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Medicine

People Typically Experience Shifting Mental Disorders Over Their Lifespan, Study Finds (psypost.org) 130

An anonymous reader quotes a report from PsyPost: New research based on four decades of longitudinal data indicates that it is rare for a person to receive and keep a single mental disorder diagnosis. Rather, experiencing different successive mental disorders appears to be the norm. The findings, published in JAMA Open, suggest that psychiatrists and other mental health professionals should move toward adopting a life-course perspective on mental disorders.

The researchers examined data from the Dunedin Longitudinal Study in New Zealand, which used repeated standardized psychiatric assessments to track 17 mental health conditions from age 11 to age 45. The study included more than one thousand participants and the mental health conditions were diagnosed according to DSM criteria. "These disorders included externalizing disorders (for example, ADHD, conduct disorder, substance dependence), internalizing disorders (for example, depression, anxiety, eating disorders, PTSD), and thought disorders (for example, mania, schizophrenia, OCD). This is the most detailed time series of mental-disorder life-histories ever assembled," explained Avshalom Caspi, a professor of psychology and neuroscience at Duke University.

The study also included neurocognitive examinations during childhood and adolescence, along with a neuroimaging-based assessment of brain aging at age 45. About one-third of the participants experienced the initial onset of a disorder by age 15 years and 86% met the criteria for at least one disorder by age 45 years. The researchers found an "ebb and flow" of mental disorders over time. Participants with a disorder from any one of the three diagnostic families were at higher risk for disorders from other diagnostic families in the future. Participants characterized by one consistent mental disorder were not the norm. "The primary finding is that over decades, individuals experience many changing disorder types, shifting between internalizing, externalizing, and/or thought disorder families. People seldom 'get' one disorder and keep it. Every disorder predicted significantly increased risk for every other disorder," Caspi told PsyPost.

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People Typically Experience Shifting Mental Disorders Over Their Lifespan, Study Finds

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  • by memory_register ( 6248354 ) on Tuesday August 11, 2020 @12:01AM (#60388133)
    By needing a DSM diagnosis in order to provide care for any useful length of time, we seem to have created a problem by creating identity labels that become internalized: I have depression, I have anxiety, etc., These labels can be very sticky even after mental states shift dramatically.

    Perhaps we would be better served as a species if we changed our standard of care to a more temporally bound one: I feel depressed, I feel anxious., etc.
    • I've thought something similar about personality tests. If you look at popular personality tests (like MBTI), a lot of the questions aren't something innate at all, they are skillsets people have or don't have. This is especially obvious in the Judging/Perceiving spectrum (Do you have the skill to make or follow a schedule? Do you have the skill to spontaneously respond to events and disruptions? both are important skills), but it is also true of the Introvert/Extrovert dichotomy (people are both depending
      • by fazig ( 2909523 ) on Tuesday August 11, 2020 @12:43AM (#60388191)
        Well, I can tell you that most people from the field of psychology will say that the MBTI, and by extension similar tests, are absolutely useless bullshit.
        It's about as useful as reading a horoscope in that it is far too generalized and appeals to confirmation bias of the people who take that test.
        • I think you are exaggerating. Horoscopes are based on date of birth, location and current day, while MBTI is based on a battery of self reporting questions. I agree that MBTI is lacking at least one direction of variability and has lots of other problems, such as the binary classification, but at least it can be used for better self understanding or at least to find likeminded people and discuss about similar problems they have.
        • Specifically, it's binning people into Jungian personality types. It's not absolute BS, but it is of limited utility.
        • Psychologists don't like the MBTI trademarked tests, but ask them about "Introvert/Extrovert" and they will discuss it as established dogma.
        • "Well, I can tell you that most people from the field of psychology will say that the MBTI, and by extension similar tests, are absolutely useless bullshit."

          Person. Woman. Man. Camera. TV.

