I read the study, and it appears that the findings are actually less dramatic than the media make them out to be ... again.

Yes, about 46% of college-age adults were diagnosed with a DSM-IV diagnosis, but about 30% were due to substance-related disorders, i.e. alcohol abuse and dependence, and drug abuse and dependence. That doesn't strike me as particularly exaggerated.

The remaining 15% was due to the following:
-- Mood disorder, past or present (10-12%).
-- Anxiety disorder (12%), but mostly a specific phobia (8%), which I don't think is an exaggeration.
-- Personality disorder (18-20%) assessed over a lifetime basis, and mostly obsessive-compulsive at 8%, which I think would be reasonable, especially in college.

These figures could be overestimated, especially the antisocial PD's at 5-9% -- that's a lot of sociopaths in college! -- but probably not wildly so.

Even if you exclude social anxiety and bipolar disorder as dubious diagnostic categories, which I disagree with, you still have basically the same prevalence rates of psychiatric disorders as presented above. I was actually surprised that they did not measure borderline personality disorder at all.

Failure to fulfill major work, school, or home responsibilities
It is not difficult to find college kids who technically "have" a "mental disorder." Each condition in the DSM is identified loosely as a "mental disorder." DSM does not declare what a "mental disorder" means, other than it means you fit the criteria. It does not mean specifically that you will have this disorder forever, or that it is genetic, or that it is even analogous to any medical problem such as cancer, emphysema, or heart failure. It might and it might not.

So: here is the easiest way to attach a "mental disorder" to an adult: assess for "alcohol abuse." Basically, if you have ever "abused" alcohol, then you are categorically in the "mental disorder" category. Done. Ever drive drunk once? Done. You are now in the "mental disorder" category forever.

Here are the DSM-based criteria for alc abuse (taken from Psychology Today website - it popped up easily when googled):

Any of these "symptoms":
-Drinking in situations that are physically dangerous, such as while driving a car or operating machinery
-Having recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk
-Continued drinking despite having ongoing relationship problems that are caused or worsened by the drinking.

It is not a good idea to drink excessively or foolishly. Nonetheless, by DSM, if you have, you have crossed over into the "mental disorder" category. Evidence shows that in our US culture, many young adults abuse alcohol, in culturally recognized and encouraged ways. Esp in college setting. The majority progress in life to decrease and give up on this behavior. On their own, without meds, without a rehab stint, without a psychiatrist.

The rest of us recognize this as just life. I don't think it is a good thing. But it is the reality. I am doing what I can so that my kids avoid this specific life experience. But this pattern will still happen on college campuses.

Should each of these college kids be placed in the "mental disorder" category?

It shows something else too. Just imagine it is true for one second -- what it shows is that we are one screwed up society with enough social and cultural ills to make just about everyone in it "sick." Maybe we should start addressing some bigger issues instead of accusing each little individual who is suffering from stress related to being part of this mess as being "disordered" or having a "disease."

Nicotine dependence is in the DSM. So is caffience intoxication and um, soiling in children. If they used the entire DSM I'm surprised the percentage wasn't closer to 99%. Adjustment disorders are so easy to diagnose it's hard to find someone who doesn't have one at traditional college age. We used to call it late adolescense......

Ok, I need some help here - Having not read the original report, are they looking at the DSM for what constitutes a Psychiatric Disorder or are they lumping any broad based issue in to the category?

Like you pointed out cigarettes isn't a DSM related cause but as Alison reminds us Substance Dependence is, so are the publishers of this article simply throwing any thing that ties to a DSM related criteria and calling it "a problem".

While not knowing the full story here, I think people have gotten used to calling just about anything a Psychiatric Disorder thereby. My fear is this type of thinking has the potential to hurt those who truly need help by glossing over their issues.

Best,
Van

http://vansantos.com

Alison:

The study authors did actually include nicotine dependence, and found it to be prevalent at 15-20% over the year, but found nicotine use to be 30-40%. They did not include adjustment disorders at all.

MedsVsTherapy:

Actually, you are wrong about the DSM-IV criteria for alcohol abuse. You cannot have gotten drunk on a few occasions and made some stupid mistakes. The criteria actually specifies that the conditions that you mentioned have to occur in a RECURRENT FASHION for AT LEAST ONE YEAR.

In other words, the problems at work, home, school due to alcohol; the getting into dangerous situations while drunk; the legal problems due to intoxication, and so on, must be happening AGAIN AND AGAIN in a way that results in "clinically significant impairment or distress". That is just for alcohol abuse. Dependence is much worse.

You can read the criteria at:

http://www.alcoholcostcalculator.org/business/about/dsm.html

Just wanted to clarify these things. :)

Dguller,

"Clinically significant impairment or distress," define clinically significant.

What if the problems and work, home and school are not due to alcohol? Is everyone who has problems at work, home and school mentally ill, some due to alcohol some due to bipolar disorder, some due to skizzy attitude disorder, or is it just that everyone who has a pulse has problems at work, home and school?

Psychiatrists are getting paid to treat life, everyone has a life so everyone has a label and a need for a "medical intervention."

If a college kid gets drunk at the homecoming game, the Christmas Party, Spring Break and once on that summer beach vacation and makes stupid mistakes over the course of a year, does this count as having "gotten drunk on a few occasions and made some stupid mistakes" or is this "a Recurrent Fashion for at least one year," and is the diagnosis or lack there of is a value judgment masquerading as medical decision?

