You've Got What? Curious Conditions, Debated Diagnoses
A look at conditions: some still meet with skepticism from the public.
May 27, 2008— -- Intermittent Explosive Disorder. Oppositional Defiant Disorder. Mathematics Disorder.
If you've never talked to your doctor about these conditions, it should come as little surprise; they are arguably some of the stranger diagnoses floating around in the medical literature. And whatever you might think, many medical professionals say that these disorders are legitimate conditions that often warrant treatment.
Yet, this acceptance within the medical community has not quelled debate on the existence of many of these conditions.
"Illness is always a social construct," notes Dr. Nortin Hadler, professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and author of the book "Worried Sick: A Prescription for Health in an Overtreated America."
"People have to agree -- both people, in general, and those in the medical community -- that a life experience should be labeled an illness," Hadler says. "For example, the Victorians medicalized orgasm, and we medicalize the lack of it."
Dr. Igor Galynker, director of The Family Center for Bipolar Disorder at Beth Israel Medical Center in New York, says that some psychiatric conditions, in particular, tend to be a target of widespread controversy.
"In psychiatry, part of a disorder is clinically defined and part is societally defined," he says, adding that conditions, such as Attention Deficit Disorder, or ADD, are particularly contentious.
"An ADD diagnosis is very controversial, especially after a recent paper suggested some children with ADD 'grow out' of it at age 25," he says. "That would mean that ADD is a phase in development, rather than a disease. ... It is all fluid."
But not all medical experts believe many of these disorders should be dismissed so readily by the public.
"Individuals should not think these disorders are trivial," says Dr. David Kupfer, a clinical professor of psychiatry at the University of Pittsburgh Medical Center, who is part of the team charged with drafting the new Diagnostic and Statistical Manual of Mental Disorders (DSM), a periodically updated compendium of psychological conditions for professional reference. "They are real. By having them in the DSM, hopefully it makes the stigma less."
The following are just a few of the many controversial diagnoses in the medical literature today.
And while the diagnosis may sound odd, it may be more common than you think. A June 2006 study funded by the National Institute of Mental Health found that Intermittent Explosive Disorder may affect as many as 7.3 percent of adults in the United States, mostly men.
While these people may fly into uncontrolled rage on a fairly regular basis, many feel remorse or embarrassment for their actions afterward. For this reason, Galynker adds that Intermittent Explosive Disorder can be thought of most effectively as an "aggression disregulation" and that a lot of people have gradations of it.
But is it for real? Galynker, for one, thinks so. And he says those who live with Intermittent Explosive Disorder often experience the consequences of their rage.
"A lot of people can't manage their aggression, and a lot of them end up in jail after an explosion," he notes.
But, as with many such disorders, some people may question whether someone who has been diagnosed with such a condition should be held fully responsible for their actions. Indeed, while some may argue that applying such diagnoses to this type of disposition could give some people a blank check for bad behavior, others might say the condition could warrant leniency.
Galynker, however, is adamant that an Intermittent Explosive Disorder diagnosis should not be enough to get someone off the hook for hyperaggressive behavior.
"The fact that people can't control their behavior doesn't mean that they are not responsible for their behavior," he says.
A number of different drugs are used to treat Intermittent Explosive Disorder, including anti-anxiety medications, like Valium and antidepressants, like Prozac. Psychiatrists have also used behavioral therapy to treat those with the condition.
In 2006, Brandi Koch of Clearwater Beach, Fla., told ABC News that she was one of many to suffer from the condition; she claims she has colored fibers coming out of her skin.
"The fibers look like hair, and they're different colors," Koch said.
And while most medical professionals doubt the existence of the condition, at least one -- pediatrician Dr. Greg Smith of Gainesville, Ga. -- claims to actually have experienced the condition firsthand.
"It felt like somebody stuck a pin in my toe and wiggled it and it just continued to hurt," Smith told ABC News in 2006. "I've certainly had those crawling sensations, and the fibers which come out of the skin are really bizarre, and really odd."
However, Dr. Vincent DeLeo, chief of dermatology at New York's St. Luke's-Roosevelt Medical Center, weighed in on what he'd say to someone who came to him with this condition: "I don't think this is any different than many patients I've seen who have excoriations and believe that there is something in their skin causing this."
DeLeo says the open lesions are a result of scratching the skin.
Like some of the other diagnoses on this list, these conditions appear in one form or another in the DSM. And Kupfer says there is a good reason for including them; specifically, he says these collections of symptoms can often cause a certain level of personal distress or impairment -- the very definition of a disorder.
"In a way, what we are looking for is to diagnose things reliably to allow individuals to seek treatment," Kupfer says.
With regard to Sibling Rivalry Disorder, treatment can mean counseling that could solve family problems or prevent future psychological conditions. Teaching someone to cope with caffeine abuse may save them from sleep-related problems. It is in these situations, Kupfer says, that labeling such conditions as disorders is helpful.
But Hadler cautions that labeling can also have its downsides.
"A label will always change your self perception," he says. "Sometimes it elicits a positive change, sometimes a negative one."
And as far as Mathematics Disorder goes, most are skeptical that receiving such a diagnosis will get you much pity from your teachers.
