Recognition of the False Epidemic of ADHD by a Major Newspaper Its About Time

Finally, there has been recognition by at least one major metropolitan newspaper, the New York Times, about the phony “epidemic” of ADHD diagnoses among both adults and children. Not that doctors pushing the disorder would ever admit to it. (News to some: a high percentage of these diagnoses are made by non-psychiatrist physicians such as pediatricians).

An e-mail newsletter from the American Psychiatric Association contained the following story on 12/10/2013:

 “The Centers for Disease and Control and Prevention (CDC) reports that there has been a 42% increase in attention-deficit/hyperactivity disorder (ADHD) diagnoses in children aged 4 to 17 from 2003 to 2011. Data were published in the Journal of the American Academy of Child and Adolescent Psychiatry. The study included 2011 data from a randomized, cross-sectional national survey of more than 95,000 U.S. households known as the National Survey of Children's Health. …The results showed by 2011, 11% of children—or 6.4 million children nationwide—had received a diagnosis of ADHD. Among those with a diagnosis for ADHD, approximately 70% were currently taking medication for the disorder—increasing by 28% from 2007 to 2011. Nearly 1 in 5 high school boys was diagnosed with ADHD, compared with 1 in 11 high school girls. ADHD-diagnosis frequency was most prevalent in Kentucky, at 15 percent, and least prevalent in Nevada, at 4.2 percent.

"The authors [of the study] speculate that 'better detection of underlying ADHD, due to increased health education and awareness efforts' may be the reason for the increase of ADHD diagnoses among American children."

BETTER RECOGNITION?? REALLY?!?  A story in the New York Times by Alan Schwarz on December 14, 2013 had a far more reasonable explanation.  It said that even the person most responsible for recognition of ADHD in children, Keith Conners, questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

Keith Connors, Ph.D.

The Times story continues:

“The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

… The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.

Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.”

The story was followed by an editorial on 12/18/13, An Epidemic of Attention Deficit Disorder.  Hooray for the New York Times!!  Some of what it said:

“The hard-sell campaign by drug companies to drive up diagnoses of attention deficit hyperactivity disorder, or A.D.H.D., and sales of drugs to treat it is disturbing. The campaign focused initially on children but is now turning toward adults, who provide a potentially larger market…Many of these children, it appears, had been diagnosed by unskilled doctors based on dubious symptoms…

“Shire, an Irish company that makes Adderall and other A.D.H.D. medications, recently subsidized 50,000 copies of a comic book in which superheroes tell children that “Medicines may make it easier to pay attention and control your behavior!” Advertising on television and in popular magazines has sought to persuade mothers that Adderall cannot only unleash a child’s innate intelligence but make the child more amenable to chores like taking out the garbage…

“The potential dangers should not be ignored. The drugs can lead to addiction, and, in rare cases, psychosis, suicidal thoughts and hallucinations, as well as anxiety, difficulty sleeping and loss of appetite…So many medical professionals benefit from overprescribing that it is difficult to find a neutral source of information. Prominent doctors get paid by drug companies to deliver upbeat messages to their colleagues at forums where they typically exaggerate the effectiveness of the drugs and downplay their side effects. Organizations that advocate on behalf of patients often do so with money supplied by drug companies…

“Curbing the upsurge in diagnoses and unwarranted drug treatments will require more aggressive action by the F.D.A. and the Federal Trade Commission, which share duties in this area. It will also require that doctors and patients recognize that the pills have downsides and should not be prescribed or used routinely to alleviate every case of carelessness, poor grades in school or impulsive behavior.”

Dr Allens Book for Therapists about Treatment of Borderline Personality Disorder Now Available in Paperback

Now available in paperback at http://www.amazon.com/Psychotherapy-Borderline-Patients-Integrated-Approach/dp/1138012750/ref=mt_paperback?_encoding=UTF8&me=

Getting to Know More about Dementia

"It wasn't until 1995 that I first noticed that Peter was acting strangely. I thought he wasn't interested in his business any more. He appointed a manager and took early retirement at the age of 54. From then on, he became a different person…” These are the words of a woman whose husband was diagnosed with Alzheimer’s Disease- the most common type of dementia. To read the full story and get to know the every day struggles of people who suffer from dementia and their loved ones.

Dementia is a general term to describe symptoms involving difficulties with cognitive functions such as memory, language, reasoning, planning, recognizing, or identifying people or objects.

