DSM Disorders Disappear in Statistical Clustering of Psychiatric Symptoms (2024)

https://www.psychiatrymargins.com/p/traditional-dsm-disorders-dissolve?r=2wyot6&triedRedirect=true

by rendx • 10 months ago

162 111 10 months ago

psychiatrymargins.com

gsf_emergency_2• 10 months ago

For nerdsnipers who would like see if DSM-IV is "better" the wiki is

https://www.ncbi.nlm.nih.gov/books/NBK519711/

Going back to DSM-III TFA has a good link

https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2...

This is unproblematic as long as DSM criteria are understood to index rather than constitute psychiatric disorders.

With "index" taken to mean:

a pragmatic and well-validated way to identify [a] syndrome

I.e. "Do DSM Compress?"

raverbashing2• 10 months ago

Here's the thing. As much as the quality of professionals vary a lot, the practical aspects of understanding DSM (or even medical issues) plays an important part

This is probably exacerbated by the closure of mental institutions where you could see in person what the textbook means exactly.

Trying to understand diseases just by the text (and not even considering differential diagnosis) is an exercise in frustration. And I feel more professionals lately are just "Chinesing room" it instead of having actual experience

skissane2• 10 months ago

Another paper I like which reaches similar conclusions, but with a rather different methodology - https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/ - looking at the biological validity of the ASD-vs-ADHD-vs-OCD distinction in children and adolescents - it concludes the boundaries between the three disorders (and between the disorders and “normality”) are a poor model of what is really going on

jppope• 10 months ago

wow. thats mind bending right there... I'd love to see it with some additional dimensions to it. even a 3D graph would be super interesting no doubt

oofbey4• 10 months ago

The raw data are in hundreds of dimensions. To visualize it meaningfully I think you’d need to run a t-SNE clustering, which would be fine in 2D. Raw PCA or anything like that which preserves the original structure probably wouldn’t show much even in 3D. But it would be fun to see the clusters more directly.

SV_BubbleTime• 10 months ago

That’s interesting. Aren’t there some social contagions that are listed in DSM? I would think those basically require large groups of varying symptoms.

kennywinker3• 10 months ago

Not an expert, but I don’t think - and cursory googling seems to agree - there are any “social contagions” in the dsm. The concept is not exactly proven science, and it’s worth mentioning that it’s also a bit of a dogwhistle term used to undermine a lot of queer and gender identities.

Fwiw I think it’s patently obvious behaviors can influence people, but in my mind they influence the avenue of expression - they don’t create disorders from scratch. So like e.g. body image would be the underlying disorder, and if it expresses as bulimia or anorexia or cutting could be somewhat “socially contagious”.

vasco3• 10 months ago

They are correct in terms of eating disorders, bulimia is socially contagious.

user_7832• 10 months ago

I'm happy to see such results be "properly" recognized. The DSM is imo helpful only as a baseline, especially in contexts where without it, doctors might have (significant) personal bias. And... this might ruffle some feathers with the "live and die by the book" crowd, but a good, perceptive doctor doesn't need the DSM to diagnose anything.

I've had video calls with a doc who took maybe 5 minutes at most of hearing subjective experiences to confidently reach a conclusion. I've also had a 45 minute "by the book" DSM-based session where boxes were being ticked... and the questions were f---ing *terrible*, if you pardon my French. "Do you have trouble concentrating" is terribly vague and can always be justified either way. Not to mention, it takes maybe a few moments to "catch on" on how to answer which questions; which seems to be a terrible way of introducing bias into the answers (as also mentioned in the article). Having someone describe their personal life is in many ways much better because it cannot be a rigid yes/no question.

And all this talk is without mentions of other aspects that also need addressing, like the continuous spectrum of many conditions...

peepee19823• 10 months ago

I have had such bad experiences with psychiatrists and psychologists being contrarian and demanding filling in generic tests leading to no working solutions (aka you're depressed here's a prescription for an SSRI. Still depressed? We'll up the dose).

