disease du jour

Personally if I had to choose an over diagnosed fashionable disease it would be celiac disease which of late seems to be caused by being a Prius driving yuppie. I can’t tell you how many people I run into lately who’ve sworn off gluten as if it’s some sort of health food craze.

Original article : http://www.straightdope.com/columns/read/3154/how-did-autism-become-the-latest-fad-disorder

A disease that is in law (de jure) rather than in fact (de facto)?

Or, perhaps you meant disease du jour (or even better, maladie du jour)?

Last one, that’s what I get for trusting spell checker

MODERATOR COMMENT: I fixed the title. French, Latin, it’s all Greek to me.

Bear in mind that bowlweevils is not an actual clinical psychologist. But he does have a PhD in cognitive psychology, a field that addresses expert decision-making including clinical diagnostics. He has provided analyses of clinical diagnostic accuracy in connection with litigation involving assessments of causation and severity of mental health disorders.

There is one particular flaw in the process that seemed rather common. When conducting a diagnostic interview on a potential patient, the guidance in the DSM states that this is a multi-step process. First, an assessment may be made as to whether a person has action and/or thought patterns that are associated with a mental health disorder. This should be followed by an assessment of the degree to which these action and/or thought patterns impact a person’s life. If the actions and thoughts have no, or minimal, negative impact, or even a positive impact, it would not be correct to state that a person is suffering from the mental health disorder that these thoughts and/or actions may be associated with.

Often, this assessment is not included in the diagnostic process. In other words, if you do things that are on the list of symptoms for a particular mental health disorder, you tend to be diagnosed as suffering from that mental health disorder, and are in need of some sort of treatment.

By failing to address impact on a person’s life, an overly high diagnosis rate occurs. Or at least an overly high estimate of proportion of the population in need of treatment for a mental health disorder occurs.

A comparison to a physical medical phenomenon may be helpful. Scoliosis is a deviation of the curvature of the spine from the normal, or ideal, range. There may be a very high rate of incidence of scoliosis in terms of there being a deviation in curvature of the spine that is noticeable by medical examination. This would mean that, technically, the rate of scoliosis in a population may be extremely high. Depending on the strictness of the range of curvature that is considered normal or ideal, it may be the case that a majority of a population may have some degree of scoliosis.

However, it will also likely be the case that most people with scoliosis do not suffer to any appreciable degree from the spinal deviation - no back pain, no difficulty engaging in the normal range of movement, and so on. It could even be the case that the spinal deviation allows for movements that are superior to the normal range.

In these situations, there would be no treatment necessary for the scoliosis. Perhaps there may be periodic questioning or examination to determine if the scoliosis has increased or has caused problems that were not present before. But in many cases, it would also be reasonable to say that most people who have a minor but medically noticeable deviation in spinal curvature do not have scoliosis. Or at least that they do not suffer from scoliosis.

Failure to engage in this type of assessment for mental health disorders results in overestimates of what most people would consider to be genuine cases of the disorder; i.e., that there is a negative effect on a person that requires treatment.

It is this type of failure that leads to the pondering as to whether having Asperger’s syndrome, or otherwise failing into the autism-spectrum range, may actually be a positive thing. And it may indeed be justifiable to say that some people do experience positive effects of the syndrome. But it may be more reasonable, and accurate, to say that they have action or thought patterns that are associated with autism but do not have autism.

So being able to focus on numerical information without being distracted by the social environment could be considered a symptom of autism or it could just be a useful skill. Determining which it is would involve examining the impact of this action pattern on a person’s life. If they cannot disengage and attend to social matters when needed, with the result of deterioration of important relationships, this would be harmful. But if they can disengage and attended to important relationships when needed but are not distracted by the conversation the people at the next table are having about vacation plans, this may be beneficial.

We associate a medical diagnosis with suffering, and rightly so. When clinicians divorce the presence of potential symptoms from suffering, the rate of incidence is artificially inflated.

Hear hear and well said …

<nitpik>
A thorough physical examination should be done first, to eliminate any “organic” causes. For example, bullet wounds to the brain have been known to produce autism-like symptoms, maybe just removing the bullets will bring relief.
</nitpik>

Being disabled means a person is not able to perform one or more basic life functions, like preparing food or bathing themselves. We all know the type of person who gets upset if anyone moves something on their desk. They want things just so. This is a symptom of autism, but the question is whether it’s disabling. In many cases, not at all. On the other hand, if this person is showing up for work buck nekked on a regular basis, okay, we have a problem now. They need someone at home to check before they leave for work that they have indeed actually dressed themselves.

There are people who truly need help, and others who just want an excuse for their laziness.

