you missed that "Psychoses" bit. Not all psychoses are schizophrenia. In any case, the article is based on a very small, localized sample, and has yet to be replicated. It's interesting, but certainly doesn't rule out genetic causes like you seem to indicate.

So far, the only well-established eitiology for any schizoform disorder is a genetic pre-disposition triggered by a pre-natal viral infection. Environment can exacerbate symptoms, but doesn't appear to have that much effect on

You acknowledge that the word schizophrenia is in fact a term for a spectrum of diseases similar in manifestation, and then you go and talk about it as if it's a single entity, by denying cannabis could possibly have an effect on it. In fact, some experienced scientists and psychiatric workers have concluded that there is a form of schizophrenia which is brought on by cannabis, a little different from the usual.

For more information on the latest research, see, for example: Schizophrenia Linked To Dysfunction In Molecular Brain Pathway Activated By Marijuana

Sorry, that's not the latest research. That study has already been disproven. As I said earlier, I posted info a more recent study that conclusively disproves the cannabis-schizophrenia link.

And here's just one of those people who thinks there's a form of schizophrenia related to substance misuse: 'Substance Dependency-Induced Psychosis' (SDIP)

You really need to learn to read more carefully. Even the text you posted refutes your claims.

SDIP resembles schizophrenia, which it's usually diagnosed as. It is also nearly as common as schizophrenia.

Resembles, not is. The article is careful to differentiate between SDIP and schizophrenia. You should do the same.

Most cases of "full recovery from schizophrenia" are actually cases of SDIP, where the persons have stopped their addictive substance use.

Again, SDIP and schizophrenia are similar, but unrelated disorders. The fact that SDIP is often misdiagnosed as schizophrenia means exactly nothing beyond the fact that they appear similar.

From the website whose information you unfairly disparaged:

Complementary Schizophrenia Treatments

I didn't disparage it. I stated, and demonstrated, that much of their information is outdated and unproven, and much of the rest of the says something different from what you claim it said.

In any case, they put too much emphasis on unproven treatments, many of which are merely old, disproven treatments with new jargon and a fresh coat of paint.

There are several other interesting techniques out there.

"Interesting" does not equal "useful".

a "self-help" book doesn't necessarily mean a book that says you have to do everything it suggests by yourself.

Nor does it mean that it's necessarily helpful to anyone or anything but the author's bank account. There's a reason why reputable medical journals don't publish "self-help" texts.

 

[Dancing David]

I do recall a thread on another sub-forum about homosexuality being considered an mental illness in need of treatment not so long ago.

Okay, evasion noted. You, as usual, did not couch your statements in terms of past practices based upon social/cultural prejudice. Did you?

Nope you used the presnt tense. in other words you made rash statements that you can not support. There are not , from the data you have presented, a large number of people who are currently receiving mental health treatment that are actualy well.

As usual for anti-medicine people you make blanket statements based upon errouneous information unrelated to the issue at hand. Now if you wish to discuss the well know problems of diagnosis and treatment, That is fine.

This is what you said

I think it should matter because I believe it is important to be able to correctly identify people with specific mental illnesses from those who are well, or have different mental illnesses, before applying labels and handing out medication.

So what current treatments and categories are you addressing?
What alternative do the doctors and clinicians have Ivor?

What specific issue do you think need to be addressed? I have discussed these issues rationaly in many athread and will do so. But you have not said what you are talking about.

-Patient freedon to not have talk therapy?
-Medication seeking?

 

[Ivor the Engineer]

David,

You asked for me to provide evidence to back up my statements, which I have done. You merely asserting that my presentation of this evidence are evasions makes you appear foolish, which I know you are not.

If you want an example of a contemporary psychiatric diagnosis which is being used to label healthy people as ill, I (and more importantly medical professionals) would say ADHD is over-diagnosed in children and adolescents.

As with all diagnoses based on cognitive ability and behaviour there is going to be a large sociological input into what is classed as pathological. Thus when society at large considered homosexuality as "wrong", it was seen as a disease. Women who could not orgasm from penetrative sex were considered abnormal.