My current psychiatrist figured out my main issues after talking to me for 15 minutes. Sent me off to a psychologist back up his assumptions before prescribing anything. Recommended therapists who specialize in the area I needed support in.

The psychologist I went to was great as well (after seeing one that was a terrible). She did a lot of testing (three sittings lasting around two hours) but said the tests were really just to rule out other things. The important part were the conversations.

My life improved tremendously after that.

512• 10 months ago

How does one find a good psychiatrist/psychologist? My experiences have ranged from "very bad" to "OK at best" and I think finding someone a bit more invested into figuring things out might help a lot.

it_is_beautiful• 10 months ago

My ex was on antidepressants which had a huge impact on her life. If she missed her meds or (god forbid) was late on her prescription, it was terrifyingly bad.

Orthogonally, she also had sensitivities to light and epileptic symptoms. She told the doctor this, and the doctor doubled her dose of antidepressants. Just one of many, many stories. I've come to consider the higher-level of medicine quite scientific, but the on-the-ground doctors as unscientific. They mostly don't have time or enough feedback to make good decisions in most cases I've seen. That's a profession that shouldn't work on faith.

d1sxeyes• 10 months ago

The DSM is not designed as a list of questions to use to ask patients, it’s designed to describe disorders.

Asking you “do you have trouble concentrating?” is lazy (at least, on its own. Asking a patient to perform a self-assessment is not bad medicine necessarily). A doctor should also be evaluating your concentration in other ways.

nialse• 10 months ago

This. Clinical symptoms are latent descriptors of manifest variables, ie it is not expected that a person can verbalize or even introspect the symptom descriptions. If the (prospective) patient could do this themselves, the clinical assessment would not be necessary.

reedf1• 10 months ago

Sounds like the field needs to acknowledge the weakness of prescriptivism similar to software engineering with design patterns. The need for diagnostic criteria is understandable - but it definitely should be up to the discretion of the doc.

skissane2• 10 months ago

I'm happy to see such results be "properly" recognized. The DSM is imo helpful only as a baseline, especially in contexts where without it, doctors might have (significant) personal bias. And... this might ruffle some feathers with the "live and die by the book" crowd, but a good, perceptive doctor doesn't need the DSM to diagnose anything.

My own personal experience with psychologists and psychiatrists, is most of them don’t go by the text of the DSM, they go by the understanding of various disorders they’ve received from their teachers, mentors, supervisors, colleagues-which at times has a rather loose relationship with what the text of the DSM actually says-and once they’ve made their minds up as to what is the correct diagnosis, then-when required for a formal report-they look at the DSM text and work out how to justify their diagnostic decision by relating what the text says to the evidence at hand

DemocracyFTW2• 10 months ago

"Do you have trouble concentrating" is terribly vague and can always be justified either way

To be fair, for the practitioner this shouldn't be a question about objective capital-letter Truth, it's one throw of darts representing a self-reported aspect of self-experience and self-perception.

As someone who has designed questionnaires for a public health agency, reading the article made me feel we should've fully randomized the order of appearance of individual questions, including the 'front-matter' stuff like self-reported gender, age, education, marital status.

As someone who got quite upset about a particular questionnaire's formulations at the tender age of 10, I'd now say let's not get too wrought up about this, a questionnaire can be a valid tool but it will also always be a somewhat blunt tool, so let's use it bluntly: don't fret, put your mark into one of those five boxes, move on to the next question, done, over, out. If it's about me then it's about how I feel about it, now, and I can choose to feel extremely good or bad or fairly somewhat well-nigh indifferent about sh*t, just here and now. As the one being questionnaired, I also have the right to lean into the questions and bend the outcome as I see fit. Been there, done that.

vidarh• 10 months ago

don't fret, put your mark into one of those five boxes, move on to the next question, done, over, out

That is not always seen as an option for some patients. Having observed a family member take a specific autism questionnaire, I can tell you that as for some people - often exactly the people who should be dianosed - it does not always feel possible to pick an option that to them is wrong.