It’s true that many people are going off gluten for reasons other than an actual diagnosis of celiac disease. That’s not the same thing as saying that everybody who avoids gluten is simply following the fad of the moment. Undoubtedly, some are and I have no idea of that number or percentage.

But gluten is a known trigger for other problems like Irritable Bowel Syndrome (IBS). You can argue that IBS is itself pretty slippery, since it’s a collection of symptoms without a single identifiable cause. But I have it and I’ve researched it for years and I’m confident that it’s real, especially since a medication that works against what’s considered a primary causal agent works for me.

So if you haven’t found a medication that works for you, eliminating known triggers can be remarkably successful at symptom control. Gluten is certainly one of them. If removing gluten makes you feel better, either because of physiological or psychological reasons - and I don’t discredit the placebo effect for digestive complaints where it seems to be especially powerful - then by all means do so. Even reducing the amount of gluten may help, as some triggers have a threshold effect.

I don’t do low-gluten myself, but I think it’s wonderful that a large range of gluten-free products appear in stores. I know I’m lactose intolerance through clinical testing and I can remember when there were practically no lactose-free products. Why should anybody else go through that?

The people who are using gluten as a fad will get tired of the inconvenience. But gluten-free products will live on because there’s a real audience for them. We’ll see in five years how large this audience is.

People avoiding gluten as a dietary choice arent usually claiming to have celiac disease in my experience - more often they have just accepted a bunch of woo about how OMG WHEAT IS KILLING US! Which is not very different from previous scares about how salt, fructose, red meat, milk, etc is supposedly killing us.

I used to be a social worker, who worked maintaining community housing with autistic, and other disabled people. I cannot tell you how many times I have tried to explain the above to people, and they don’t want to listen.

This is the main reason (the others are 1) you are not a psychiatrist or neurologist and 2) you have not met the person) you cannot go around diagnosing historical figures as autistic. If the person was not just functional, but highly successful, the person was not autistic, not matter how quirky they were.

BTW, my personal experience leads me to speculate that there are at least two other contributing factors to the rising rate of autism.

One is that until 1974, states were not required to educate autistic children, but most states had residential schools for the mentally retarded, so it was highly advantageous for autistic children to be misdiagnosed. I’m sure there were many who were deliberately misdiagnosed, and many who were borderline cases. As long as their behavior was manageable, the school accepted them. This is probably also the reason that for a long time, people expected autistic people to be self-injurious, quick to anger, and rigidly obsessive and compulsive in their behavior, because those people represented the small minority who couldn’t “pass” for MR in order to get into the only schools available to them. This all changed when public law 94-142 (The Education of All Handicapped Children) passed.

Another is that in the 1960s, some people believed that autism was a childhood manifestation of schizophrenia, and so the label “juvenile schizophrenia” existed, and was lapped on some autistic children. In the 1980s and 90s, many adults had their diagnoses revised to “autism,” which is what they always had, the label was just changed, but it altered the statistics, by increasing the number of people with autism in the US.

If you look, you do find a decrease in the number of certain types of schizophrenia, but you also see an increase in other types, and an increase in bipolar disorder, which can account for some of the decrease in schizophrenia. It’s hard to tease out what caused what. There was also a drop in diagnoses of mental retardation, but along with increases in autism, there have been increases in specific learning disorders, and also decreases in some causes of MR, like maternal rubella, so again, it’s difficult to sort it all out.

It’s pretty clear that there isn’t an epidemic of severe to profound autism, though.

IMO, talking about a spectrum is bad, because it hides actual numbers. An increase in diagnoses of mild autism can hide the fact that there perhaps might even be a decrease in profound autism, since we talk only of the incidence of autism as a whole.

For comparison, many more children get braces than ever before. During WWII, when my father had braces, a child had to have severe malocclusion-- buck teeth out two inches, or teeth crowing sideways. Maybe 1 in 200 kids got braces. There has been no increase in that kind of malocclusion, just more people getting cosmetic correction.

Yeah, but what do YOU think about it? Or are you the personality (I always preferred “avatar,” but it never caught on) who does the typing? :wink:

Interesting discussion, people, and so far unsullied by the wooish.

Two things:

I have a kid who’s Aspergers. He’s the smartest person you’ll ever meet, but does not do well in the third dimension. My sister has commented that he seems to live his entire life as one massive out of body experience.

I’ve been working with him for years. Running constant battles with teachers. Pushing him not to sit around and space out. It’s tough. What’s really tough is all the promise he has, and him being unable to utilize it. I can imagine him living with us for the rest of our lives and being unable to live an independent existence. It’s so difficult to see someone so bright, capable, and lost.

