Spikes in mental disorder are usually due to studies who hire cheap labor with poor clinical discretion
Every so often, the newspaper will report that rates of mental disorder are climbing, sometimes dramatically. The best current examples are autism and ADHD. Don’t believe the numbers. The “rates” have been generated by psychiatric epidemiologists, using a method that is inherently flawed and systematically biased in the direction of overreporting.
How can an entire field of scientific endeavor have gone so far astray? It comes down to simple dollar-and-cents considerations. Epidemiological studies have to sample huge numbers of people in the general population, usually using telephone interviews. It would be too expensive to employ clinicians in so extensive an endeavor—so the studies rely on the cheap labor provided by lay interviewers who have no clinical experience and no discretion in judging whether symptoms are clinically meaningful. They make their diagnoses of psychiatric disorders based on symptom counts alone with no consideration of whether the symptoms are severe or enduring enough to really warrant diagnosis or treatment.
This results in rates that are always greatly inflated. Psychiatric symptoms in mild form are widely distributed in the general population—from time to time, almost everyone will have some sadness or anxiety, and others may have difficulty concentrating or be a bit eccentric. But isolated or mild symptoms alone do not define mental disorder—they must cohere over time in a specified way and also cause significant distress or impairment. Epidemiological studies routinely ignore these crucial requirements. They mistakenly diagnose as mental disorder symptoms that are mild, transient, and lacking in clinical significance.
Results generated in this rough-and-ready way are no more than an upper limit on the prevalence of any given mental disorder. They should never be taken at face value as a true reflection of the real extent of illness in the community. Unfortunately, the exaggerated rates are always reported without proper caveat and are accepted as if they are an accurate reflection of the real prevalence of mental disorder.
References
- Frances, Allen. (2013). Saving Normal CHAPTER 3. Diagnostic Inflation (p. 123). New York, NY: HarperCollins.
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Type:🔴 Tags: Psychiatry Status:☀️