In said case, they ended up getting diagnosed with autism elsewhere, because that one question on the first questionnaire was one they felt impossible to move past, and so it was never submitted.

Thankfully they had another option that wasn't being gatekept with a broken quesionnaire.

This might not be directly relevant to the article, but I think it's worth mentioning it in the general context of questionnaire design.

siva74• 10 months ago

The point is to make a differential diagnosis which isn't possible in 5 minutes. So if someone concludes after 5 minutes your psychiatric diagnosis, you can be almost sure they aren't following good practice for their profession. Or to use another word - malpractice.

Aurornis2• 10 months ago

I've also had a 45 minute "by the book" DSM-based session where boxes were being ticked... and the questions were f---ing terrible

The DSM isn’t the source of those question inventories. There are different question sets for different conditions that each have their own source, often a set of researchers or an institution that has put in some work to study and test them. Some of the more obscure question inventories are even paid material that clinicians (or their offices, more accurately) are supposed to license.

I caution against the clinicians who do rapid-fire diagnostics and slap a label on the patient within minutes of talking to them. Some patients like this when the diagnosis matches what they already self-diagnosed or they want to hear, but in these cases some clinicians are just picking up on the hints the patient gave and mirroring it back to them.

This rapid diagnostic method is an easy way to improve your patient satisfaction scores (important for performance measures at some clinics, especially when PE or corporate gets involved) and it’s an obvious way to free up some time in a clinician’s busy day.

There is a growing problem of lazy providers who try to speedrun the diagnosis and send patients on their way with a prescription for something and a request for a follow up appointment. During COVID when controlled substance prescribing rules were loosened for remote appointments there were even pill mills that would advertise for specific diagnoses on TikTok and then incentivize the providers to see as many patients per day and prescribe them all Adderall because it turned them into repeat customers for the recurring prescriptions. There was a whistleblower who revealed that they were measured on their rates of prescribing controlled substances and discouraged from prescribing alternatives with lower abuse/addiction potential even when patients admitted to having drug abuse problems. This is an extreme example but don’t discount the incentive for your provider to shorten your appointment for selfish reasons, not because the patient’s condition is obvious and easy to diagnose accurately within minutes.

tcj_phx• 10 months ago

In 2022 psychiatrist Chris Palmer MD [0] published Brain Energy [1], which shares his discovery of the 70+ years of science establishing that the behavioral/mental symptoms traditionally given 'psychiatric' labels are caused by metabolic problems. When you fix the body's metabolism the symptoms go away.

Dr. Palmer recommends the ketogenic diet, but not all people need this specific intervention to improve their metabolism. I think the best place to start for most people is simply eliminating their consumption of white flour, or at the least, fortified white flour [2].

Dr. Palmer tweeted about anemia and Vitamin B-12 deficiency [3]. Many patients are prescribed synthroid (T4) for their thyroid, but they often still have all the symptoms of hypothyrodism because their body doesn't activate T4 -> T3. Adding a source of T3 to patients' Synthroid treatment can make a big difference in their behavioral symptoms.

I have a book by some psychiatrists who were active in the 1940's -> 1950's, which is before the first 'psychiatric' medications were released. I didn't know this book was compiled by psychiatrists when I ordered it - I thought it was going to be a general book about the pro-metabolic intervention.

It's unfortunate that the prescription drug industry never figured out why some of their chemicals help with the symptoms labeled 'depression'. The MAOIs were reasonably-effective at helping acutely-depressed people out of bed. Each generation of antidepressants was less effective than the previous, until the SSRI's arrived. Now we're stuck with antidepressants that have always been known to cause people to commit suicide. At least the psychiatrists are now revisiting MAOIs as an option for people who don't respond well to the suicide pills (SSRIs).

Antipsychotics are a tragedy: anti-dopamine drugs make patients feel terrible. The one exception to the anti-treatment received by psychotics is an anti-serotonin drug approved for parkinsons psychosis [4].

