OCD Is Not a Joke(thewalrus.ca)
thewalrus.ca
OCD Is Not a Joke
https://thewalrus.ca/ocd-is-not-a-joke/
46 comments
OCD is also a spectrum.
Nice another website where you can't reject the tracking cookies. If you follow the link to "customize cookie settings" it only tells you to disable the cookies completely.
I think in the future we will realize that OCD is actually autism and autism spectrum disorders are disorders with dopamine regulation. I think this because I used to be on the spectrum until I regulated my dopamine levels and now I'm much lower on the spectrum. Anecdotal of course, but the link should be studied more.
I'd bet that almost all psychological disorders we diagnose today will turn out to have a large variety of underlying conditions that manifest in similar symptoms. We understand extremely little of the brain, we're at best in the "your humors are out of balance" phase of medical science when it comes to diagnosing problems in the brain.
That's a bit reductive as many mental health disorders rarely exist in isolation and are often "symptoms" of other issues. OCD, for example, may certainly have a high correlation with autism, but its manifestation has also been observed in victims of trauma and those with severe, untreated generalized anxiety disorder.
> its manifestation has also been observed in victims of trauma and those with severe, untreated generalized anxiety disorder
Makes sense, OCD rituals are a way to take control for people who feel the world is uncontrollable and scary and might hurt them.
There might be some genetic predisposition but I imagine environment/society is a huge factor. Make people feel safe and loved and they'll realize it doesn't really matter if their faucets drip a little or their books are skew. Conversely, if you live in a crime ridden area, it totally makes sense to worry about whether your door is locked.
Makes sense, OCD rituals are a way to take control for people who feel the world is uncontrollable and scary and might hurt them.
There might be some genetic predisposition but I imagine environment/society is a huge factor. Make people feel safe and loved and they'll realize it doesn't really matter if their faucets drip a little or their books are skew. Conversely, if you live in a crime ridden area, it totally makes sense to worry about whether your door is locked.
Here's a paper which argues that the distinction between ASD, ADHD and OCD is biologically invalid: https://www.nature.com/articles/s41398-019-0631-2
So if that paper is correct (and of course it is only one study, and we should have more studies to explore this question further), that suggests that maybe the distinction between ASD, ADHD and OCD ought to be abolished, and they all ought to be subsumed into one bigger disorder, that then might even be subdivided into a new set of subtypes (based on actual biology) which would have little in common with the existing ASD-ADHD-OCD distinction.
So if that paper is correct (and of course it is only one study, and we should have more studies to explore this question further), that suggests that maybe the distinction between ASD, ADHD and OCD ought to be abolished, and they all ought to be subsumed into one bigger disorder, that then might even be subdivided into a new set of subtypes (based on actual biology) which would have little in common with the existing ASD-ADHD-OCD distinction.
There's a pre-alpha Minecraft mod I read about that divided them into “spoons” (https://en.wikipedia.org/wiki/Spoon_theory), “brain worms” (e.g. depression, obsessive thoughts) and a generalised version of “special interests” (which models both the traditionally-ASD and traditionally-ADHD variants). It takes a very game-mechanical-as-applicable-to-Minecraft view of them, but I thought it was a decent framework. I'll see if I can find a link.
How did you regulate your dopamine levels? Stimulants?
Buproprion
It's life-changing, modern medication. I just came off of a 5-month course. I think it has left me permanently cured of the skipping record. Leads me to believe it is not a problem with dopamine levels, but the brain needed a break from the stimulus that the old neural pathways provided, in order to grow healthier ones.
I've been on it for 17 years. I have been off it twice during my adult life, about 6 months each time. Just to see if maybe I didn't need it. Tendencies I can only describe as autistic returned. For me, it seems to be long term beneficial.
+autism = +dopamine in opfcortex
or what
No mental disorder is a joke and the more joke it seems to a layman the more gravitating it is
"I have to sort my books", she cried,
With self-indulgent glee.
With senseless, narcissistic pride,
"I'm just so OCD!"
"How random guys!", I smiled and said,
Then left without a peep -
And washed my hands until they bled,
And cried myself to sleep.
- /u/poem_for_your_sprog
ETA: No way to add a single newline on HN it seems. This website can be so daft sometimes.
With self-indulgent glee.
With senseless, narcissistic pride,
"I'm just so OCD!"
