Monday, March 25, 2013

Three Medical Conditions Commonly Misused in Everyday Speech

Three Medical Conditions Commonly Misused in Everyday Speech

Authors Note:

This article mentions several mental illnesses that readers may not be familiar with, so I’ve provided some links and brief definitions. I also may later add a “further reading” section for readers who share my fascination with this subject matter.

In the interest of clarity, I’d like to start with a quick overview of how these disorders are classified in the Diagnostic and Statistical Manual of Mental Disorders, the epic tome of psychiatry. Diagnoses are currently made using the DSM-IV, but this will change once the much-anticipated DSM-5 is released this May. The DSM’s controversial history warrants a separate article which I’ll write in the near future.

DSM-IV is built on a five component multiaxial system:

Axis I: Clinical and developmental disorders typically associated with mental illness.  Among these are mood disorders, anxiety disorders, eating disorders, schizophrenia, autism spectrum disorders, and ADHD.
Axis II: Personality disorders and mental retardation. The personality disorders are grouped into four subsections: Cluster A - Odd, Cluster B - Dramatic, Cluster C- Anxious, and NOS (not otherwise specified.)
Axis III: Medical conditions and physical disorders
Axis IV: Social and environmental contributors to the Axis I or II mental disorders.
Axis V: Global Assessment of Functioning on a 0-100 scale.

I’ll mostly be discussing I and II, but all the axes are imperative in the formation of a proper differential diagnosis. Not all patients who present with mental dysfunction have a mental illness. Some medical conditions or nutritional deficiencies can produce symptoms that mimic a mental disorder but cannot be treated with standard psychotropics because their root causes lie elsewhere. Hypothyroidism can cause depression and rapid thoughts which could be misdiagnosed as bipolar disorder. In Korsakoff’s syndrome, prolonged alcohol abuse or malnutrition leads to a vitamin B1 deficiency that results in symptoms commonly seen in schizophrenia: memory loss, apathy, lack of insight and diminished conversation skills.

These are just two of many examples that reveal how important it is for doctors to examine all the pieces before trying to construct a puzzle. Jumping to a conclusion of mental illness and prescribing medications with often risky side effects can be a serious mistake with potentially tragic consequences.


Example: “She’s already lost like 10 lbs and still wants to lose more, I think she has anorexia.”
Problem: Anorexia is a symptom or an effect, not a disease.

The medical definition of anorexia is the lack or loss of appetite. It’s derived from the Greek an - without, and orexis - appetite. Often, the term anorexia is erroneously used to describe a person with a possible Axis I eating disorder. The actual name for this disorder is Anorexia nervosa.

Adding to the confusion, an “anorexic” is both the term for a person with this disorder and a term for a drug used for the purpose of appetite suppression. For this reason, I prefer to use the term anorectic when referring to appetite suppressant drugs. (There’s also a semi-related issue that appetite suppressants are often called “stimulants” but that might have to be tabled for a future discussion.)

It’s possible for individuals with anorexia nervosa to experience a self-inflicted loss of appetite as a result of fasting. A fast is simply defined as an 8-12 hour period without food, but not everyone who gets 8-12 hours of sleep wakes up famished and desperate for breakfast (break-fast.) More often however,  sufferers do feel hunger but don’t act on it in an effort to maintain control.


Example: “I’m really OCD about my house, I love cleaning it and keeping it neat and tidy.”
Problem: OCD rituals have nothing to do with enjoyment.

Obsessive-compulsive disorder is one of several Axis I anxiety disorders. People with OCD have intrusive thoughts and engage in repetitive actions to lessen their anxiety. Several OCD subtypes exist, but they’re all predicated on anxiety.  Occasionally, people misuse the term OCD because they don’t know the actual term for the condition they mean to refer to: Obsessive-Compulsive Personality Disorder, an Axis II - Cluster C disorder.