[0] https://www.chrispalmermd.com/ https://twitter.com/ChrisPalmerMD/

[1] https://brainenergy.com/

[2] Flour manufacturers tend to use the cheapest fortifications possible. For example, the type of iron used for fortification is usually simply 'iron shavings', which usually becomes rust by the time it's absorbed.

[3] https://twitter.com/ChrisPalmerMD/status/1903071654328111413

[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC5819716/

Aurornis2• 10 months ago

There are countless examples of past doctors claiming that psychiatric disorders are caused by some simple dietary issue. You can find people claiming that everything can be fixed by ketogenic diets, vegan diets, carnivore diets, Vitamin B12, niacin, magnesium, fish oil, you name it. For any vitamin or diet there is someone out there making passionate claims that it solves everything.

None of these hold up under actual studies. It’s the domain of wishful thinking that sadly preys upon people desperate for answers. Some times the placebo effect works for a while, but usually people just end up with a cabinet full of supplement bottles and a history of fad diets with no progress on their condition.

thirdacc2• 10 months ago

None of these hold up under actual studies

I agree with you overall, but interestingly, research really has found a link between lower Vitamin B12/B6/B2 levels and ADHD. Also lower Vitamin D, and delayed circadian rhythm. You certainly can't use supplements as a replacement for stimulants but they may help.

heisenbit• 10 months ago

A sizable (3-10%) part of the population can either not digest lactose or has a significantly reduced ability to absorb fructose in the gut. The resulting fermentation and low dosing of low quality alcohol can cause cognitive symptoms which can be totally alleviated by appropriate diet.

It is easy to test (drink a sugar challenge drink and measure H2 in breath) but as it is time consuming and not profitable rarely done.

DANmode3• 10 months ago

The dietary issue is infection (usually two or more, basic shit like candida in the gut, mold exposure, EBV recurrence, Lyme, parasites, more) causing systemic malnourishment, and lack of homeostasis, causing nervous and endocrine issues/misfires,

(at which point you'll often notice immunodeficiencies, minor "unexplainable" abnormalities in bloodwork),

and indeed cognitive issues, depression, anxiety, and other more severe brain malfunctions.

andoando12• 10 months ago

Ive been saying this forever. Even with single disorder like ADHD, per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD. So if someone has 6 symptoms how do you know theyre not all independently caused? Given a large enough population it's a guarantee

DANmode3• 10 months ago

The shallowly buried truth here is that ADHD, CFS, and other common conditions are not standalone random diseases,

but diagnostic names for groupings of common symptoms,

caused by seemingly completely unrelated stuff ranging from childhood trauma, to a staph infection or mercury leak in a tooth root.

thirdacc2• 10 months ago

I don't think ADHD in particular is caused by unrelated stuff. The heritability findings are pretty strong.

A study of 894 ADHD probands and 1135 of their siblings aged 5–17 years old found a ninefold increased risk of ADHD in siblings of ADHD probands compared with siblings of controls [2]. Adoption studies suggest that the familial factors of ADHD are attributable to genetic factors rather than shared environmental factors [3, 4] with the most recent one reporting rates of ADHD to be greater among biological relatives of non-adopted ADHD children than adoptive relatives of adopted ADHD children. The adoptive relatives had a risk for ADHD like the risk in relatives of control children [4].
Twin studies rely on the difference between the within-pair similarities of monozygotic (MZ) twin pairs, who are genetically identical, and dizygotic (DZ) twin pairs, who share, on average, 50% of their segregating genes. The mean heritability across 37 twin studies of ADHD or measures of inattentiveness and hyperactivity is 74% (Fig. 1). A similar heritability estimate of around 80% was seen in a study of MZ and DZ twins, full siblings, and maternal and paternal half-siblings [5]. The heritability is similar in males and females and for the inattentive and hyperactive-impulsive components of ADHD [6,7,8].

https://www.nature.com/articles/s41380-018-0070-0

derefr• 10 months ago

per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD.

To be clear, ADHD, despite having "disorder" in the name, is actually a syndrome: a complex of symptoms that, when recognized together, indicate that a certain set of interventional treatments will likely be applicable.