"How random guys!", I smiled and said,
Then left without a peep -
And washed my hands until they bled,
And cried myself to sleep.
- /u/poem_for_your_sprog
ETA: No way to add a single newline on HN it seems. This website can be so daft sometimes.
The irony here is criticizing turning OCD into a joke, while turning narcissism into a joke in the same poem (unless that's intentional?)
But nobody is going to come to the defense of narcissists because that's one of the mental disorders that makes you a "bad person".
But nobody is going to come to the defense of narcissists because that's one of the mental disorders that makes you a "bad person".
If one looks only at the effects that OCD has on other members of the family one might also consider a sufferer of OCD also a bad person. It's a pity that there seem not to be enough resources to treat each person as a person and help them manage their lives regardless of the label that us laypersons might apply.
... and the commenter calling the website "daft".
I am constantly worried about scratching even the minutest of my possessions. No matter how old they are. Obsessed with furniture being exactly at the right angle and position. I don't know if this is just attention to detail that has spilled over from my job or some form of OCD
Shortly after I took possession of my new car a few years ago I noticed that there was a blemish near the shifter. It looks like the prep person used an abrasive cleaner a bit too aggressively. Very minor though.
At first it bugged me and I was ready to go screaming back to the dealership but after a few minutes I realized that the next scratch or blemish wouldn't bother me. Considering I share the car with my teen, it removed an emotional burden.
Fingers crossed Almost 3 years later, it's still the only "damage" to the car.
At first it bugged me and I was ready to go screaming back to the dealership but after a few minutes I realized that the next scratch or blemish wouldn't bother me. Considering I share the car with my teen, it removed an emotional burden.
Fingers crossed Almost 3 years later, it's still the only "damage" to the car.
I internally say to myself, the first time a new possession is scratched or damaged in some small way, "congratulations, now you are free from the burden of trying to keep this thing perfect". It half helps.
I wish there was a forum to chat about this with other people. I feel like few with empathize with these feelings most would just laugh at me. Many do.
I believe psychologists only consider it a disorder if it interferes with you living a happy life.
Everyone has some of these traits, it's only the extreme versions that become a problem.
Everyone has some of these traits, it's only the extreme versions that become a problem.
Correct - for OCD it’s diagnosed when it affects about an hour a day of someone’s life.
My therapist used to host a support group for OCD and always mention at the start that most OCD sufferers would do anything for the disorder to only affect an hour of their day.
My therapist used to host a support group for OCD and always mention at the start that most OCD sufferers would do anything for the disorder to only affect an hour of their day.
Note there is OCPD[1], which is much closer to the pop-culture view of OCD.
1: https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_p...
1: https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_p...
So many things here that reminds me of my obsessions and compulsions with food.
I've always assumed I had OCD but never sought help so I've never been officially diagnosed. I'm officially 'agitated depressed' which as I understand it is the old name for type II bipolar.
Since I was a kid I had problems with lines when walking. My right foot always had to cross over first, and completely(i.e. not step on the line). I remember in my teenage years starting a counting ritual where I had to turn on an off a lightswitch a certain number of times, usually 3 but not always(always odd though) when I entered or exited a room. I had a praying phase, despite being sort of an atheist, where I had to pray 3 times a day for an extended time just to quiet the thoughts of imminent doom. Lots of other rituals but I've mostly forgotten them by now. I remember having issues with 'doorways' like if there was a support cable from a telephone pole over a sidewalk I would do everything I could to avoid it.
Fast forward to my mid 20s and I became a rather heavy pot smoker. That allowed me to confront my fears since I was basically too lazy to endure all the rituals. I had some relief but over a few years the rituals slowly came back in minor forms. For a while I could only turn one way in bed. I still have to have every knife in the house pointing away from the bedrooms. I don't have checking rituals, I just handle it when I see it. Most of my compulsions have some sort of abstract rule behind them, like spoons facing away from most of the house(because they're taking away), my wallet sits with the money coming towards me on my desk, etc. It sounds absolutely insane and stupid when I verbalize it, but it's a constant fight to keep my brain from making up these sorts of arbitrary rules.
I don't know if 'neat freak' type OCD folks feel the sense of extreme doom that I get when I resist a compulsion. I haven't discussed my experiences much with other people. Apparently OCD 'runs in my family' but I don't think that's backed up by a diagnosis. I know my family and I have essential tremor, tics and depression. My uncle thought we all had Tourettes but he was an odd ball(very likely autistic) and didn't get taken seriously.