      • Personality tests come from the field of psychology, which is not science. Psychology, has major problems, not least a replication crisis. It is safer to ignore anything from psychology than treat any of it as true. Put it on a par with astrology or macroeconomics.
    • I think this just proves psychiatrist are the economists of the medical field. i.e they are fake medical practitioners who try to label themselves as medical doctors.
      • They aren't fake, in either field. A better way to think of it is, they've found a set of things that are true and work (ie, anti-depressants do help in some cases, and mv=pq in economics).

        At the same time, there is a larger set of things that are very hard to test and be sure about, but both economists and psychologists often misrepresent the extent of their knowledge in these areas. It's easy to accidentally do. That is, an economist might say that he is certain it is time to raise interest rates, but
    • Perhaps we would be better served as a species if we changed our standard of care to a more temporally bound one: I feel depressed, I feel anxious., etc.

      Right, but ;-)

      For one, the state of suffering from a depression or an anxiety disorder is not the same as "feeling depressed" or "feeling anxious"...

      Then again, there actually are such "temporally bound" approaches; especially with depression, it's quite standard to speak of "episodes".

    • by sabbede ( 2678435 ) on Tuesday August 11, 2020 @08:32AM (#60388643)
      There's another issue there that cuts to the heart of the study's hypothesis. The DSM changes. The field isn't all that settled, diagnoses can be subjective, and politics tends to creep in. A person could have been diagnosed with one thing 40 years ago, and, without any change in symptoms, be diagnosed with something different today because the terms and criteria changed, or they might have decided that the symptoms no longer represent a disorder at all.
    • by MrKaos ( 858439 )

      By needing a DSM diagnosis in order to provide care.

      DSM is made for insurance companies to make a determination and categorization. 9 equally weighted behavioral traits for a personality order diagnosis is pretty unrealistic, there are good reasons why it is being questioned.

      Perhaps we would be better served as a species if we changed our standard of care to a more temporally bound one: I feel depressed, I feel anxious., etc.

      Most of those people have external locus of control, they would never say "I feel", they say "You make me feel". The only entity capable of processing a persons trauma without becoming traumatized themselves is a computer. Perpetual emotional exhaustion is a major blocker to processi

  • Disorders? (Score:5, Insightful)

    by jenningsthecat ( 1525947 ) on Tuesday August 11, 2020 @12:03AM (#60388135)

    The term 'disorder' implies that there is a reasonably objective and certain standard for what's 'normal'. I'm not convinced that's the case. I'm not minimizing mental health issues - I struggle with some, and they can be damned painful and scary and disheartening. They can suck the life out of life, sometimes literally.

    What concerns me is the tendency to pathologize thought and behaviour patterns that may be part of normal human-to-human variations and adaptive responses. For example, ADD causes a lot of problems for both people like me who have it, and those close to us. But those problems are contextual to our society. In a nomadic hunter-gatherer setting, attention that's all over the place can give one an edge when it comes to finding the next meal or avoiding being some other creature's next meal. Even in this society ADD is often associated with creativity and out-of-the-box thinking - but in a culture built around routine, hierarchy, schedules, and deadlines, it's also a real problem.

    Mental health is a very complex subject. I'm glad to see studies like this being done, and I hope they lead to people getting help for their very real suffering. But I think it's important to keep in mind that some of that suffering occurs at the interface between the individual and society. Challenging society's preconceptions about those who are judged 'mentally ill' can go a long way toward providing relief. And who hasn't been at least a little bit mentally ill at some point in their lives?

    • Re:Disorders? (Score:5, Insightful)

      by fazig ( 2909523 ) on Tuesday August 11, 2020 @12:39AM (#60388185)
      Yes, disorders.