People with OCPD are convinced they’re behaving correctly. By contrast, people with OCD are aware of the irrationality of their rituals or beliefs. They want to stop but can’t, out of fear that something bad will happen to them. The result is a vicious cycle: at first, the rituals seem like a harmless way to alleviate anxiety. Once they stop working, a sufferer might add to the rituals or adopt new ones. The more elaborate and repetitive the rituals get, the more frustrated and embarrassed the sufferers get, and their anxiety hits an all-time high.   

Whether it’s repetitive cleaning, checking, avoiding, or other actions, these compulsive rituals are not enjoyable to people with OCD. People who get a high from keeping an immaculately organized closet or pantry, or from daily vacuuming and constant counter wiping are not suffering from OCD, they may just be neat freaks, not mentally ill.

Example: A popular t-shirt quote: “I’m schizophrenic - and so am I.”
Problem: Schizophrenia has nothing to do with multiple personalities.

It’s quite popular to use the term “schizo” to describe someone who is two-faced, or who flips out for no particular reason. This characterization is false and etymology is partially to blame. Schizophrenia comes from the Greek skhizein (to split) and phren- (mind.) To many, this indicates a splitting of the personality but it actually refers to a splitting of the brain’s thought and emotional processes. This characterization leads people to confuse schizophrenia for the disorder once known as multiple personality disorder, now called dissociative identity disorder, a controversial diagnosis that some professionals feel may not exist.

DID is defined by having at least two distinct personalities which can separately take hold of an individual’s behavior. Occasionally, schizophrenia will appear alongside other disorders like bipolar disorder and borderline personality disorder - comorbidities that feature higher than average rates of suicide and substance abuse.

Symptoms of schizophrenia are typically grouped into two categories: negative and positive. These aren’t evaluative terms, but rather reflect on symptoms that are added to or subtracted from a normally functioning mental state. Positive symptoms include the trademark signs of the disorder, such as delusional thoughts and visual or auditory hallucinations. Negative symptoms include social withdrawal, apathy, flattened emotions, speech difficulty, lack of motivation, and inability to experience pleasure.

Although currently accepted, the DSM-5 may do away with the sub-classifications of schizophrenia. These include paranoid type (grandiose delusions, hallucinations), catatonic type (very slow movements, mental stupor), undifferentiated type (psychotic, but not other, symptoms), residual type (minimal presentation of positive symptoms), post-schizophrenic depression (minimal symptoms still present in post-episode depression), and simple schizophrenia (progressive negative symptoms, no psychotic episodes.)

Cautionary Note:

As a reader, you may find yourself feeling morbidly curious enough to look further at the DSM criteria for the aforementioned disorders or any other disorders. This is normal and probably to be expected, particularly of the fellow hypochondriacs and autodidacts that comprise my niche.

If you find yourself on this path, I highly advise you to proceed with caution. The DSM-IV lists 365 diagnoses - one for each day of the year.  I can guarantee that you’ll find something in there that will resonate with you. It might also worry you. On the other hand, if you’re convinced nothing in there can apply to you, then you automatically meet at least one criterion for narcissistic personality disorder.

Remember - the criteria for mental illness is met only by establishing a certain number or certain combination of symptoms, often for a specified length of time. These symptoms must also negatively impact functioning in one or more life areas such as physical and mental well-being, interpersonal relationships, social interactions, work or school performance, etc. No matter how many symptoms you can match yourself up with, if you think you’re doing a fine job of coping and not letting these presumed issues take over your life, then keep on truckin - whatever disorder you *may* have is subthreshold and requires no treatment. Either way, no treatment is one-size-fits-all.

So, if you decide to seek a professional diagnosis, take it like you should take any other tidbit of information offered up by a so-called authority figure - with a big grain of salt. Even a brain in a vat doesn’t have to accept that it’s sharing that vat with its own cooties.

There’s nothing ill-advised about the individual quest for knowledge and self-understanding, just try and have a clue about where you want to go. You likely won’t want to go to a place that pathologizes your every thought - if you gaze too strongly into that abyss you may launch yourself into oblivion. If oblivion is what you’re after, there are recreational means of arriving there that are far more desirable and pleasurable to fretting over the pedantries of an 886 page manual.

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