I feel like overcoming some of my OCD was a mixed bag. Some of that obsessive, abstract, rules based thinking made me a better engineer. It was also something I could occasionally harness for good, like getting compulsive about brushing my teeth or cleaning.
Since I was a kid I had problems with lines when walking. My right foot always had to cross over first, and completely(i.e. not step on the line). I remember in my teenage years starting a counting ritual where I had to turn on an off a lightswitch a certain number of times, usually 3 but not always(always odd though) when I entered or exited a room. I had a praying phase, despite being sort of an atheist, where I had to pray 3 times a day for an extended time just to quiet the thoughts of imminent doom. Lots of other rituals but I've mostly forgotten them by now. I remember having issues with 'doorways' like if there was a support cable from a telephone pole over a sidewalk I would do everything I could to avoid it.
Fast forward to my mid 20s and I became a rather heavy pot smoker. That allowed me to confront my fears since I was basically too lazy to endure all the rituals. I had some relief but over a few years the rituals slowly came back in minor forms. For a while I could only turn one way in bed. I still have to have every knife in the house pointing away from the bedrooms. I don't have checking rituals, I just handle it when I see it. Most of my compulsions have some sort of abstract rule behind them, like spoons facing away from most of the house(because they're taking away), my wallet sits with the money coming towards me on my desk, etc. It sounds absolutely insane and stupid when I verbalize it, but it's a constant fight to keep my brain from making up these sorts of arbitrary rules.
I don't know if 'neat freak' type OCD folks feel the sense of extreme doom that I get when I resist a compulsion. I haven't discussed my experiences much with other people. Apparently OCD 'runs in my family' but I don't think that's backed up by a diagnosis. I know my family and I have essential tremor, tics and depression. My uncle thought we all had Tourettes but he was an odd ball(very likely autistic) and didn't get taken seriously.
I feel like overcoming some of my OCD was a mixed bag. Some of that obsessive, abstract, rules based thinking made me a better engineer. It was also something I could occasionally harness for good, like getting compulsive about brushing my teeth or cleaning.
I suffer from many mental health conditions including OCD, and I'll tell you it is no fucking joke. It has caused severe problems in my life. Only now that I'm getting treatment have things ever went well in my life.
[deleted]
I hate it when someone uses this term in light or funny contexts. As a teen I first got completely destroyed by this problem. I never knew why I was getting so many extremely intrusive thoughts. It hurt my self-respect and dignity. It turned myself against me. I never knew it was a condition. My academic performance declined, and I developed some habits I never even thought of. I was able to come out of it through focusing on other things like video games and hanging out with friends but it wouldn't go away completely. I felt it was okay though since my stress levels stabilized at that point.
Again in mid twenties, it got me. This time I researched it and found it is called OCD which is a medical condition, yet I did nothing about it nor I spoke up. It devastated me again and I suffered for years. Every single day was full of stress and I remember being sleepless for a few months in a stretch. I started reading books on how to take care of it and recovery was still far away. I became suicidal for a bit but I felt it was a wrong idea because I would let it win over me if I did it.
Finally, I've come to agree that it is okay to have it and not really take it seriously. I found out the point is to have the mind focus on useful things and keep it busy continuously. I've been doing this since last year and life has improved a lot. Today, 99% of my day is free from any OCD compulsions, obsessions and the stress. Yes I do get intrusive thoughts but I discard them and treat them with no more importance than a pile of crap.
If there's any of you out there looking for any help, I am happy to provide some resources that go a long way. Technically I should have seen some professional for this, but I was way too embarrassed to share my situation with anyone else. I urge you all to never make this mistake though.
Again in mid twenties, it got me. This time I researched it and found it is called OCD which is a medical condition, yet I did nothing about it nor I spoke up. It devastated me again and I suffered for years. Every single day was full of stress and I remember being sleepless for a few months in a stretch. I started reading books on how to take care of it and recovery was still far away. I became suicidal for a bit but I felt it was a wrong idea because I would let it win over me if I did it.
Finally, I've come to agree that it is okay to have it and not really take it seriously. I found out the point is to have the mind focus on useful things and keep it busy continuously. I've been doing this since last year and life has improved a lot. Today, 99% of my day is free from any OCD compulsions, obsessions and the stress. Yes I do get intrusive thoughts but I discard them and treat them with no more importance than a pile of crap.