Now, if you have anything of substance to discuss with me then I will be happy to continue. If all you are interested in doing is making unfounded inferences about what I believe then I will let you get it out of your system and engage with you when you are of a more rational mind.

 

[Dancing David]

If you want an example of a contemporary psychiatric diagnosis which is being used to label healthy people as ill, I (and more importantly medical professionals) would say ADHD is over-diagnosed in children and adolescents.

Data and evidence please, it is often asserted but unsupported, it is a label which would fall into the category de jure (With juvenile bipolar in the lead followed by aspergers), but often it is applied as a label in schools, when it i snot warranted. However given the effects of the mdeication (which are the opposite in people with ADHD), the symptoms will always get worse in a 'well' child.

So where is your data that psychiatrists are prescribing to individuals who do not have ADHD?


Nice assertion Ivor, where are the numbers and samples?
Data, research, evidence?

 

[Ivor the Engineer]

<snip>

So where is your data that psychiatrists are prescribing to individuals who do not have ADHD?


Nice assertion Ivor, where are the numbers and samples?
Data, research, evidence?

Here's one report of research done by a pediatric psychologist.

http://www.ajph.org/cgi/content/abs...INDEX=0&sortspec=relevance&resourcetype=HWCIT

OBJECTIVES: The purpose of this study was to determine the extent of medication use for attention deficit-hyperactivity disorder (ADHD) in southeastern Virginia. METHODS: Students enrolled in grades 2 through 5 in school districts in city A (n = 5767 students) and city B (n = 23,967 students) were included. Nurses recorded students who received ADHD medication in school. RESULTS: The proportion of students receiving ADHD medication was similar in both cities (8% and 10%) and was 2 to 3 times as high as the expected rate of ADHD. Receipt of drug therapy was associated with social and educational characteristics. Medication was used by 3 times as many boys as girls and by twice as many Whites as Blacks. Medication use increased with years in school, and by fifth grade 18% to 20% of White boys were receiving ADHD medication. Being young for one's grade was positively associated with medication use (P < .01). The prevalence of ADHD was 12% in district A, 63% in district B. CONCLUSIONS: These findings suggest that criteria for diagnosis of ADHD vary substantially across US populations, with potential overdiagnosis and overtreatment of ADHD in some groups of children.

ETA: Here's what happened to LeFever after she published her work:

http://www.bmj.com/cgi/content/full/330/7493/691

Researcher to be sacked after reporting high rates of ADHD

New York Jeanne Lenzer

A US researcher who said that doctors and psychologists may be overdiagnosing attention deficit hyperactivity disorder (ADHD) in children has been placed on administrative leave “with intent to terminate” her employment. The move came after charges of scientific misconduct against her, and her computers have been seized.

Dr Gretchen LeFever, a clinical psychologist and associate professor in the department of paediatrics at the East Virginia Medical School, was notified that the school intends to terminate her employment with effect from the end of March.

Her work has been controversial. She first made headline news in 1999 when she reported that 8% to 10% of elementary school pupils in southeastern Virginia were being prescribed drugs for ADHD, a percentage two to three times the estimated national average (American Journal of Public Health 1999;89:1359-64).

Criticism grew after she published the results of a 2002 study showing that the prevalence of the disorder among children in grades 2 to 5 had risen to 17% (Psychology in the Schools 2002;39:63-71).

But she was cleared of all charges:

http://www.bmj.com/cgi/content/full/331/7521/865-a

Researcher cleared of misconduct charges

New York Jeanne Lenzer

A US researcher who was charged with scientific misconduct after she reported that doctors and psychologists may be overdiagnosing attention deficit hyperactivity disorder (ADHD) in schoolchildren has been cleared of all charges.

Gretchen LeFever, a clinical psychologist and associate professor in the department of paediatrics at the Eastern Virginia Medical School, was told earlier this year that her federally funded research was terminated and that her employment would also be terminated by the medical school after anonymous charges of scientific misconduct were filed against her (BMJ 2005;330:691).