"Would anybody actually say, 'I have math disorder and I'm getting treatment, and that's why I'm not successful'?" asks Dr. Dost Ongur, clinical director of the schizophrenia and bipolar disorder program at Harvard University's McLean Hospital in Belmont, Mass. "No, you would never get something like that. Math disorder is not like diabetes."
Galynker says the roots of this disorder are most likely genetic; aggression, he says, is one of the most highly inherited qualities. And genetic links to the kind of aggression seen in children with ODD have been proven in twin studies. Based on this, he says, ODD is likely a very real disorder.
"It's their internal characteristic to argue with their parents," he says. "Some deal better with this, while others deal worse."
An official diagnosis of ODD would likely be met first with counseling, and later with medications to help control a child's behavior. Parents may also receive counseling in order to learn more about how to control their children's behavior.
But many would argue that the blame should be more squarely placed on nurture than nature -- in order words, that parenting styles are more likely to be responsible for this disorder than genes. Ongur says it is little surprise that this may be the commonly held perception.
"For these disorders, I think it makes sense for the lay person to have that kind of reaction -- not because they are fake disorders, but because of the way it plays out in society," he notes.
Hadler, however, has a different take -- that ODD is yet another example of the medicalization of commonly seen behavior.
"No young child can be a brat anymore," he says. "Now, what right do we have to do that?"
Such cases are examples of dissociative fugue state. In these cases, an individual will disappear, leaving everything behind -- including their memories and identity. In some cases, the sufferer even assumes a new identity, which persists until they are reunited with their old surroundings and allowed to return to their old persona.
Few psychological disorders have attracted such wonder from the public -- and sparked so much debate among experts in the field. Nowadays, most psychological experts agree that such cases are not simply about individuals running away from their problems, but, rather, a legitimate condition.
"The thing that people experience as 'fugue state' does happen," Ongur says. "There are people who wake up in other cities and don't know what has happened."
The fugue state is actually part of a larger family of conditions known as dissociative memory disorders. The trigger for these conditions is usually a traumatic event -- the death of a loved one, for example, or an extraordinarily stressful event at work. It is also more common in those who bear past trauma from events like natural disasters and war.
As the name implies, CFS is most often associated with severe, debilitating fatigue. Non-specific pain and other symptoms are also common hallmarks of the condition, which is disproportionately experienced by women. As the condition persists, patients will often become depressed at the current lack of proven treatments to remedy the problems they experience.
But while the condition is starting to receive more attention and support, the underlying causes largely remain a mystery. Some have cited Epstein-Barr virus as a likely culprit. Others point to anemia, while still others implicate allergies.
Perhaps it is for this reason that the borders of this diagnosis remain contentious at best. Symptoms run the gamut from long-lasting flu-like symptoms to memory loss. Treatment can involve antidepressants, antihistamines or acupuncture.
To Hadler, CFS seems less like an actual condition and more like a rapidly growing hodge-podge of symptoms associated with a number of different diagnoses that are becoming increasingly more prevalent.
"Now it overlaps with post-traumatic stress disorder, fibromyalgia -- all of these labels include symptoms of fatigue," he says.
Still, dozens of studies -- many federally-funded -- are seeking answers as to the true nature of this condition.
Those who experience DID will create at least one "alter" personality that manifests itself in certain situations -- in essence, "taking control" of one's personality. These changes occur involuntarily, and DID in its most severe forms can limit one's ability to interact with others.
By the same token, the condition can occasionally go mostly unrecognized. Football great Herschel Walker is just one example; in his recently released book, "Breaking Free: My Life with Dissociative Identity Disorder," Walker says his life was fragmented by a number of independent "alters" -- at least one of which led him to attempt suicide.
Ongur says early psychological trauma is one of the most common underlying causes of the disorder.
"When people describe these things, it is certainly often associated with a severe history of child abuse," he says. "This was one way for them to cope."
And, as in Walker's case, psychological treatment involves unifying the alters into a single personality -- allowing those who suffer from the condition to regain full control over their lives.
"The task is to get this person feeling whole again," Ongur says.
In labeling this as a disorder, he says, medical professionals have been able to help millions of people who otherwise would have been told that they were simply shy.
Ongur agrees. "It's familiar to people because it's shyness, but it's really extreme shyness," he says. "It is something that can be very real and very impairing."
Those who suffer from SAD often find themselves faced with seemingly insurmountable anxiety when it comes to interacting in certain social situations. Most common are feelings of being watched, scrutinized and criticized by others. So intense is this anxiety that it can sometimes lead to a panic attack.
In most cases, these fears are unreasonable. Counseling can often help those who live in near-constant fear of being embarrassed or humiliated in front of others. Coaching in social skills may also be needed in order to help those with SAD better integrate themselves into comfortable social circles.
"Social phobia ... is a relatively new diagnosis," Galynker says. "Many people have difficulty socializing, of course. This is just a label to help treat people who have it."
And Galynker says the changing perception of SAD and psychological conditions like it will hopefully help remove the stigma so often associated with such disorders.
"Everybody has a problem, really," he says. "Nobody does not have some sort of diagnosis."
Katie Escherich contributed to this story