This study is really troubling. What if there were studies showing that 1% of the population was "normal" and 99% abnormal? What would that mean, think about when the population of normal drops below 50% in terms of holding office, owning property, etc. in a human animal where generally the control of the many is done by the few.

Think about how if there really are mental illnesses which really are medical diseases this is possible because after all it's possible, though not likely, that 99% of the population could have diabetes and 1% not have it.

Think about how some folks on this list think they have mental illnesses because they have emotional problems that cause them more suffering than they think others experience but some think of mental illness as a privilege they are entitled to which makes them more human than others, i.e. misfits who are entitled to be cared for.

And then there's the folks who think they are not mentally ill but other people, other less human people are. Many but not all of the parents, loved ones and therapists on the list fall into this category (of course not Stephany, and compared to other pshrinks, not you either Dguller)." When you think that because of a brain disease someone else's moods, emotions and need for exercise including sex ...are so wrong they are a biological disease, you are by definition defining that person as less human than you. To them the "mentally ill" are misfits from whom society most be protected.

Apparently the big message humans should be learning, that we are all equally human, ain't getting through to psychiatric clinical study designers, among others.

When I was in college there were a couple of evangelists who would hit our campus and others around the country preaching about the evils of alcohol. There's always been drinking and it's opponents and there are good and bad things about booze, maybe even wonderful and horrible things.

The preacher railing that booze can cause damnation has sent his son to medical school and now the son is railing that booze is a symptom of a brain defect and needs "treatment." I concede that there are alcoholics, and whether or not alcoholism is a medical disease is a huge matter of controversy, one that, when Social Security decided that alcoholism wasn't, caused treatment centers and pshrinks all through the land to lose big bucks (until they came up with the idea of labeling everyone who has ever been intoxicated bipolar).

12 step programs are free, anoymous, compassionate ways to deal with the problems of alcohol, crugs, and interestingly have no official opinion on this matter. Whether a problem be it shyness or moodiness or dog drunkeness is classified as a disease or not has little to do with solving the problem, but it has a lot to do with controlling people and making money. What if what society needs is support groups, lack of judgment, and compassion instead of medical labels and billing codes and "assisted" outpatient treatment?

The for profit mental health industry will make a lot of money in the short term if it can get 50 percent of all college students to owe them money for life, but if they just get every parent who caught their kid drunk around the pool between semesters, still the bucks roll in, well, in the short term.

This study is a criticism of the perceived moral state of college students masquerading as science.

Match it up with the sort of Post Cho monitoring schools and society in general think should be done to college students and college looks like something worse than Orwell ever conceived. But at least for a few minutes psychiatrists have taken their focus off of three year old boys and their mothers.

Sally:

First, "clinically significant" just means that a clinician judges that the distress (i.e. psychic pain) or impairment (in function at work, school, home, etc.) is significant, marked, or substantial in intensity or duration. I agree that it is not especially clear, but the general idea is that someone is suffering disturbing psychological and behavioral consequences of their psychiatric symptoms. This is often quite clear and not controversial, but you are correct that there are times when it is unclear whether a person is suffering impairment due to psychiatric symptoms, and then it is essential to get collateral information from friends and family who know the patient well.

Second, clinically significant distress or impairment is necessary, but not sufficient, for a psychiatric diagnosis. In other words, if a psychiatric illness is present, then there must be clinically significant distress or impairment, but if there is clinically significant distress or impairment, then there is not necessarily a psychiatric illness. So, no, not every case of distress or impairment is due to mental illness.

Third, regarding your hypothetical example of a teenager who gets drunk at social events on several occasions, and "makes stupid mistakes", I would need more information on the "stupid mistakes".

Are they due to alcohol intoxication? Do they involve a "failure to fulfill major role obligations at work, school, or home" (e.g. repeated absences or poor work performance related to being drunk often; multiple suspensions or expulsions from school for being drunk, etc.)? Did they result in repeated situations where it was physically hazardous for them to be drunk, e.g. drunk driving on several occasions? Did they involve legal problems, e.g. arrests? Did they result in interpersonal conflicts with loved ones, e.g. arguments with their parents or girlfriend about their alcohol use?

If none of these situations would cause you to be concerned about a teenager, then perhaps you can tell me, when WOULD you be worried about something problematic going on?

Fourth, your comments about normality are well taken. Fortunately, the DSM-IV does not define what is "normal", as if anything could. It simply focuses on whether certain symptoms result in significant psychic pain or an inability to complete life goals in various areas in their life, e.g. with family, friends, coworkers, teachers, etc.

Fifth, I wouldn't medicate someone who abused alcohol. I would refer them to an addictions program, which would certainly involve AA.

Take care.

Sally,
Your comment: "Whether a problem be it shyness or moodiness or dog drunkeness is classified as a disease or not has little to do with solving the problem, but it has a lot to do with controlling people and making money." is such an excellent one.
Thanks.

The diagnosis: Clueless needs to be added to the DSM. My former shrink was convicted of a DUI as was his PA side kick. I'm afraid both of these individuals have exhibited such profound lack of insight & poor judgment that the only humane thing to do would be to forcibly treat them.