Diagnosing someone with a syndrome does not indicate any knowledge is available on the cause (etiology) of the symptoms. Many different things can cause the same set of symptoms. But if a certain treatment ameliorates anything qualifying as that syndrome, regardless of the upstream cause, then the diagnosis of the syndrome (and so the existence of the syndrome as a concept) is useful, even if it's not informative.

The DSM actually covers two very different categories of what we might call "mental" illnesses: neurocognitive illnesses, and neuroendocrine (or neurohormonal) illnesses.

Neurocognitive illnesses — structural problems with the brain or its cells (think Parkinson's Disease, or ALS, or Lewy Body dementia) — are usually traceable to specific etiologies, as each one usually has either a very unique presentation of signs and symptoms, or has unique markers that can be assayed/biopsied for.

Neuroendocrine illnesses, on the other hand, are almost always syndromes. Many different upstream problems (genetic, toxic, nutritive, auto-immune, etc) can potentially cause the same small menagerie of messenger-chemicals to get out of whack, and due to this, many different upstream problems end up looking like the same few "templates" of symptoms. If you can put the particular out-of-whack messenger-chemicals back into whack with drugs that do that, then you've fixed the symptoms — which doesn't fix the upstream problem (if it even can be fixed), but does fully compensate downstream for the upstream problem.

andoando12• 10 months ago

If we fully admit that the DSM is merely a tool for treatment, a stastical tool to say "this drug might help the issues youre feeling" fine, however this is not the view Ive commonly seen in phycitatric literature, which points at ADHD being a "real disorder", as something definite one "has". Patients also commonly believe they have a definite disorder, saying things like how they finally "discovered" they have ADHd or even that they might "have undiagnosed ADHD". If we agree that the diagnosis is not informative, thst it is merely putting a name to something one already knows about themselves, do we then agree that this kind of talk is invalid?

If so, and if this view is really prevalent in psychiatry, somehow it's completely lost on the general public and media.

peepee19823• 10 months ago

I wish this were more common knowlegdge. Every time I see someone whether ADHD "exists" I think to myself "Dude, we decided that certain traits falling in a certain range on a spectrum warrant their own category because it might facilitate research and treatment. Whether it's real or not isn't even a question."

I just want to know whether my issues are normal and I'm gaslighting myself into thinking I'm broken or a loser, or if my specific issues are actually falling outside the norm. This way I know what treatment modalities might help, and which literature I can peruse instead of wasting my time reading up productivity advice meant for neurotypical people that will try to solve the wrong issue for me and just make me feel worse.

andoando12• 10 months ago

Also if its just meant to serve as a stastical tool, isnt manually making up these classifications complety outdated? Why not just feed people's data into a machine and find statsical corrolations for what helps?

thesmtsolver• 10 months ago

diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD

It does not logically follow that different symptoms -> different causes.

(Fire can cause smoke, heat, soot, etc. Depending on the wind and other conditions, only some of them may be observable.)

One root cause can manifest in different ways depending on interactions with other factors.

The genetic basis for ADHD is well studied and points to a single set of core causes.

andoando12• 10 months ago

I have symptoms 1-6, you have symptoms 4-9. We only share 4,5,6. Or I have 1,3,5,6,7,8, you have 2,4,6,7,8,9.

Surely then, each of the symptoms (precieved, subjective symptoms) at that, can exist without ADHD.

So my question is, how do you know I simply dont have multiple completely independent things that together present the 6 symptoms? Even if we are to agree its a genetic condition, the diagnosis of sny particular individual isnt based on genes so theres room for criticism of the diagnostic process

cardanome• 10 months ago

That is why we do differential diagnosis.

Any ADHD diagnosis includes checking for any other mental or physical issue that could explain the symptoms. Any when anything else is ruled out AND it can be established that the person always struggled with those symptoms (ideally that they were present in childhood) will you get a diagnosis.

Furthermore we know that ADHD has a genetic link. You have a 40% chance to have it when your parent has it. While we don't know every detail about how ADHD develops, we know it is something you are born with.