If there's any of you out there looking for any help, I am happy to provide some resources that go a long way. Technically I should have seen some professional for this, but I was way too embarrassed to share my situation with anyone else. I urge you all to never make this mistake though.
[deleted]
Thing don't have the be jokes to be funny - or to be made into jokes.
We have jokes about death, murder, WWII, the big C, and tons of other things besides.
Heck, if a joke doesn't touch some deeper/dark truth, mortality, fragility, etc, it's not much of a joke, it's more into "man slips on a banana" territory.
We have jokes about death, murder, WWII, the big C, and tons of other things besides.
Heck, if a joke doesn't touch some deeper/dark truth, mortality, fragility, etc, it's not much of a joke, it's more into "man slips on a banana" territory.
I agree we should be able to make jokes about deeper life issues, humor is a coping mechanism for many. But it's more nuanced than that.
Like in the article when a woman jokes "I'm so OCD" when arranging pens by color whilst in the presence of someone whose life is basically directed by the condition (and thus causes a lot of suffering), it can be very offensive, and the comment could be taken as demeaning.
I had similar feelings when r/WSB used the term autism as a joke to describe themselves. They were focusing on one or two stereotypical traits of the condition to make jokes about while ignoring all the other traits/struggles/behaviors that people with the actual condition struggle with every day of their lives.
These supposedly lighthearted jokes can attack a persons sense of self-worth, leading to (even more) depression, anxiety, suicide
Like in the article when a woman jokes "I'm so OCD" when arranging pens by color whilst in the presence of someone whose life is basically directed by the condition (and thus causes a lot of suffering), it can be very offensive, and the comment could be taken as demeaning.
I had similar feelings when r/WSB used the term autism as a joke to describe themselves. They were focusing on one or two stereotypical traits of the condition to make jokes about while ignoring all the other traits/struggles/behaviors that people with the actual condition struggle with every day of their lives.
These supposedly lighthearted jokes can attack a persons sense of self-worth, leading to (even more) depression, anxiety, suicide
As someone with the autism struggles, I get where you're coming from.
I think the world is the world though, and it's best for people with the issue to be more thick-skinned than to expect (or regulate) others to change such behavior.
By overprotecting ourselves and expecting others to be kind all the time, we create a self-fulfilling prophesy of more depression, anxiety etc when the world doesn't give us that.
And by regulating this (or legislating this), we create an even more toxic environment where everyone is faux-polite, and anxious of saying the wrong thing or making the wrong joke.
I think the world is the world though, and it's best for people with the issue to be more thick-skinned than to expect (or regulate) others to change such behavior.
By overprotecting ourselves and expecting others to be kind all the time, we create a self-fulfilling prophesy of more depression, anxiety etc when the world doesn't give us that.
And by regulating this (or legislating this), we create an even more toxic environment where everyone is faux-polite, and anxious of saying the wrong thing or making the wrong joke.
Agreed that we should not be too overprotective in this, the world is the world as you said and per the serenity prayer we should have the courage to accept the things we cannot change, but being thick-skinned is not an easy skill for many people with ASD and its comorbidities. One of the behaviors used for diagnosing ASD is a lack of social awareness, people with what used to be called Aspergers have a really hard time detecting sarcasm and humor and often take things more seriously than they are intended.
The HN audience is special, it has (in my opinion) an increased incidence for conditions like ASD/ADHD/OCD/gifted, in part that makes us good at what we do. But I also feel that this incidence is biased towards the higher functioning/higher intelligence side of the spectrum. Not every person diagnosed with ASD has the same cognitive skills to reason about and contextualize something they read or hear. And even people on the higher functioning side have days where this is hard or even impossible.
I've had days where the walls were closing in on me, totally consumed by my issues and not seeing a way out. If in a moment like that I read someone joking lightheartedly that they "are so autistic" because of one stereotypical trait they zoom in on, I feel like someone is mocking me personally, I feel like a failure for who I am, and that can lead to a depression episode lasting for days or weeks.
An environment where everyone is on their toes and faux-polite all the time is not a solution. I think it mostly comes down to increasing awareness about these conditions, what they are and how they affect people so we as a society can all live together in harmony. Which is what this article is trying to do for OCD, which is also why I have spent the last 60 minutes trying to write a 4 paragraph HN comment on a post that is not even on the frontpage anymore. I don't even know where I'm going with this anymore, my attention is shot, my emotions all over the place, I think I need a walk outside.
