By Allen Frances
The three major “epidemics” of psychiatric illness occurring during the past 15 years — childhood bipolar, autism and attention deficit disorder — have all mainly involved children. And two new DSM-5 proposals that also apply mostly to youngsters —“psychosis risk” and “temper dysregulation” — may trigger the next fads in psychiatric mislabeling. Giving a name to difficult problems that are poorly understood provides a kind of false comfort, but the label often doesn’t really add to the understanding and may carry risks of its own — especially unnecessary treatment, stigma and wasted resources.
Two questions naturally come to mind. Why are the recent epidemics in psychiatric disorder all concentrated on children? And why is this happening now? Ten interacting causes together provide an answer:
1). Youngsters are inherently more difficult to diagnose than adults. By virtue of their youth, they have a very short track record of symptom presentation and evolution, often have atypical clinical pictures influenced by developmental factors, by drugs and by family, school and peer stressors, and may be unable or unwilling to freely share what they are really experiencing. The lack of diagnostic clarity invites fanciful and faddish labeling.