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Comment by phren0logy | Hacker News Reader

>"I've become really disillusioned with clinical psychology because of things like this."

I agree with your points about people using diagnostic jargon in conversation in a way that distorts its meaning. I'm sure that happens in other fields also, but speaking as a psychiatrist one thing that I have noticed is that it tends to make people feel like experts on mental health when that conclusion is not justified. There are, however, relatively specific technical definitions for terms like Bipolar Disorder and ADHD. This article doesn't use them, but it's not being published in a peer-reviewed journal.

Don't let this article disillusion you, because it's not about clinical psychology or by a clinical psychologist. It's by someone with some interesting observations who is mis-applying technical terms.

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I wasn't really referring to the article in particular; I was more just ranting about something that I was thinking about before that the article reminded me of.

I think the problem runs a bit deeper than people thinking they're experts when they're not, though. I think when most people try to diagnose themselves, they look online for symptoms and such. If they already have some conviction in their diagnosis, they might think that they should also have other symptoms when they don't, or start noticing borderline things that they otherwise would easily ignore. Then, when they finally go to the doctor, their list of self-reported symptoms is no longer a list of what they independently noticed but a laundry list of whatever they read on webmd.

I'd be interested in hearing if you think this is actually the case, since you definitely have more experience and knowledge in it than I do. I'm basing most of this off of the personal experience of a few of my friends and the modicum of knowledge I have from a few clinical psychology classes I took in college.

>"Then, when they finally go to the doctor, their list of self-reported symptoms is no longer a list of what they independently noticed but a laundry list of whatever they read on webmd."

Sure, it happens all the time, in all areas of medicine. Not just psychiatry. The key here is that when someone says "I'm depressed," or "I have 5 of 9 criteria of a Major Depressive Episode," or "I have gout," that does not mean that the diagnostic evaluation is over. It's important to get clear examples of what people have noticed. Despite their conclusion, is this better explained by cancer, or anxiety, or a thyroid problem, or substance abuse? Like migraine, psychiatric illness is evaluated clinically rather than by imaging or lab tests, but there can be important overlaps that sometimes make these tests helpful to rule out other causes.

A patient's own conclusion is an important piece of the puzzle, but it's still just one piece.

The DSM-IV criteria have never impressed me as particularly specific or technical; especially for milder (more common) diagnoses like hypomania, ADHD, bipolar II, etc...

It's important to check the back of the manual for definitions of all of the terms in the criteria. Reading the criteria, you may be interpreting them through their conversational meanings. It also underscores the need for doing observed interviews during training, to make sure that you are applying the terms correctly. However, you are right in saying there's always room for improvement.

What's lacking from the psychiatric process is any sort of objectivity in the choice of thresholds distinguishing "normal" from "atypical". The criteria for most disorders apply to huge swaths of the population. They're not symptoms of disease, but symptoms of being human. In order to separate the diseased from the healthy, the psychiatrist must then twiddle nobs to find a distinguishing threshold.

"If you're only annoyed at the shape of your nose, well that's normal. You have a somewhat ugly nose. But, this other chap is really preoccupied with his nose. It's impairing his life quality--- he must be suffering from body dysmorphic disorder. Antidepressants might do the trick!"

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