I am so sick that people pretend that ADHD is some vague concept. No, it is vague for you because you are ignorant about it.

Yes, ADHD can show up very differently in people. Which is not surprising because people happen to be different. Covid-19 can have widely different symptoms between people, doesn't mean it is not real.

As an ADHD person when I interact with other with ADHD people, yes there are huge differences but there is always a shared understanding. I never have the feeling the person has a completely different thing. There is always shared understanding.

siva74• 10 months ago

That's understood by physicians and is also the reason why they are doing many questionnaire's with you (if they follow diagnostic guidelines) which might seem first confusing to the patient like unrelated to your actual symptoms but it's to rule out many other common diseases.

andoando12• 10 months ago

Unrelated? Theyre so in your face its ridicously easy to get the diagnosis you're looking for

oofbey4• 10 months ago

The paper described makes a statistically rigorous attempt to recover common psychiatric diagnoses (like major depressive disorder MDD) from raw unbiased data about people’s experiences. And seems to conclude that the Venn diagram for common presentations of these conditions doesn’t line up well with the official diagnoses. Not that the conditions don’t exist. But that we are grouping together distinct conditions under the same name. They give examples of anhedonia and suicidality as distinct clusters in their data even though both would be considered MDD under the DSM.

To me this begs the question of whether the DSM authors might actually know something real and useful that the data don’t show. For example that anhedonia often progresses to suicidality even though the two might not coexist in the same person often. (Doesn’t sound right to me, but that’s how I read the article.) I think it’s plausible that the direct implication of this research is actually wrong. The obvious conclusion is that the DSM is full of it and doesn’t match real people’s experiences. But I suspect it might be that the DSM captures useful correlations and progressions that this method didn’t collect. Perhaps because the data here are from a single point in time, not a progression.

bawolff• 10 months ago

Even still, wouldn't youvwant to separate X & Y are the same thing from X eventually progresses to Y.

I think the most obvious conclusion is not that the DSM is bunk, but that some of things it groups together might be better to group separately. The real question of course is which grouping corresponds better to the group responding the same way to a similar intervention. After all the point diagnosing is to put people into groups so we can learn from the patterns of similar people to figure out better treatments.

oofbey4• 10 months ago

Fair point. I agree. If there’s structure in people, the DSM should capture it. MDD phase 1,2,3 would be a useful update.

rusk3• 10 months ago

To me the conclusion is that the DSM is out of date. Not the document, or specific iteration itself but the mindset driving it. When DSM was simpler and we didn’t know as much about mental illness, then what DSM was trying to achieve wasn’t such a tall order, and it was a useful diagnostic companion. However it seems to me it’s gone from being merely useful to being considered canon, and through successive iterations has tried to fill those boots to the point where people are calling out the DSM as being entirely flawed when in fact what is going on is it’s just stepping out of its bounds.

dboreham• 10 months ago

The DSM exists to satisfy US medical insurance industry which requires the patient be diagnosed with a specific "condition" before they will pay for anything.

oofbey4• 10 months ago

That’s one reason. Another less cynical reason is to ensure professionals mean the same thing when they use specific words. Brains are complicated, of course. Making predictions about how one person will react to medication based on their experiences is very difficult. Being able to collect data and group it consistently makes this prediction task much easier. “We known that many people who answer these questions with these answers improve after taking this medicine.” That’s genuinely useful, needs the DSM or something like it, and has nothing to do with insurance.

halayli• 10 months ago

you've checkboxed two fallacies with one stone: motivated reasoning, and attribution of malice. I am defending reasoning and logic here, not insurance industry. what you said might be true but you need to back up your claims.

moi23882• 10 months ago

This is a good start, but it still clusters based on symptoms

It’s like going to the doctor and getting an HIV diagnosis because you’ve got a runny nose.

SiempreViernes• 10 months ago

That's how all diagnosis starts, what did you expect?

moi23882• 10 months ago

Start. But in psychology, it’s the end of it.