      They usually come with a certain list of check marks that have to be checked. And that's not a check list that you can answer as quickly as those bullshit online quizzes you find all over the internet. Psychoanalysis takes some time of interaction between a trained professional and a client.
      Anyway, back to the check list. In virtually all cases a person must be suffering from their behaviour for it to be classified as a disorder. Suffering that they either recognize actively or perhaps justify in some way (personality disorder). And that suffering must have been present for at least half a year or so. Psychology does recognize that human behaviour can be quite flexible and is strongly affected by events that happen around one. For example someone close to you dies and you are saddened by their death for a while with all the markers of depression showing, doesn't mean you can be diagnosed with depression unless those feelings last for a long time.
      And again, this can't be done with something as simple as an online quiz, it has to be determined over the course of perhaps 4 or 5 one hour sessions over the course of a month by a qualified professional.

      That is how it works in the field of psychology as far as I've learned the methodology. You have the researching side where you deal with quantitative data, like this study, which however is useless when it comes down to the individual. And then you have qualitative data from individuals, which says something about the individual but may not apply to anyone else.
    • by pjt33 ( 739471 )

      And who hasn't been at least a little bit mentally ill at some point in their lives?

      This study seems to put an upper bound of 1/6 of the population on the answer to your question, although from the design as described it probably can't rule out the possibility that talking to mental health professionals causes mental health problems.

    • You have a layman understanding of what is considered a mental disorder. Thought patterns alone are not considered disorders, just character traits. It only becomes a disorder if it reduces functioning and interferes with the daily life.

      As for TFS, my personality disorder at least hasn't shifted over my lifespan, just has become progressively worse over the past decades. Would have been far more successful in life without it instead of barely managing.

    • by AmiMoJo ( 196126 )

      The term 'disorder' implies that there is a reasonably objective and certain standard for what's 'normal'.

      That's how it works, yes. It's why believing in little green men armed with anal probes is considered a sign of mental problems, while believing in an undetectable omnipotent being who subtlety and invisibly influences our lives isn't.

      The more important question is what to do about it. Little green men delusions are mostly harmless, many organized religions are not.

    • The term 'disorder' implies that there is a reasonably objective and certain standard for what's 'normal'. I'm not convinced that's the case.

      Well, there is.

      If you talk to lamp posts, and you believe that the lamp posts are really answering you, then you are mentally ill. To take the extreme example.

      Certainly we can debate lesser examples, but we are then just haggling about the details, not that mental illness exists.

    • by sjames ( 1099 )

      There are a lot of cases where I also wonder if they're pathologizing normal behavior. I wonder how often ADD is actually boredom due to an insufficient curriculum, for example. There seem to be other cases where the condition is unpleasant to the sufferer that probably are legitimate pathology.

      However, I have encountered some people with serious thought disorders and I assure you, it was pathological. I'm not talking about people who think Elvis was an alien, I mean people who think the red light on the sm

  • Why is this a surprise? I'm surprised that this is just now being "discovered" or understood.

    Lots of us have seen this spectrum of mental impairments that change over time firsthand with family members, spouses, acquaintances, etc.

    In short, yes, quite a few people with mental health issues can and will present with different disorders over time.

    I personally suspect it's due at least in part to the changes in brain chemistry that occur naturally (and in some cases unnaturally) as we age.

  • “Every disorder predicted significantly increased risk for every other disorder," or to look at another way, maybe there aren’t “such things as [discrete] mental disorders”: https://www.newscientist.com/a... [newscientist.com]
  • Misdiagnosing (Score:4, Interesting)

    by Anonymous Coward on Tuesday August 11, 2020 @12:29AM (#60388171)

    People make mistakes. After the 2009 crisis when I lost my job and my wife, I was diagnosed bipolar after complaining I had some issues with feeling angry lately. They applied a random label to me, who had never had a problem in my life, because of a few scattered events over the course of a few months.
    As it turns out I simply suffer from anxiety and angry outbursts were the result of feeling fragile and insecure after losing everything I had. Asshats.
    Now if I go to a hospital it says on my record that I'm bipolar. I'm not fucking bipolar you idiots, I never had an incident of mania in my life and was depressed only once, 11 years ago. My moods don't randomly change every few months. All of this because I was a bit hypochondriac once and may have inflated my self-reported symptoms.
    The next time I was fired I went to a therapist and complained I had difficulty paying attention to things. Bam, now I have ADHD. Well, I used to be a really good student when I was a kid, and I certainly don't have any problems with my work right now. Have you ever thought that people might be unmotivated at a certain job and happy with another?
    There is no problem with my life, I have a beautiful house and a beautiful woman and I'm paid quite a lot more than I ever made before. Since I don't have any problems functioning socially or at work, I can't possibly be "suffering" from mental illness.