Now me. It is very likely that today, I would have been classified as Aspergers when I went to school. I was a weird geeky kid, and didn’t understand why I had no friends and why so many kids made fun of me in school. Being severely Dyslexic didn’t help matters.

Back then, my official classification was lazy. I tried my best, but never seemed to understand what was expected of me, and why I simply couldn’t do what the teachers wanted me to do. Instead, the teachers joined with the students in making fun of me. After all, I deserved it, and if I didn’t like it, I would behave. I was lazy, and it’s all my fault.

However, I grew up, and made friends in college, got married and been that way for 30 years, and have been a productive citizen. People take me seriously in my job, and constantly ask for my advice. I’ve been given massive amounts of responsibility, and given the lead for major projects.

So, was I just a geeky kid, and like other geeky kids, made fun of in school. And once out of that confined institution, I was able to find others like me and blossomed? Or, am I Aspergers?

The truth is I would have loved to have the label of Aspergers while I was in school. It wouldn’t matter whether or not I am. It would have been a signal to teachers that maybe I wasn’t lazy. Maybe I was really trying, and just didn’t understand and needed some help and guidance. Maybe they shouldn’t encourage other students to taunt me. Maybe they shouldn’t call me in front of the classroom and berate me in front of the other students.

I know it seems that every kid in school is now LD, ADHD, or Aspergers. And, that each child has their own IEP and there are millions of teacher conferences, and there are just no more normal kids out there. But, is this a bad thing?

Maybe the kid is just a bit energetic and isn’t ADHD. Maybe that kid is a bit shy and geeky, and not Aspergers. But, at least instead of yelling and calling kids lazy, wild, out-of-control, or just bad, we’re at least attempting to understand them. And maybe that school is no longer a factory where we attempt to force every kid to be processed and stamped in an identical way is a good thing.

Or, according to my parents, people just wanted to show off how much money they had to throw around.

Many kids with high-functioning autism or Asperger’s were also believed to be acting the way they were on purpose, whether to embarrass their parents or for some other reason.

Ewww.

I’m low gluten. I may or may not have celiac’s - I do run to the bathroom a lot more often with IBS when I consume gluten - so I avoid it.

I think we are simply more informed about food triggers, and less willing to put up with something like having to sit around a restaurant for an extra half an hour so you can make that last dash before getting into a car.

And, it sucks…it sucks enough that there are plenty of days where I eat gluten because finding something without gluten isn’t convenient, or because you really want a cupcake. Although both those things have gotten much easier - while I still can’t expect much gluten free at the McD’s drive through, I can find GF baked goods and GF pasta at mainstream restaurants. I can’t imagine successfully sustaining the diet for reasons of “fad”

It’s rather hard to find, for some reason, but I’ve seen a chart that showed the diagnosed rates of mental retardation and autism over the last several decades. There is a VERY strong inverse correlation between the two.

ANECDOTE WAR!

I have IBS, and products with wheat flour help me. I have a very mild case, and the best thing for me is just a balanced diet, especially with fiber-- not too much, and not too little, and making sure to eat it throughout the day, not all at once.

It also used to be that almost all children with autism were also diagnosed with a degree of MR, but that’s no longer the case. Since it was usually an informal process which disorder was considered primary, for a long time, children with both were “retarded,” because there were no therapies for autism. There are now, and children whose primary disability is autism usually get more funding and more hours of therapy, so of children with both labels, 30 years ago, about 80% of them were MR as “primary,” and now nearly 100% of them have autism as “primary.”

And yet, most special ed. teachers overseeing classrooms of mixed autistic and MR kids have no training in dealing with autistic kids at all.

Perhaps following the money trail provides an answer. Did all those newly diagnosed bipolar people run out of assistance?

And what new form of bipolar is this? Gone are the days of Mr. Toad, flying high, king of the world bipolarism. The new bipolar is cranky and dissatisfied.

Treating everyone in a social setting as a special individual sounds so good in our hearts and on paper that I’d vote for it if it actually produced good results. But it seems best left to individual interactions and out of the realm of institutions.

You know what’s REALLY trendy these days? Calling a disease “trendy” just because it’s newly discovered or understood.

People who do that must have been a real thrill back in the days when we were discovering that microbes were the cause of many diseases, or that mental illness isn’t caused by demon possession.

Shut up, all those amateur doctors out there. Stop bashing real people’s problems and calling them non-existent. You don’t know what you’re talking about.

But that’s not about the diagnosis, it’s about how one is treated based on the diagnosis. Which is kind of your point. But don’t assume that a diagnosis is what gets you help. It’s the degree to which you are disabled that gets you accommodations (or at least it should be).