Magazine article Psychology Today

Do You Have a Disorder or Just a Trait?

Magazine article Psychology Today

Do You Have a Disorder or Just a Trait?

Article excerpt

RETHINKING THE IDEA THAT PSYCHIATRIC "ILLNESS" IS EASILY

BLOOD PRESURE is not a disease. All of us have one and the numbers, if measured across a large sample of people, fall into one of those classic bell-shaped curves. At a pressure above 140/90, however, that characteristic becomes an illness and worthy of treatment with remedies ranging from a low-salt diet to prescription medications.

Yet modern psychiatry has resisted such a view of its conditions, opting instead for an all-or-nothing model in which a person either does or does not have a psychiatric illness. Our temperament or personality traits, it follows, don't have much to do with these disorders. Happy people can get depressed, and fearless people can develop anxiety disorders.

Certainly there are many cases where such presentations are true, but are the worlds of personality and psychopathology really that distinct? Mounting research consistently shows that they are not, and that many if not most disorders exist not in a binary yes-no form but as more of a continuum, not unlike blood pressure. The relationship between a child's activity level and attention span and the diagnosis ADHD is likely one of the best examples of this phenomenon.

At what point does active become hyperactive? Similarly, where does shyness end and social anxiety disorder begin? With temperament dimensions such as "attention span" and "quality of mood" existing alongside ADHD and major depression, there is bound to be confusion about the relationship between traits and disorders.

In child psychiatric assessment, it is widely recognized that most behaviors labeled as pathological exist at lower subthreshold levels, with the line between normality and pathology a moving target across development. Nobody would expect a 3-year-old to be able to focus on a simple cognitive task for very long, but the bar rises for a 15-year-old.

How much it should rise becomes our task as "experts" who have seen hundreds or thousands of children and have at our disposal questionnaires and rating scales that are standardized according to a patient's age and sex. Yet despite the evidence and tools available, the boundary between normality and abnormality is still the subject of much speculation and controversy.

Moreover, there is good reason to suspect that the "speed limit" between what is considered a normal and an abnormal level of behavior has been dropping over the past several decades- seen in everything from ADHD to bipolar disorder. This shift is likely responsible for at least some of the "epidemic" rates of psychiatric disorders observed today, despite other evidence that the overall level of problem behavior in children has remained fairly constant. …

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