Symptoms of dementia

 

Based on the website for medical news today, the most common symptoms of dementia are:

• Frequent and progressive memory loss. People with dementia begin to forget more and more, and the most recent events seem to be forgotten most quickly. Occasionally though, clear "pockets of memory" are still present, and these are usually triggered by familiar faces, smells, touches, songs, or rituals.
• Language difficulties: People with dementia are often unable to understand instructions or to follow the logic of moderately complex sentences. He or she may not understand his or her own sentences, and have difficulty forming thoughts into words. Occasionally, everyone has trouble finding the right word, but a person with dementia often forgets simple words or substitutes unusual words, making speech or writing hard to understand.
• Confusion: This behavior causes a person with dementia to become "estranged" from others and to be unpredictable in interactions. Confusion can also occur "acutely", that is, suddenly and limited in time (for example, triggered by a hospital stay). In addition to this general confusion, people with dementia are disoriented in time and place. They often forget the current time and get lost in a familiar environment.
• Inability to perform familiar tasks. People with dementia often find it hard to complete everyday tasks that are so familiar we usually do not think about how to do them. In particular, people with dementia have great problems carrying out activities in the proper sequence. For instance, they may not know in what order to put on their clothes.
• Difficulty with abstract thinking. People with dementia often show unusual difficulty performing mental tasks. For instance, planning tasks, making decisions, or organizing projects become more and more difficult. They also lose the ability to make simple monetary transactions such as paying a bill.
• Misplacing belongings. Anyone can temporarily misplace his/her wallet or keys. A person with dementia may put things in unusual places such as an iron in the fridge or a wristwatch in the sugar bowl.
• Rapid mood swings: People with dementia become extremely moody, switching between emotions within a matter of seconds for no apparent reason. Alternatively, a person with dementia may show less emotion than s/he used to do previously.
• Behavioural changes: A person with dementia may seem different from his/her usual self in ways that are difficult to identify or explain. A person may become suspicious, irritable, depressed, apathetic, anxious, or agitated, especially in situations where memory problems are causing difficulties.
• Apathy/ lack of initiative: A person with dementia may become very passive, sitting in front of the television for hours, sleeping more than usual, or appear to lose interest in hobbies.

While there are some common symptoms of dementia, it is important to remember that everyone is unique. Some people may show all of these symptoms, while other may only exhibit some of them, but to a greater extent.

Progression of Dementia through its three stages

 Mild or Early-Stage dementia

Dementia usually begins gradually with very minor changes in the person's abilities or behaviour. In this phase, such signs are often attributed to stress or bereavement or, in older people, to the normal process of aging. Mostly, one only realizes by looking back that these signs marked the beginning of dementia. During the early phase of dementia, the person may:

• Become more forgetful of details of recent events
• Be more likely to repeat themselves or lose the thread of a conversation
• Be slower to grasp complex ideas and take longer to complete routine jobs
• Have difficulty handling money
• Show poor judgement and make poor decisions
• Blame others for 'stealing' lost items
• Lose interest in hobbies or activities
• Be unwilling to try new things
• Be unable to adapt to change
• Become more self-centered and less concerned with others and their feelings
• Be more irritable or upset if they fail at something
• Appear more apathetic, with less sparkle

Moderate or mid- stage Dementia

As dementia progresses, the changes become more marked and disabling.

People with dementia slowly move from forgetfulness into confusion. The person lives more and more in his/her own, dreamlike world in which present and past blend together and in which the rules and structures of the 'old world' - what is right, what is important - lose importance. At this stage people with dementia increasingly see themselves not as confused in a logical environment, but as oriented in a very unfamiliar environment.

During the moderate phase of dementia, the person may:

• Be increasingly forgetful of recent events. Memory for the distant past seems better, but some details may be forgotten or confused
• Repeat the same question or phrase over and over
• Be confused regarding time and place
• Become lost if away from familiar surroundings
• Forget names of family or friends
• Fail to recognize people or confuse them with others
• Forget saucepans and kettles on the stove. May leave gas unlit
• Wander around streets, perhaps at night, sometimes becoming lost
• Behave inappropriately - for example, going outdoors in their nightwear
• See or hear things that are not there (hallucinations)
• Become very repetitive
• Be neglectful of hygiene or eating
• Become angry, upset or distressed through frustration

Some people at this stage become very easily upset, angry or aggressive, perhaps owing to frustration, or they may become overly attached to a certain person.

At this moderate stage, the person will need more support to help them manage their day-to-day living. They may need frequent reminders or help to eat, wash, dress and use the toilet.

Severe or Late-Stage dementia 

At this stage, a person with dementia becomes severely disabled and will need even more help, gradually becoming totally dependent on others for nursing care.

