I read less and less of the Psychiatric literature as time goes on. This is not because there are not amazing advances being made in the Neurosciences on an almost daily basis, there are, but because too much Psychiatric literature is uninformative or worse. Occasionally, the Psychiatrists conducting "studies" produce work of such fatuousness as to warrant reporting in the finest MSM institutions. Such is the case this week with an article on Bloomberg, which I imagine will be quoted extensively on the radio and in the news:
About Half of College-Aged Had Psychiatric Disorders
Almost half of college-aged adults had a psychiatric disorder over a one-year span, based on research criteria that ranged from bipolar disease to substance abuse including smoking. Few sought treatment, the study found.
About one in five students failed to fulfill an obligation, had a legal problem, did something dangerous or caused social problems by using alcohol, the study found. The next most common psychiatric problems were so-called personality disorders, including obsessive-compulsive behavior, at 18 percent, according to the report in the Archives of General Psychiatry.
I decdied to take a look at the orignial article before commenting since, in my experience, inaccurate reporting of scientific literature is the norm. Unfortunately, the original article, in spite of lots of statistical data, did not do much to allay my initial impression. The authors start the article with a non-sequitur (not available on-line):
The tragic events of April 16, 2007 at Virgnia Polytechnic Institute and Ferbruary 14, 2008, at Northern Illinois University have called attention tstudents and other yougn adults.
This is a non-ubecasuse the actual article, a survey of the mental health of college students does not in any way relate to the problem of homicidal violence on college campuses. In fact, while the gunman at VPI had a Psychiatric history and had been in treatment, the vast majority of college age killers have never come to the attention of Psychiatrists and the article does not address the incidence and types of mental illness that might be correlated with homicidal violence. So what does the article purport to do?
Mental Health of College Students and Their Non–College-Attending Peers
Results From the National Epidemiologic Study on Alcohol and Related Conditions
Results Almost half of college-aged individuals had a psychiatric disorder in the past year. The overall rate of psychiatric disorders was not different between college-attending individuals and their non–college-attending peers. The unadjusted risk of alcohol use disorders was significantly greater for college students than for their non–college-attending peers (odds ratio = 1.25; 95% confidence interval, 1.04-1.50), although not after adjusting for background sociodemographic characteristics (adjusted odds ratio = 1.19; 95% confidence interval, 0.98-1.44). College students were significantly less likely (unadjusted and adjusted) to have a diagnosis of drug use disorder or nicotine dependence or to have used tobacco than their non–college-attending peers. Bipolar disorder was less common in individuals attending college. College students were significantly less likely to receive past-year treatment for alcohol or drug use disorders than their non–college-attending peers.
Conclusions Psychiatric disorders, particularly alcohol use disorders, are common in the college-aged population. Although treatment rates varied across disorders, overall fewer than 25% of individuals with a mental disorder sought treatment in the year prior to the survey. These findings underscore the importance of treatment and prevention prevention interventions among college-aged individuals.
To which I can only say that we should pray to whatever deity we believe in that our adolescent and young adult children can escape the clutches of such intervention and treatment programs. Allow me to explain: In America, and in modern Western society in general, adolescence has been expanded. Although for training purposes the American Psychoanalytic Association defines adolescence as extending until 22, in reality, (late) adolescence, psychologically, extends through that period of time in which young people are physically mature but have not yet taken on adult responsibilites. It is a unique construct and since the baby boomers have (refused to) come of age, adolescence has been extending to later and later ages. The age of 22 was chosen in part because it was the age at which most children graduate college and begin to support themselves. Now, because of Graduate school, professional schools, and various levels of continuing dependency on parents, adolescence can extend to the late 20s. This is significant for two reasons:
A person with adult appetites, few restrictions, a societal licence to "just do it", and few responsibilities has little reason to limit or moderate his or her behavior.
Adolescence, a time of transtion between childhood and adulthood, has particular developmemtal tasks for the person and is a time of increased internal conflict and stress as a result.