    • I'm not crazy! Everyone else is!

    • If you are so mentally healthy, why do you keep looking for psychiatric care? Having interacted with the system, I am extremely skeptical that you were able to get a bipolar diagnosis completely out of the blue, it is generally not a preliminary diagnosis, if for no other reason than due to the difficulty of treatment. (as opposed to depression-here's your Prozac.)

      If your answer was "I was compelled to seek treatment" then I'm sorry you are going to have to do quite a bit to convince me you don't have a dis

  • It could be that parts of the brain that have to compensate for others get worn out or overwhelmed. It's kind of like how a bad ankle may end up causing other leg injuries because one changes their gait to compensate for the bad ankle.

    • I think this is probably part of the truth, over the years you use coping methods to overcome your issues that themselves are or eventually become problems. I myself have ADD which was untreated, and developed into anxiety from the stress of constantly keeping my life from exploding and depression from feeling like I had no self-control. Fail to manage these long enough and don't doubt I would develop other pathologies, and so on.
  • by fredrated ( 639554 ) on Tuesday August 11, 2020 @01:13AM (#60388203) Journal

    I've only been depressed. I feel better already!

    • I felt so bad one time that I tried to commit suicide by taking a whole bottle of Tylenol. I was unsuccessful in my attempt. After I took the first two, I felt better.
  • Because it's cheaper than actual therapy? Keep covering up the symptoms? Especially when someone isn't happy happy happy all the time!, which everyone knows is just them being rude and thoughtless, right? If you have any negative emotions whatsoever and (shocking!!!) express them in any way, you must have a mental disorder! /s
  • Except we won't make you come to confession, we'll make you take drugs your whole life.
  • by Nocturrne ( 912399 ) on Tuesday August 11, 2020 @03:03AM (#60388289)

    I lived overseas for 18yrs and came back to the US last year. I was surprised to find a very high percentage of the population is on some kind of meds - antidepressants, antipsychotics, anti anxiety, anti insomnia, meds for bipolar disorder, anti social anxiety, etc. Before I left the US, nobody I knew was on any kind of meds. WTF happened? How did everyone turn into such a bunch of entitled, over weight, weenies?

    • by istartedi ( 132515 ) on Tuesday August 11, 2020 @03:15AM (#60388303) Journal

      Even if you were overseas, you should have been aware that the US healthcare industry is a racket. Aside from the more subtle psychoactive meds you list, they've literally been pushing opiates at ridiculous volumes.

    • Re: (Score:3, Informative)

      by phantomfive ( 622387 )

      I lived overseas for 18yrs and came back to the US last year...Before I left the US, nobody I knew was on any kind of meds. WTF happened?

      You got old. Welcome to the club, take your daily aspirin.

    • The USA has a culture problem. Why are there so many angry people? A good example is people with Schizophrenia in the USA hear voices that tell them to do violent things while elsewhere the voices are more humorous or maybe even mischievous.

    • by MrKaos ( 858439 )

      How did everyone turn into such a bunch of entitled, over weight, weenies?

      Advertising.

  • by JakFrost ( 139885 ) on Tuesday August 11, 2020 @03:50AM (#60388339)

    "About one-third of the participants experienced the initial onset of a disorder by age 15 years and 86% met the criteria for at least one disorder by age 45 years."

    I think psychiatry over aggrandizes itself as a tell-all & be-all solution and answer to mental health and if such a large number of people meet the criteria for one disorder by the age of 45 then their methods and definitions are in doubt, especially when their solutions often result in the over prescription of pharmaceutical medications then followed up by therapy while ignoring the fundamental human condition which is a constant roller coaster of life, emotions, and feelings.