Loss of memory may be almost complete, with the person unable to recognize familiar objects or surroundings or even those closest to them, although there may be sudden flashes of recognition. Patients are also less able to establish and maintain eye contact and appear to see through people. They may even stop recognizing themselves in the mirror.

Access to their 'bubble'-like world in which they hide and retreat becomes more difficult as language deteriorates. Repetitive movements might emerge, like rocking, undressing, or walking up and down.

Although they can't speak anymore, they are sometimes able to sing hymns and say prayers (automatism).

At this stage, the person may:

• Be unable to remember - for even a few minutes - that they have had, for example, a meal
• Gradually lose their ability to understand or use speech
• Be incontinent
• Show no recognition of friends and family
• Need help with washing, bathing, using the toilet or dressing
• Show difficulty in eating and sometimes swallowing
• Fail to recognize everyday objects
• Be disturbed at night
• Be restless, sometimes looking for a long dead relative
• Be distressed and aggressive, especially when feeling threatened or closed in
• Become increasingly physically weak, starting to shuffle or walk unsteadily, eventually becoming confined to a wheelchair
• Have uncontrolled movements

Eventually, immobility will become permanent and, in the final weeks or months, the person will be bedridden.

References

http://www.medicalnewstoday.com/articles/142214.php

http://www.nhs.uk/Conditions/dementia-guide/Pages/living-with-dementia-real-story.aspx

Some Questions Answered About Family Dynamics in Borderline Personality Disorder

"Letters, we get letters

We get lots and lots of letters"

I had an interesting exchange with a reader who asked me some questions about my ideas about the family dynamics of people with borderline personality disorder. I thought other readers may have similar questions, and she gave me her permission to reproduce the exchange in a blogpost. So here t'is, with my answers in blue:

I think my mother has BPD. I am trying to make sense of it, and I am digging into my family's history, to see if I can find a possible cause for her BPD.

The mother of my mother seems to be like the mother in the movie Thirteen, that you commented on in your article. She is always stating she would do anything for her children, but at the same time she sometimes drops things like, 'I sacrificed my life for them." Which pretty much sounds like playing the victim, to me.

It is new to me, that parents who are not physically or emotionally abusive, can also provoke BPD in their offspring. Thank you for attracting my attention to that.  Researching more about this, I read an article that stated that parents who are 'over-involved' can do the same, because they don't allow their children to grow into beings with clear boundaries. Do you agree on this statement? If this is true, than the hypothesis, that BPD patients always have poor attachment to their primary care givers, doesn't stand? 

One last question is: Can patients who have BPD get cured without professional help? I am asking this question, because I realize that I also have had several traits of BPD during the course of my life - although they never co-occurred. Coming to a point where I am realizing that my mother probably has BPD, I am also evaluating my own personality, and if I am honest, I can see that, especially during my twenties, I have had several symptoms, though never more than one at the same time.

Can you please provide me with some clarity ? I would be most grateful. I however will understand if you don't have the time to answer.

In answer to your questions as they apply in general - I am not able to speculate about your situation in particular without having seen and extensively evaluated you and your family situation:

1. The family dynamics of BPD involve the parents being conflicted over the role of having kids. They go back and forth between hostile under-involvement and hostile over-involvement. In a given family, one of these sides may predominate most of the time, but if one waits long enough, the other side shows up.

2. BPD is not a "disease" but a combination of traits by which someone adapts to the above family behavior. Some people have a lot of these traits, some many fewer. The traits can range from very mild to very severe, and severity levels can change dramatically in a short period of time. They can also appear and disappear depending on what is going on in a person's family life at any given moment.

Even in people who show these traits most of the time, many of the traits may start to get better on their own as the person gets older, although certainly not in all cases. Their relationships may continue to be poor, however.  Professional help can be very useful, but whether it's absolutely necessary in every case , the answer is that it depends on a lot of different factors.

Family-oriented psychotherapy is hard to find.  The models I recommend are listed at the end of the post:  http://www.psychologytoday.com/blog/matter-personality/201205/finding-good-psychotherapist. I'm not sure which ones might be available where you are. In England, the most common one is cognitive-analytic therapy (CAT).

What if no other siblings had symptoms while living in this 'borderline producing family?' Does it make sense to develop symptoms only after having left the parental nest? (Because in this case, the 'spoiler' doesn't develop his behavior to balance the mother's moods: instead she only starts to be a spoiler once married, like my mum ... Then this behavior is of no use? (only to act out own frustrations maybe .. but it is not in the interest of balancing the family system). Does this make sense then ?

(Going to a family therapist in my/my mother's case is a non-option for my mother, so unfortunately I have to kind of figure these things out by myself.)