The first issue is germane to the diagnosis of Alcohol Abuse and Dependency. According to the survey, 7.85% suffer from alcohol abuse and 12.52% suffer from alcohol dependency. The use of such precise statistics should not obscure the fact that the results are nonsensical. For any substance abuse, prior to the establishment of a true addiction, the number who abuse will always be higher than the number who are dependent. Very few adolescents get diagnosed with alcohol dependence, which leads me to think that the authors are overly reliant on a strict reading of the DSM-IV defintion of alcohol dependence:
Physiological dependence on alcohol is indicated by evidence of tolerance or symptoms of Withdrawal. Especially if associated with a history of withdrawal, physiological dependence is an indication of a more severe clinical course overall (i.e., earlier onset, higher levels of intake, more alcohol-related problems). Alcohol Withdrawal (see page 215) is characterized by withdrawal symptoms that develop 4-12 hours or so after the reduction of intake following prolonged, heavy, alcohol ingestion. Because Withdrawal from alcohol can be unpleasant and intense, individuals with Alcohol Dependence may continue to consume alcohol, despite adverse consequences, often to avoid or to relieve the symptoms of withdrawal. Some withdrawal symptoms (e.g., sleep problems) can persist at lower intensities for months. A substantial minority of individuals who have Alcohol Dependence never experience clinically relevant levels of Alcohol Withdrawal, and only about 5% of individuals with Alcohol Dependence ever experience severe complications of withdrawal (e.g., delirium, grand mal seizures). Once a pattern of compulsive use develops, individuals with Dependence may devote substantial periods of time to obtaining and consuming alcoholic beverages. These individuals often continue to use alcohol despite evidence of adverse psychological or physical consequences (e.g., depression, blackouts, liver disease, or other sequelae). [Emphasis mine-SW]
Note that the diagnose typically includes withdrawal symptoms but that the caveat, that the diagnosis does not require withdrawal states, allows for an expansive diagnosis. Young adults do often, too often, use too much alcohol. A literal minded researcher, using the DSM-IV for cover, could presumably diagnose alcohol abuse in any number of youngsters who behave the way irresponsible college kids behave. If missed classes, regular drinking to intoxication, binge drinking, etc, is considered compulsive drinking (as it would for adults and some adolescents) then it is possible to over-diagnose alcohol dependece without much trouble.
Now consider the diagnosis of alcohol abuse, which includes very typical college age behavior, viz a viz alcohol:
Alcohol Abuse requires fewer symptoms and, thus, may be less severe than Dependence and is only diagnosed once the absence of Dependence has been established. School and job performance may suffer either from the aftereffects of drinking or from actual intoxication on the job or at school; child care or household responsibilities may be neglected; and alcohol-related absences may occur from school or job. The person may use alcohol in physically hazardous circumstances (e.g., driving an automobile or operating machinery while intoxicated). Legal difficulties may arise because of alcohol use (e.g., arrests for intoxicated behavior or for driving under the influence). Finally, individuals with Alcohol Abuse may continue to consume alcohol despite the knowledge that continued consumption poses significant social or interpersonal problems for them (e.g., violent arguments with spouse while intoxicated, child abuse). When these problems are accompanied by evidence of tolerance, withdrawal, or compulsive behavior related to alcohol use, a diagnosis of Alcohol Dependence, rather than Alcohol Abuse, should be considered. However, since some symptoms of tolerance, withdrawal, or compulsive use can occur in individuals with Abuse but not Dependence, it is important to determine whether the full criteria for Dependence are met.
There are reasons why adolescents drink too much and very good reasons why most adolescents who drink too much do not become alcoholics. The ability to drink too much without suffering grievous consequences encourages those who have not yet accepted adult responsibility to drink irresponsibly, especially since alcohol (in the short term) is a social lubricant and anti-anxiety substance. Living in a cultural milieu that encourages excessive drinking (and noticeably encouraged by a larger society; just watch all the beer commercials populated with attractive young people who do not show any indication of concern over their intake) also facilitates drinking in college age young people. And this leads to my final point, concerning late adolescence as a time of increased internal conflict and stress.
I will not here review the difficult developmental tasks of late adolescence but suffice to say that it is a common age for young people to have psychiatric symptoms for the first time. (I would add that very young children often have transient psychiatric symptoms, such as excessive handwashing, which typically improves in ealry adolescence.) It is a well known and worth repeating fact that even a diagnosis of Psychosis in a young person must be made with a fair amount of caution. Highly stressed young people can have all sorts of frightening psychiatric symptoms and can resemble adult Manic-Depressives or Schizophrenics, yet the disturbances are transient, often respond well to interventions, and often never repeat. Perhaps M_O_M, in her comments on this story, puts it most eloquently and colloquially:
Laughing: Could There Be A Connection?
Since when have teenagers NOT been crazy? Isn't that sort of the problem with adolescence? And is smoking really a mental disorder? And if smoking is a mental disorder, does that mean we have a deranged President Elect who should seek treatment?
I found myself feeling great skepticism as I read this article!
It may well be the dream of many Psychiatrists, other Mental Health Workers, and Pharmaceutical companies to diagnose us all with treatable mental illness but by ignoring the specific developmental issues of adolescence and treating all of the vicissistudes of our mental life as pathological, these kinds of reports do us all a disservice.
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