    There is a major disparity between a "disorder" that is a serious condition that prohibits you from living your life in a ~normal fashion and the occasion flux of emotions and feelings that come and go naturally due to life and bodily functions. Everyone should feel the ups and down of life along with anxiety and panic and other traumatic feelings every so often in life during appropriate moments in life and afterwards due to their effects.

    Fuck this study and their overly wide criteria and conclusions.

    How about repeatable results from Psychiatric studies?

    How about some biological relationships between neurology and psychiatry?

    • Yes, they act like your inability to adjust to a shit world is something wrong with you.

      You shouldn't be able to adjust to people shitting all over your life. You SHOULD become agitated, angry, even violent.

  • by Archtech ( 159117 ) on Tuesday August 11, 2020 @05:14AM (#60388405)

    "...experiencing different successive mental disorders appears to be the norm".

    These are known to ordinary people as "moods". In a world such as ours, it is quite understandable that most people have occasional - or not so occasional - moods of black despair.

    Sometimes, though, normal human optimism and happiness break through - briefly.

    To a clever psychiatrist or psychologist with a career to build, fees to earn, and tenure to obtain, there is no mood so simple and everyday that it cannot be written up in five volumes and given a fancy name. For instance, anyone whose life circumstances make them alternately happy and sad must be "bipolar". Anyone who appreciates peace and quiet has a "social disorder". (Or should that now be "societal"?)

    • I think it goes a little deeper than just moods.

      Consider the well known case of patient A.H.

      After the first war A.H. suffered from depression and became disillusioned with society. He wrote about his struggle in a book which became a best seller.
      Later he suffered from bipolar disorder with clear signs of mania in his public appearances
      A few years on, and megalomania set in. He believed he was an infallible general
      From there he succumbed to paranioa seeing enemies on every front
      And finally patient A.H.becam

      • Who is A.H.? Doesn't seem to quite fit Huxley or Hemingway.

      • Later phases of the subject's disorder may have been driven by chemical dependence. They were receiving daily injections of a cocktail that included large doses of amphetamines.

        It represents an interesting case, as the medical treatments harmed the patient but inhibited the disease spreading across Europe.

    • by sabbede ( 2678435 ) on Tuesday August 11, 2020 @09:08AM (#60388725)
      The diagnostic criteria account for that. Like, not just "black despair", but that it persists for a given length of time and reoccurs with a certain frequency. Not just that you experience it, but that it causes significant impairment. Maybe the person who "appreciates peace and quiet" is actually trying to avoid panic attacks triggered by severe social anxiety.
    • For instance, anyone whose life circumstances make them alternately happy and sad must be "bipolar". Anyone who appreciates peace and quiet has a "social disorder". (Or should that now be "societal"?)

      You have no idea what bipolar is like. I was married to someone with bipolar. She would go without sleep in her manic phase claiming she "couldn't turn her head off to sleep." She would watch me sleep waiting breathlessly for me to show signs of stirring so she could bombard me with the million "genius" ideas she formed while I slept. She built enormous intricate plans she was certain would make her rich and famous and happy but without a clue on how to implement them. Pointing out inconsistencies and

    • Sadly, you're wrong. It's more complicated and more sever than this.

      For example, when you take the bus everyday and then somebody asks you what the second person on the left near the entrance was wearing 5 days ago will most people fail to remember these details. When then shown a picture with the passengers inside the bus of that day will many people actually remember the details. The picture will not seem new to them, but instead will they remember it and the details will come back. What this means is tha

  • It may be used, but it's not even licensed for use as a diagnostic tool in America, let alone anywhere else.

    I'd say ignore it.

    Mental disorders will shift over time, because (as R. D. Laing pointed out) they're mapping errors in the brain and not intrinsic or permanent.

