Diagnostic Inflation: Do You Really Have a Mental Disorder?

Diagnostic Inflation: Do You Really Have a Mental Disorder?

This lecture on "diagnostic inflation" or the over-diagnosis or mental disorder by Allen J. Frances, the chair of the DSM-IV task force, is important. Watch it.


Frances lays out absolutely staggering levels and rates of change in the recent diagnosis of mental disorder and argues that there is nothing other than diagnostic inflation capable of accounting for it. Rates of diagnosed anxiety disorder, mood disorder, childhood bipolar disorder, autism, ADD and more have boomed in just a few years. Consider ADD. Frances says:

The diagnosis of attention-deficit disorder used to be about 3 - 3 1/2%. Now it's 10%. And 4% of kids in American schools are getting medication. A recent Canadian study really indicates the nature of the problem. It was found that -- and this was a very large number of kids, in Canada -- it was found that one of the strongest predictors of whether you had ADD or not was your birthday. If you were born in December, you are much more likely to have ADD than if you were born in January. The only reason for this could be the school year. That the kids who were younger in the classroom, less mature, instead of being accepted as less mature are being medicalized as having attention-deficit disorder and are all too frequently given medication. A tripling of ADD in just ten years.

The ADD birth lottery example nicely captures how perfectly normal variation -- the fact that slightly younger kids will tend to be less mentally and emotionally developed than slightly older kids -- is now regularly interpreted as evidence of pathology. Frances goes on the explain how very small changes in the diagnostic criteria can lead to an explosion in diagnosis. Even very small proposed but rejected changes can create an inflationary shift in diagnostic norms.

Even if you want to squelch the [tendency toward over-diagnosis in the] system as much as possible, it leaks. Diagnostic inflation is like economic inflation: it's very hard to keep under control; it has many causes; not all of those causes are within your control. The book as written may be very different than the book as used. And once the genie is out of the bottle and the book is published, people can use it their own way, which may be radically different from what you intended.

Frances goes on to explain why he thinks the new DSM-V, focused on prevention, will only make things worse and lead to millions more people being misdiagnosed with mental disorders for perfectly normal and totally healthy psychological conditions. This is a terrific talk stuffed with interesting facts and important insights about the nature of the psychiatric diagnostic system and the incentives at play in the definition of diagnostic categories and the application of these categories to healthy people. Highly recommended, especially if you or someone you care about has been diagnosed with a mental disorder.

If you're interested in these issues, I discuss them further in my Reason review of The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorderby Allan V. Horwitz and Jerome C. Wakefield.

A brief history of human dignity

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Urban foxes self-evolve, exhibiting Darwin’s domestication syndrome

A new study finds surprising evidence of the self-evolution of urban foxes.

A fox at the door of 10 Downing Street on Janurary 13, 2015.

Photo by JUSTIN TALLIS/AFP via Getty Images
Surprising Science
  • A study from the University of Glasgow finds urban foxes evolved differently compared to rural foxes.
  • The skulls of the urban foxes are adapted to scavenging for food rather than hunting it.
  • The evolutionary changes correspond to Charles Darwin's "domestication syndrome."

How much can living in the city change you? If you were an urban fox, you could be evolving yourself to a whole new stage and becoming more like a dog, according to a fascinating new study.

Researchers compared skulls from rural foxes around London with foxes who lived inside the city and found important variations. Rural foxes showed adaptation for speed and hunting after quick, small prey, while urban fox skulls exhibited changes that made it easier for them to scavenge, looking through human refuse for food, rather than chasing it. Their snouts were shorter and stronger, making it easier to open packages and chew up leftovers. They also have smaller brains, not meant for hunting but for interacting with stationary food sources, reports Science magazine.

Interestingly, there was much similarity found between the male and female skulls of the urban foxes.

The observed changes correspond to what Charles Darwin called the "domestication syndrome," comprised of traits that go along with an animal's transition from being wild, to tamed, to domesticated.

The study was led by Kevin Parsons, an evolutionary biologist at the University of Glasgow.

"What's really fascinating here is that the foxes are doing this to themselves," Parsons told the BBC. "This is the result of foxes that have decided to live near people, showing these traits that make them look more like domesticated animals."

The researchers are not suggesting you should go out and get a fox as a house-pet just yet. But they are seeing the evolutionary process taking place that's moving the urban foxes along the path towards becoming more like dogs and cats, explained the study's co-author Dr. Andrew Kitchener from National Museums Scotland.

A fox beneath a tree in Greenwich park, south east London

A fox beneath a tree in Greenwich park, south east London on May 14, 2020.

Photo by Glyn KIRK / AFP

"Some of the basic environmental aspects that may have occurred during the initial phases of domestication for our current pets, like dogs and cats, were probably similar to the conditions in which our urban foxes and other urban animals are living today," said Kitchener. "So, adapting to life around humans actually primes some animals for domestication."

The specimen came from the National Museum Scotland's collection of around 1,500 fox skulls.

You can read the study in the Proceedings of the Royal Society B.

fox sleeping beneath stadium seats

A fox at the LV County Championship, Division two match between Surrey and Derbyshire at The Brit Oval on April 9, 2010 in London, England.

Photo by Clive Rose/Getty Images

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