With actual doctors, they will take blood work, perform tests to find the actual virus, bacteria or other cause.

They find the cause, not just a list of symptoms.

Psychology and psychiatry is only now starting to actually research causes.

perlgeek• 10 months ago

It's like going to the doctor and getting a runny nose diagnosis because you've got a runny nose.

In the end, a diagnosis only helps the patient if it enables a treatment, hopefully an effective one. If you have a cluster of symptoms with two possible causes, and there is no difference in the care for the patient, what's the point of further differential diagnosis?

ryanjshaw• 10 months ago

Important to note the various limitations of this approach:

It relies only on self-reported symptoms, and features requiring clinician observation are missing; symptoms are decontextualized (e.g., insomnia due to substance withdrawal isn’t differentiated from insomnia due to anxiety); all symptoms were assessed using a 12-month time scale, even though different symptom patterns exist at different time scales.

In particular, I’m not sure how this would identify somebody with the traditional schizophrenia + anosognosia combo, which requires another person to help diagnose.

TeeMassive• 10 months ago

Every time I read a part of the DSM-V, as a layman, I'm flabbergasted how vague and redundant and arbitrary symptoms and diagnostics are made (e.g. "if 6 out of 10 then..."). It just seems that on its face, while psychiatry has improved and began doing more good than harm since deinstitutionalization, it still lacks the rigor found in other applied scientific fields such as cardiology and oncology for example.

This study is a very good step in the right direction. The other direction is more quantitative methods such as measuring the brain waves response to a retinal laser flash to detect mental disorders (look it up, it's real)

mwidell2• 10 months ago

Could it be that everything we call mental illness is just natural variation of people's psyche, at the ends of the bell curve?

Many of the mental illnesses are of course bad, but in an evolutionary perspective it makes sense that we have these variations in a population, to optimise adaptation.

AlecSchueler• 10 months ago

What do you mean by "natural variation?" A great many of mental health issues develop as a result of trauma. You could say that a broken leg is a natural variation of a leg, as it happens naturally as the result of physical trauma, but does that help you understand it or treat it better?

mwidell2• 10 months ago

I mean natural variation as in genes. Trauma often triggers mental health problems, but there usually needs to be genetic susceptibility as a foundation for it to happen.

Danjoe4• 10 months ago

Psychiatry is loosely based on science and 90% of the drugs they prescribe are net harmful

TeMPOraL• 10 months ago

I really like the approach, this is exactly what statistical tools are for. I like it all the way up to the very end, where I feel this report drops the ball, in trying to derive a hierarchy from the results.

Hierarchies don't exist. Nothing in nature is organized in trees (data structures), not even actual trees (the other kind). Organization, relationships, form directed graphs (or the continuous domain equivalent). Hierarchies are deceptively simple because they planarize, meaning you can draw them on paper without crossing lines, or introducing indirect references. But that's often as deceiving as it is helpful.

Think of the "tree of life" - there is no one tree of life, its shape depends on which aspects of phenotype or genotype you select and organize around. Think of corporations and governments - you can either accept there's a lot of "dotted lines" in the org chart, turning it into a dense DAG, or never understand why people do what they do. And so here, it's also quite apparent there are correlations cutting across the proposed hierarchy, clearly visible even on Figure 2 - the one that urges us to disregard the left-to-right ordering of the constructs.

I mean, the researchers are likely perfectly aware of this. My worry is that 90%+ of the insight of the proposed model will get lost in final planarization into a hierarchy that gets into the next DSM.

dr_dshiv• 10 months ago

This is very much in line with the research-alternative to DSM— the so-called RDoC — which takes a clustering vs category approach:

https://www.nimh.nih.gov/research/research-funded-by-nimh/rd...

nraynaud• 10 months ago

I'm very happy that they are trying to re-classify the DSM, it's probably the sign of a maturing medical field. Let's also hope that re-clustering will help with the reproduction crisis.

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DSM Disorders Disappear in Statistical Clustering of Psychiatric Symptoms (2024)

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