    But they won't shift as much as is being suggested because most modern treatments worsen MH rather than improve it.

    Treatment is for life and should be for everyone, but what we have as treatment is totally inappropriate for the problem.

  • Most of us here have autism. That's genetic and is for life. But it isn't a hindrance, it's a strength. Yet MH practitioners call it a disability because it means we're not the same as neurotypicals.

    A neurotypical has poorer senses, inferior sensory processing, inferior ability to connect ideas and inferior flow of data across the brain. But they're not considered disabled merely for having these disabilities.

    We need help to exploit our strengths, so do Olympic sprinters. And that's the key. Mental health studies assume inferiority, coaching assumes superiority.

    But it's the same bloody thing they're looking at, it's about the perspective of the "help" and not about the person being helped.

    Once you realize that, diagnoses become a matter of where the doctor stands and has nothing to do with the patient.

  • "The primary finding is that over decades, individuals experience many changing disorder types, shifting between internalizing, externalizing, and/or thought disorder families. People seldom 'get' one disorder and keep it. Every disorder predicted significantly increased risk for every other disorder,"

    At the core we pretty much define a mental disorder as something that significantly deviates from norms and is somehow harmful to the individual. If disorders are in fact this common, mutable, and often self resolving perhaps they are not far enough outside norms to be classified as disorders at all.

    Looking at modern life from a really individualist rather than societal standpoint I think its probably far liberal in terms of external pressure to conform than in the past. That is disorders are given room to

    • by PPH ( 736903 )

      That is disorders are given room to run, we don't shame people and force them conform in order to participate in social life perhaps as much as we should. Brains get trained, and shaming and exclusion are powerful influences that could teach brains to move to more normative behavior.

      Shaming and the use of psychiatry to make people 'conform'. Whatcouldpossiblygowrong [wikipedia.org]. And aside from the political angle, what is wrong with expanding the definition of normal to include people nearer the fringes, so long as they are no dangerous to themselves or others? John Nash [wikipedia.org] learned to ignore his hallucinations and get on with his career (dramatized in 'A Beautiful Mind').

  • by sabbede ( 2678435 ) on Tuesday August 11, 2020 @08:44AM (#60388673)
    Forty years ago, the DSM-III was published. Seven years later, the DSM-III-R, then in 94 came the DSM-IV, the DSM-IV-TR in 2000, and finally the DSM-5 in 2013. Each revision involved changes in names, definitions and diagnostic criteria. It is possible for a 40 year old to have been diagnosed with something in childhood that no longer exists, or changed names, or was reclassified as two separate disorders, then back to one.

    If you were diagnosed as manic-depressive back in the 80's, you're one of four types of bi-polar now. You haven't changed, what they call you has.

    So, is this study finding something about how patients change, or how psychology/psychiatry is changing?

  • Yet another reason why psychology is totally a science without need to start from observation of physical evidence or now even give consistent results despite diseases only being consistently diagnosed using self-reinforcing criteria within their own model.

  • by nbritton ( 823086 ) on Tuesday August 11, 2020 @01:19PM (#60389779)

    I don’t agree with is article at all, the reason the diagnosis changes is usually due to ineptitude, not accounting for comorbid conditions, or the provider not caring enough to do a proper different diagnosis.

    I’ve experienced all of this first hand, I’ve been diagnosed with practically everything in the DSM, but nothing ever really fit, until at age 41 I found a very competent doctor that finally correctly diagnosed me with Autism Spectrum Disorder. The evidence had been in my first grade school medical reports the entire time, but previous providers were too lazy to do proper due diligence.

  • Some of this sounds like people simply being subject to the psychiatric system. Even if most asylums have been shut down, once a person has been diagnosed, they are more likely to:
    a) seek help from the medical field
    b) be targeted by health multinationals.
    c) and be issued with another diagnosis

    Remember, the vast majority of mental health problems are undiagnosed.

    Also, people with unresolved mental health problems tend to become depressed.;;

    Source: clinical therapist for 23 years.

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