Society could solve much if this issue if they focused on making context-specific theories about shared factors and personality traits of each of these constructs rather than treating them as separate entities with separate etiologies and interventions and one single, APA/FDA-approved theory for each.
When people find the label that resonates and hence internalize it, but then any change whatsoever in their life, personality system, or "symptom" set occurs, then this automatically threatens their very identity. Thus: a new DSM diagnosis with each new medical field interaction also causes an identity crisis. What is instead happening are extreme personality traits that have not been suitably actualized in a reliable manner, and so, manifest various DSM categories across different life chapters.
Thus, rather than looking at broad categories like Schizoid PD, Borderline PD, ASD, and such and such, I believe it's more useful to look at many combinations of underlying constructs like hyper-systemizing, alexithymia, high sensory sensitivity, extreme error detection (eg, inconsistency detection), elevated conscientiousness or openness, and so on. From these alone, it is not difficult to create a process model that spits out a different DSM category each time. If so, this is useful because it proves we should focus on said traits as causal rather than (weakly) emergent DSM categories that are unreliable from the start by virtue of their ever-changing natures. That is, Big 5 traits tend to be extremely stable across 5 year durations but schizophrenia does not have this same reliability.
You mentioned OCPD, which is strongly correlated with abnormally high conscientiousness and abnormally low openness to experience: hence, cognitive rigidity. But rather than trying to "treat OCPD", I'm saying people should here focus on increasing trait openness to experience in this one (literally n=1) example, which would lead to cognitive plasticity at the expense of over-control and over-inhibition. There are now dozens of long-term (multi-year) longitudinal studies showing that psilocybin increases trait Openness in dozens of of DSM categories without meaningful safety effects.
Notice, however, I did NOT say "We should indiscriminately treat OCPD with psilocobyn". It is not even implied. Instead, I said people should focus on influencing the underlying personality traits unique to each individual person (hence, n=1), that just so happen to manifest many kinds of DSM categories every few months or years. Modifying one's personality traits, especially one at a time, with the goal of changing oneself is not a controversial idea.
An excellent source of theories about how such combinations of traits shared across the DSM can manifest is Evolutionary Psychopathology by Del Giudice. Unfortunately, people misinterpret the book as arguing DSM categories are themselves "evolutionary adaptations". But he explicitly rejects this. Instead, the UNDERLYING personality traits are possible adaptations-to-context (NOT society), that, when the context abruptly changes afterwards, become maladaptive and therefore manifest a new DSM category on each occasion. This suggests contexts, not individuals, are what become broken. But if persons and contexts are always changing then so will DSM categories. Therefore, we should focus on the suspiciously unchanging (highly reliable) contexts and personality traits correlated to suffering, rather than ever-changing DSM categories diagnosed post-hoc that are apparently unmeasurable.
I'm so glad you made this post. I see this so much and it can be so discouraging to see ASD diagnoses applied indiscriminately, particularly because the ASD interventions aren't helpful if the individual's symptoms are much better explained by another more appropriate diagnosis. A big red flag is the criterion B - many people just don't meet that despite being given the diagnosis.
My cousins son is 40, still living at home, no job. I recommended he get assessed when he was a kid, but both parents refused as they did not want him “labeled.” Anyway, my cousins husband died in January and she is showing signs of dementia. We are trying to get her into an assisted living, but that leaves her son with no support. Is it possible to get a 40-year-old man diagnosed with autism so that he can get services? I truly believe that would be the diagnosis.
A diagnosis is possible at any age after a suitable diagnostic evaluation. Access to services and supports varies, though. Many counties and states have boards of developmental disabilities that can help with things like group homes with suitable supports. Case managers at community mental health services can also be helpful in arranging group homes and assisted living.
Society could solve much if this issue if they focused on making context-specific theories about shared factors and personality traits of each of these constructs rather than treating them as separate entities with separate etiologies and interventions and one single, APA/FDA-approved theory for each.
When people find the label that resonates and hence internalize it, but then any change whatsoever in their life, personality system, or "symptom" set occurs, then this automatically threatens their very identity. Thus: a new DSM diagnosis with each new medical field interaction also causes an identity crisis. What is instead happening are extreme personality traits that have not been suitably actualized in a reliable manner, and so, manifest various DSM categories across different life chapters.
Thus, rather than looking at broad categories like Schizoid PD, Borderline PD, ASD, and such and such, I believe it's more useful to look at many combinations of underlying constructs like hyper-systemizing, alexithymia, high sensory sensitivity, extreme error detection (eg, inconsistency detection), elevated conscientiousness or openness, and so on. From these alone, it is not difficult to create a process model that spits out a different DSM category each time. If so, this is useful because it proves we should focus on said traits as causal rather than (weakly) emergent DSM categories that are unreliable from the start by virtue of their ever-changing natures. That is, Big 5 traits tend to be extremely stable across 5 year durations but schizophrenia does not have this same reliability.
You mentioned OCPD, which is strongly correlated with abnormally high conscientiousness and abnormally low openness to experience: hence, cognitive rigidity. But rather than trying to "treat OCPD", I'm saying people should here focus on increasing trait openness to experience in this one (literally n=1) example, which would lead to cognitive plasticity at the expense of over-control and over-inhibition. There are now dozens of long-term (multi-year) longitudinal studies showing that psilocybin increases trait Openness in dozens of of DSM categories without meaningful safety effects.
Notice, however, I did NOT say "We should indiscriminately treat OCPD with psilocobyn". It is not even implied. Instead, I said people should focus on influencing the underlying personality traits unique to each individual person (hence, n=1), that just so happen to manifest many kinds of DSM categories every few months or years. Modifying one's personality traits, especially one at a time, with the goal of changing oneself is not a controversial idea.
An excellent source of theories about how such combinations of traits shared across the DSM can manifest is Evolutionary Psychopathology by Del Giudice. Unfortunately, people misinterpret the book as arguing DSM categories are themselves "evolutionary adaptations". But he explicitly rejects this. Instead, the UNDERLYING personality traits are possible adaptations-to-context (NOT society), that, when the context abruptly changes afterwards, become maladaptive and therefore manifest a new DSM category on each occasion. This suggests contexts, not individuals, are what become broken. But if persons and contexts are always changing then so will DSM categories. Therefore, we should focus on the suspiciously unchanging (highly reliable) contexts and personality traits correlated to suffering, rather than ever-changing DSM categories diagnosed post-hoc that are apparently unmeasurable.
Thank you, agree with a lot of what you are saying!
I'm so glad you made this post. I see this so much and it can be so discouraging to see ASD diagnoses applied indiscriminately, particularly because the ASD interventions aren't helpful if the individual's symptoms are much better explained by another more appropriate diagnosis. A big red flag is the criterion B - many people just don't meet that despite being given the diagnosis.
My cousins son is 40, still living at home, no job. I recommended he get assessed when he was a kid, but both parents refused as they did not want him “labeled.” Anyway, my cousins husband died in January and she is showing signs of dementia. We are trying to get her into an assisted living, but that leaves her son with no support. Is it possible to get a 40-year-old man diagnosed with autism so that he can get services? I truly believe that would be the diagnosis.
A diagnosis is possible at any age after a suitable diagnostic evaluation. Access to services and supports varies, though. Many counties and states have boards of developmental disabilities that can help with things like group homes with suitable supports. Case managers at community mental health services can also be helpful in arranging group homes and assisted living.