[d1sxeyes]

Not just teenagers.

How many adults have you come across who (inappropriately) describe pedantry as OCD, or losing focus from time to time as ADHD, or being a bit withdrawn as 'autistic'?

There's no scope for people to simply be imperfect people with imperfect character traits any more. Any minor deviation is considered to be a personal disability.

That's not to say ADHD and OCD and autism don't exist—of course they do. And I also believe that they've been under-diagnosed historically. But not all symptoms are diseases. I don't know how we solve it without ignoring people who really need help, but it's definitely an issue.

[nilsherzig]

I have a recent ADHD diagnosis (M 21 / from Germany) and this apparent social media trend of having ADHD makes it very hard for me to get taken seriously with my diagnosis.

I'm very sure that my diagnosis is right (they even talked with my primary school teachers and I respond very well to the meds), but I still get these moments of self doubt / imposter syndrome in which im thinking, that I might just have made this up to trick other people and lift some responsibility from myself.

[viraptor]

On the other hand, it's the trend of talking about mental health more openly that allowed me to figure out my issues. It's going to take some time for things to cool off and stabilise either way. Let's just keep in mind both the positive and negative effects here.

It's actually HN itself where someone mentioned a paper/medication that turned out to work quite well for me.

[nilsherzig]

Oh absolutely, I didn't mean to imply that these minor annoyances outweigh the benefits for society.

Being able to talk about issues like mental health problems is incredibly important and even nowadays in a modern country like Germany, not everyone is happy to do so. Every little bit of normalization helps.

Apart from that, I think it's better to help a few people who "didn't really need it" than to make it harder for those who really need help to get it.

[d1sxeyes]

That sucks :( sorry to hear that.

[nilsherzig]

Thank you, but everything is fine. I know that these thoughts are not true and the advantages of the diagnosis clearly outweigh them :).

[grumpy-de-sre]

Like everything in the health world it's a spectrum isn't it. Where you draw the cutoff for something being a disorder and needing intervention is super subjective. Probably something where too much talk doesn't necessarily help, as it seems to dilute that threshold over time.

I guess that's just it, it's a spectrum and even "normal" people can be somewhere on it. And decisions about diagnosis or labeling etc should be taken based on degree of impairment to functioning.

Saying that, we really do want to make kids aware of mental health issues (the same as health in general). I really could have benefited from an education about OCD, as it took me more than ten years to understand why I struggled so much.

[d1sxeyes]

Absolutely agree on the 'spectrum' point, and I would argue that it's not that case that 'normal' people can be somewhere on it, but everyone is on it, even if they're all the way to the left.

If we take OCD as an example, there's clearly a huge range from 'I like the TV volume to be set to an even number' through to massive impairments to functioning to the point it's impossible to hold down a job, or that it's damaging your personal relationships.

I am a bit less comfortable with saying that it's "super subjective" where you draw the cutoff though. I agree there's some subjectivity there, but the diagnostic cutoff (per DSM-V) is quite clearly defined, and leaves relatively little room for subjective interpretation: "The obsessions or compulsions are time-consuming (e.g. - take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning."

I think it's unhelpful if folks who (for example) like their TV to be set to an even number talk about 'their OCD'. Or people who like things to be neat and tidy. Similarly for ADHD, the verbiage is: 'interferes with functioning or development/there is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.' Or ASD, where it's defined as 'caus[ing] clinically significant impairment in social, occupational, or other important areas of current functioning.'

[grumpy-de-sre]

Yeh I kinda threw that out there and wasn't the clearest but yes I'm 100% in agreement that everyone is somewhere on the spectrum and I guess we need to reach a place as a society where everyone is okay with that and that there are thresholds where intervention and disorder verbiage makes sense and thresholds where perhaps a conservative approach is sufficient (and these can change over an individuals life).

Totally true that the DSM uses concrete cutoff values in an attempt to limit subjectivity, given that, what do you think is driving "overdiagnosis"? Eg. given we have guidelines in place?

> I think it's unhelpful if folks who (for example) like their TV to be set to an even number talk about 'their OCD'.

I guess we can agree that a tiktok mental health awareness is a poor substitute for a proper education (broad, balanced, evidence based etc). The sad thing is tiktok awareness is popular because people just aren't getting good information elsewhere.

At the same time I don't think gatekeeping is particularly good, the folks who struggle the most are often the quietest.

[d1sxeyes]

> what do you think is driving "overdiagnosis"? Eg. given we have guidelines in place?

This is a super interesting question, and I don't know the answer.

My personal, completely unsupported opinion is that people now feel more pressure than ever to be perfect, when people are not. It is therefore logical that when people look at themselves and find imperfections, they try to find a 'cause' or a 'reason' that they can blame those imperfections on. I suspect that once you have convinced yourself that your imperfections are caused by something, you have a sort of Baader-Meinhof effect of the mind which causes you to see more and more 'symptoms' and attribute more and more negative things to that 'cause'.

Agree on both the TikTok mental health awareness and gatekeeping points however.

[grumpy-de-sre]

And to top it off, the same pressure to be perfect can also exacerbate underlying risk factors, and cause a legitimate increase in illness.

Agreed, plus the controversial take, some young adults seem to take an odd pride in strongly identifying with their diagnoses, an in-group effect if you will.

Either way back to the original article, talk is cheap, action is harder. If we want to actually improve mental health we're going to talk less and do more, eg. reducing the pressure on young people (housing/education reform anyone?).

[BoredPositron]

Looking at how mental health was treated before the 80s-90s and that you easily lost control over your life. It's understandable not disclosing serious mental health problems. Personally I didn't disclose my bipolar diagnosis for 20 years because of prejudice like yours. It's not that you don't recognize mental health issues; it's that often people with your mindset don't believe that others are truly sick because they are acting otherwise "normal".

[d1sxeyes]

I'm sorry that you feel that way, that wasn't the intention of my comment at all, and to be clear, I am not trying to refute any individual diagnosis. I strongly believe that those suffering with mental health issues, whether they're chronic or acute, deserve recognition and support. I'm not a psychiatrist, and even if I were, I don't know you at all, so please don't take my comment personally, or assume any negative prejudice on my side.

That being said, there is a significant and growing body of evidence which indicates that autism[0], ADHD[1], and OCD[2] are being overdiagnosed, or diagnosed without proper clinical rigour.

How can those who are suffering from these disorders hope to get the best quality help if there are so many challenges around proper diagnosis?

[0]: https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.... [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042533/ [2]: https://pubmed.ncbi.nlm.nih.gov/26132683/

[grumpy-de-sre]

Ah but that OCD study suggests the opposite of OCD overdiagnosis.

People who actually have OCD are being misdiagnosed with other more specific disorders due to a poor understanding of the heterogeneity of the condition.

[d1sxeyes]

Thanks—I may well be wrong about OCD.

[grumpy-de-sre]

OCD is extremely difficult to talk openly about, even in this TikTok era, society just isn't ready yet.

So by and far it's diagnosis is actually made very late, but I guess over time it'll become trendy aswell.

[viraptor]

I think every name that's common enough will get misused in a casual context at some point. It's not even restricted to mental health. How many people saying "you gave me a heart attack" actually experienced that rather than just being scared? How many people are mention stroke when smelling something weird? We just need to use social skills to figure out when the "haha, forgot that because of my ADHD brain" is real and when it's a joke.