The school seized her computers, saying that Dr LeFever had held a research trial without getting informed consent from the participants.

Dr LeFever had previously been charged with scientific misconduct—and later cleared by the school—after allegations by an anonymous whistleblower of changing the wording in a questionnaire published in Psychology in the Schools (2002;39:63-71) from that actually used.

The school’s most recent actions triggered international outrage. Thirty nine psychiatrists and psychologists signed a petition that they sent to the medical school’s president, saying that instead of threatening to fire Dr LeFever, the school "should have commended and promoted her for having the courage to be among the first to sound the alarm about these concerning trends."

 

[Baby Nemesis]

Here's an interesting article:

http://ajp.psychiatryonline.org/cgi/reprint/160/1/4.pdf

I'm glad they're looking into this and taking it on board. It could prevent things like psychiatrists medicating for disorders when they later decide people have different illnesses entirely and thus need different treatments. I've mentioned someone on the board before who had to put up with that kind of thing.

So where is your data that psychiatrists are prescribing to individuals who do not have ADHD?

For general interest, rather than to inform David of things he's going to get angry about being told because he's well aware of them already:

Here's a news article about a study that found that children with ADHd were given medication when therapy would be better, which is of course a different thing, but a problem that could do with airing:

Drugs for ADHD 'not the answer'

Treating children who have Attention Deficit Hyperactivity Disorder (ADHD) with drugs is not effective in the long-term, research has shown.

A study obtained by the BBC's Panorama programme says drugs such as Ritalin and Concerta work no better than therapy after three years of treatment.

The findings by an influential US study also suggested long-term use of the drugs could stunt children's growth.

It said that the benefits of drugs had previously been exaggerated. ...

"There's no indication that medication's better than nothing in the long run."

Prof Pelham said there were "no beneficial effects" of medication and the impact was seemingly negative instead. ...

That's not to say that people with ADHD should never be medicated, since it's believed there might be chemical and genetic risk factors. I just don't think medication should ever be considered the only option.

 

[Iconoclast08]

Here's one report of research done by a pediatric psychologist.

http://www.ajph.org/cgi/content/abs...INDEX=0&sortspec=relevance&resourcetype=HWCIT

Ivor-

While this is certainly something to consider in conjunction with additional evidence (if you have any, I would be genuinely interested in viewing it), it is worthwhile to mention that this particular review study was based solely on prevalence rates. It's also pretty crummy that the only third-party verification was, quote, a "nurse research assistant" who merely reviewed records to "verify the accuracy of the school health database" (p. 1360). Currently, the gold standard for ascertaining diagnostic accuracy is conducting what are called inter-rater reliability studies where multiple licensed clinical psychologists conduct diagnostic interviews blind with respect to one another and then compare Axis I and II decisions afterward. If there are good studies out there demonstrating that Cohen's Kappa coefficients (index of inter-judge reliability with nominal/categorical diagnostic outcomes) are weak, then those would definitely be worth serious consideration and would marshal evidence for your position. Do you have any of those on hand to put on the table?

With prevalence rates, there are just too many other rival explanations that threaten the accuracy of the claim. And to preface this, "rival explanations" does not mean that I think these are necessarily true, but rather that they cannot be definitively ruled out based solely on prevalence rates. Just for starters, the number of diagnostic predictions do not necessarily speak toward the accuracy of those predictions per se. Base rate estimates are not always necessarily accurate, either. It could be that ADHD is actually more prevalent, and the increase in dx's is more on the mark. There really isn't a sure-fire way to rule this out just given prevalence statistics.

As a piggy-back onto this point, perhaps clinicians/diagnosticians are better trained in ADHD detection than previously and they are getting more true positives. Again, with just prevalence and DSM-IV-TR Task Force estimates alone (and God knows the latter have been way off base in the past), we cannot accurately disentangle false positives (Type I error rates), false negatives (Type II error rates), true positives, and true negatives.

Dancing David is correct to cast skepticism on this claim. I certainly have considered the possibility that certain disorders are over-diagnosed, but again, I think it's better to exercise caution with a lack of better quality evidence.