OM DENNE EPISODE
"We've made it advantageous to have a diagnosis."
Is ADHD overdiagnosed? Nation asks a plain question first: somebody walks in convinced they have ADHD. How do you find out whether they do? Roger's answer is the diagnostic triage.
There are two roads to a diagnosis. Psychometric testing, with the MMPI and the MCMI as the gold standards. Or the diagnostic interview, where each category has a list of criteria and you have to meet three of five, or six of nine. Then three more tests that some clinicians have stopped applying: it has to cause significant distress, it has to last, and it has to be unrelated to life events. If your mom dies, you have every symptom of depression. That is not depression. That is grief, and we know its course.
Then the buckets in the DSM: mood, thought, developmental (where ADHD sits), personality, eating, anxiety. The diagnostic language used to be contained within a profession. The internet democratized it. Read the manual and you are convinced you have everything in it.
Roger says overdiagnosis is a piece of the story without a doubt, and he names the incentive. Schools give extra time on a test to a kid with a diagnosis. Social media rewards a self diagnosis worn as a badge of honor. A friend's daughter reports that nobody at her high school is a jock or a theater kid any more. They are in the "I have this disorder" group. Victimhood pays, so you get more of it.
The negativity bias explains why it sells, and Tierney and Baumeister's The Power of Bad explains the bias. Then the therapist's side. If all you have is a hammer, everything looks like a nail, and a therapist's best tool is the diagnostic category. Behind it is a training problem: eight students a class in his program, thousands in two-year programs now. What do you call the person who graduated last in medical school? Doctor.
A mental health diagnosis is a cluster of about eight symptoms, and calling yourself mentally ill when you are not does a disservice to the people who really have the illness. You are not your trauma. You are not your diagnosis. There is far more to you than those narrow categories.
The conversation continues in Episode 77: Seligman's farewell address, character strengths, and why everybody's life is hard.
What we cover:
- Distress, duration, and unrelated to life events: the three tests that get skipped
- Grief looks exactly like depression and is not depression
- The DSM buckets, and where ADHD actually sits
- Why overdiagnosis is a piece of it without a doubt
- Diagnosis as a badge of honor: self diagnosis on TikTok
- Extra time on the test: how schools made a diagnosis advantageous
- The Power of Bad and the negativity bias
- If all you have is a hammer: the therapist whose best tool is the diagnosis
- Diploma mills, and what you call the last in the class
- You are not your trauma. You are not your diagnosis
Books shown: the DSM-5 (American Psychiatric Association) and The Power of Bad by John Tierney and Roy Baumeister.
Chapters
0:00 We've made it advantageous to have a diagnosis
1:26 How do you find out if you have ADHD? The diagnostic triage
2:12 The MMPI and the MCMI
3:49 It has to last, it has to distress you, and it has to be unrelated to life events
4:08 Grief looks exactly like depression. It is not depression
5:23 Normal problems in living
7:01 The DSM buckets: mood, thought, developmental, personality, eating, anxiety
8:24 The rise in ADHD diagnoses since the 90s
9:10 The DSM used to belong to a profession. Then came the internet
10:44 TikTok and the diagnosis as a badge of honor
11:56 We've made it advantageous to have a diagnosis
12:50 Rewarding victim status: the friend's daughter at school
14:16 If it bleeds, it leads: The Power of Bad and the negativity bias
16:04 If all you have is a hammer: the therapist's best tool is the diagnosis
17:15 Priests, incantations and the box of tissues
19:42 Eight students a class then, thousands in two-year programs now
20:26 Diploma mills, and what you call the last in the class
21:41 I am my diagnosis. No, you're not
22:24 You are not your trauma. You are not your diagnosis
22:54 Next week: Episode 77
23:13 Share this with a friend
Images: DSM-5 cover via Wikimedia Commons (public domain); The Power of Bad cover via Open Library.
Second Thoughts, Episode 76.
Dr. Roger Hall is a Peak Performance Psychologist who helps leaders master their thinking and achieve greater power, freedom, clarity, and calm.
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