The HN audience is special, it has (in my opinion) an increased incidence for conditions like ASD/ADHD/OCD/gifted, in part that makes us good at what we do. But I also feel that this incidence is biased towards the higher functioning/higher intelligence side of the spectrum. Not every person diagnosed with ASD has the same cognitive skills to reason about and contextualize something they read or hear. And even people on the higher functioning side have days where this is hard or even impossible.
I've had days where the walls were closing in on me, totally consumed by my issues and not seeing a way out. If in a moment like that I read someone joking lightheartedly that they "are so autistic" because of one stereotypical trait they zoom in on, I feel like someone is mocking me personally, I feel like a failure for who I am, and that can lead to a depression episode lasting for days or weeks.
An environment where everyone is on their toes and faux-polite all the time is not a solution. I think it mostly comes down to increasing awareness about these conditions, what they are and how they affect people so we as a society can all live together in harmony. Which is what this article is trying to do for OCD, which is also why I have spent the last 60 minutes trying to write a 4 paragraph HN comment on a post that is not even on the frontpage anymore. I don't even know where I'm going with this anymore, my attention is shot, my emotions all over the place, I think I need a walk outside.
I understand where you are coming from.
But I worry that a lot of people in the "ASD community" – this might not be true of you personally – seem to me to believe in a sort of hard boundary between ASD and non-ASD, ignoring the concept of BAP (subclinical ASD).
An oversimplified one-dimensional model might look like this: you have the "neurotypical" at one end, and ASD at the other, and BAP is somewhere in the middle. A lot of people who joke about being "so autistic" may well actually have BAP, and BAP is adjacent to ASD and has an unclear boundary with it. The boundary between the two is in part determined by non-intrinsic factors such as cultural differences between diagnosing clinicians, patient/client differences in cultural awareness of ASD which influence the likelihood of seeking out a diagnosis, and differences in the supportiveness of the person's environment. (Some "borderline" cases may in a supportive life situation have insufficient clinical dysfunction to justify putting them on the ASD side of the BAP-ASD line, but if their life had turned out a bit differently and they'd found themselves in a less supportive environment they might have ended up on the other side of it, even though the extent to which they innately have core autistic traits might be exactly the same in the two cases.)
(That model is oversimplified for two reasons: ASD has a lot of overlap with other psychiatric/neurodevelopmental conditions, and ASD itself is not a one-dimensional construct.)
But I worry that a lot of people in the "ASD community" – this might not be true of you personally – seem to me to believe in a sort of hard boundary between ASD and non-ASD, ignoring the concept of BAP (subclinical ASD).
An oversimplified one-dimensional model might look like this: you have the "neurotypical" at one end, and ASD at the other, and BAP is somewhere in the middle. A lot of people who joke about being "so autistic" may well actually have BAP, and BAP is adjacent to ASD and has an unclear boundary with it. The boundary between the two is in part determined by non-intrinsic factors such as cultural differences between diagnosing clinicians, patient/client differences in cultural awareness of ASD which influence the likelihood of seeking out a diagnosis, and differences in the supportiveness of the person's environment. (Some "borderline" cases may in a supportive life situation have insufficient clinical dysfunction to justify putting them on the ASD side of the BAP-ASD line, but if their life had turned out a bit differently and they'd found themselves in a less supportive environment they might have ended up on the other side of it, even though the extent to which they innately have core autistic traits might be exactly the same in the two cases.)
(That model is oversimplified for two reasons: ASD has a lot of overlap with other psychiatric/neurodevelopmental conditions, and ASD itself is not a one-dimensional construct.)
I'm going to look into BAP as I had not heard from it before but the concept feels very familiar: I have always tried to explain ASD not as a one-dimensional spectrum but as a set of spectra (oversimplified: one spectrum for each trait) that when combined form a picture that describes a persons autistic behavior.
A comparable visualization I like is how Leafly (the marijuana strain website) describes each strain as a set of traits with percentages and then shows each trait score as a horizontal bar.
I have similar worries about the idea of a hard boundary between ASD/non-ASD, mostly because I believe that the concepts of "neurotypical" and "neurodiversity" are social constructs we have created because the majority of people behave in a similar way, and everyone who does not is an outlier. We gave the majority behavior a name "neurotypical" and that created an "us vs them" polarization.