Again, many possible explanations, so I can't say anything about your situation in particular.

In general, in the type of situation you are describing, the person's spoiling behavior with the new spouse stabilizes his/her parents in some way, but is only needed by those parents when the adult child is in the context of a marriage. Often gender role conflicts and repressed anger are at the root of such a pattern - for example, a daughter might act out the mother's repressed rage about having to cater to her (the mother's) own inadequate husband (the daughter's father or step father). Through the daughter's behavior, the mom experiences vicarious satisfaction of her own rage as she watches her daughter frustrating the daughter's husband efforts to "take care" of her.

If a mother acts in a way that produces BPD in her offspring, is it always the case that the child will become a spoiler? In the particular case of my mother, everyone from her family of birth tells me how "good, quiet, well behaved..." she was. It is like she only started to have BPD symptoms when she got married and had kids. Does that make sense? 

No, not always. In fact, family dynamics are like the proverbial true-false test: nothing happens "always" or "never." There are an almost infinite number of other factors which may alter the developmental course of a child - especially other relationships including the other parent, other relatives, or supportive mentors. There is what they call a "chaos" effect - small differences in initial conditions can multiply into big differences later on. Also, in some families, only one sibling will volunteer and/or be chosen to be "it," while the others remain relatively unaffected. If the "it" child stops playing the spoiler, one of the other siblings may suddenly step into that role ("sibling substitution").  The more severe the parental internal conflict, the more additional siblings will be affected or recruited at the outset.

If BPD is not a disease, how is it that the amygdala in people with BPD seems to be different ?

The amygdala is subject to neural plasticity like many areas of the brain, which means that it normally changes in size and activity as it adapts to the environment - especially the social environment.  It's one of the bases for conditioned responses. See http://www.davidmallenmd.blogspot.com/2014/05/borderline-personality-disorder-why.html and http://www.davidmallenmd.blogspot.com/2013/02/neural-plasticity-and-error-management.html

Why do almost all of the experts state that BPD is as good as is incurable, even if the patient is willing to cooperate?

"Cure" is a strange word to use since it's not a disease. Borderline traits absolutely can go away, and the relationships of someone with BPD can change for the better, especially with treatment that focuses on family-of-origin behavior.

You say that the traits of BPD sometimes disappear with aging, as they are not needed anymore. But I thought that BPD primarily stems from a fear of abandonment. So I don't see how someone can get rid of this deeply rooted feeling, even when he doesn't live with his parents anymore / is not being abused by them anymore / or maybe they even died. If there is a 'hole' inside you because of non-attachment with your parents, I thought that this emptiness will always be there, and it will just manifest itself by clinging to - pushing away spouses instead of the parents, or the same behavior towards offspring.

The issue of what happens after the parents die is still somewhat of an open-ended question for me.  For some people, they are freed up for the most part, although the "emptiness" never completely goes away. Other people get worse than ever after the parents die, even if other family members do not seem to be feeding into their problems. I think it has something to do with PTSD-like effects. The more obsessive a patient starts out, the more likely they are to obsessively recreate conversations with their parents in their heads. 

I had one patient who got a lot better after seeing the movie A Beautiful Mind. She realized that even though she couldn't stop hearing those conversations in her head, she didn't have to believe them. She discovered the secret of "Acceptance and Commitment Therapy" (ACT) before it had been "discovered" and written about - although I don't think ACT really works if the parents are still feeding into the problem, as they are more powerful in shaping a person's behavior than any therapist.

Are there cases in which a person with BPD manifests traits towards her spouse, but not towards her children? What does it mean?

There are all kinds of different permutations and combinations, and plenty of traits of other personality disorders that can co-exist and come and go with any patient. The family issues that the patient's behavior is designed to solve determines this, and every family is different. The details matter.  The stuff I write about only represents prototypes or the most common patterns.

Decent L A Times article about panic and anxiety

A recent article in the L.A. Times provides a pretty good overview of causes of and treatments for anxiety disorders. A sample:

Though the best course of treatment for an anxiety disorder remains trial and error for now, doctors and patients aren't entirely in the dark. Some predictors point to whether therapy, medication or both will likely work best for a patient.

As a general rule, the milder the anxiety is, the better patients tend to respond to psychotherapy.

People who are more insightful and committed tend to respond better to therapy... They must be able to determine why they feel a certain way and to talk about it, and since treatment is very interactive and can be tedious, they have to be motivated to do the work.

Access, of course, is another factor in the probable treatment course: A lot of people see a primary care provider, get medication and never see a therapist. Medication is a lot cheaper than therapy, which is not always covered by insurance.

Artwork by Malin Lind.