Hence why I'm an advocate of raising awareness about mental health conditions with the ultimate goal of getting rid of this polarization. You seem to have similar goals in mind when I read your comments about BAP.
A comparable visualization I like is how Leafly (the marijuana strain website) describes each strain as a set of traits with percentages and then shows each trait score as a horizontal bar.
I have similar worries about the idea of a hard boundary between ASD/non-ASD, mostly because I believe that the concepts of "neurotypical" and "neurodiversity" are social constructs we have created because the majority of people behave in a similar way, and everyone who does not is an outlier. We gave the majority behavior a name "neurotypical" and that created an "us vs them" polarization.
Hence why I'm an advocate of raising awareness about mental health conditions with the ultimate goal of getting rid of this polarization. You seem to have similar goals in mind when I read your comments about BAP.
> I have always tried to explain ASD not as a one-dimensional spectrum but as a set of spectra (oversimplified: one spectrum for each trait) that when combined form a picture that describes a persons autistic behavior.
The term "spectrum" gets used in two different senses (1) a a continuum of severity, stretching from "normal" individuals, to the "mild" cases, through to the "severe" ones (2) to refer to the heterogeneity of different symptoms, such that two people might have a very different mix of symptoms despite having "equal severity". I think both ways of understanding the term are legitimate; some people insist that only sense (2) is correct and sense (1) is wrong, but in fact you'll find both senses being used in the research literature.
In some ways it is justifiable to view ASD as a two-dimensional construct: DSM-5 ASD is defined in terms of two domains, the social communication domain and the RRBI+sensory domain. And the DSM-5 says that a diagnosis should provide a level number from 1 to 3 for each of those two domains, and in principle you could have a different level in each domain. (That said, my personal impression is few clinicians actually do that in practice.)
ASD is not unique in being a "spectrum". There is also the schizophrenia spectrum (DSM-5 has a whole section called "schizophrenia spectrum and other psychotic disorders"), the obsessive-compulsive spectrum (DSM-5 didn't end up including that concept in its main text, although it was being considered for inclusion, a fact which the front-matter of the DSM-5 briefly alludes to), the bipolar spectrum (not mentioned in the DSM-5, but widely discussed in the literature), among others. In fact, for many different psychiatric/neurodevelopmental disorders, you'll find people in the literature adopting a spectrum-approach to them. But in the popular consciousness, the word "spectrum" gets treated as something specific to ASD rather than the much more general psychiatric/psychological concept which it is.
> I have similar worries about the idea of a hard boundary between ASD/non-ASD, mostly because I believe that the concepts of "neurotypical" and "neurodiversity" are social constructs we have created because the majority of people behave in a similar way, and everyone who does not is an outlier. We gave the majority behavior a name "neurotypical" and that created an "us vs them" polarization.
I agree with you, but I have another concern as well – the evidence for the "neuro" part just isn't there. The distinction between the "neurotypical" and the "neurodiverse" is actually clinical – it is based on the presence or absence of clinically significant dysfunction, in other words it is based on how well you function in contemporary society, not on any individualised study of brain structure. There is actually genuine neurodiversity among "neurotypicals". For example, most right-handed individuals activate left perisylvian regions of the brain during language processing, but a small minority of right-handed individuals activate right perisylvian regions instead. That small minority are an example of genuine biological neurodiversity. But nobody is going to call them "neurodiverse" unless they have some clinically significant problems with functioning in society, and that example of neurodiversity has no known clinical significance. (Indeed, almost nobody in that small minority would know they are in it, because unless you get someone to do language tasks under MRI, you can't tell whether they belong to it.) The "neurotypical"/"neurodiverse" distinction is fundamentally a clinical distinction masquerading as a neuroscience one. Hence I worry that the us-vs-them polarisation that you mention is both socially harmful and scientifically illiterate
The term "spectrum" gets used in two different senses (1) a a continuum of severity, stretching from "normal" individuals, to the "mild" cases, through to the "severe" ones (2) to refer to the heterogeneity of different symptoms, such that two people might have a very different mix of symptoms despite having "equal severity". I think both ways of understanding the term are legitimate; some people insist that only sense (2) is correct and sense (1) is wrong, but in fact you'll find both senses being used in the research literature.
In some ways it is justifiable to view ASD as a two-dimensional construct: DSM-5 ASD is defined in terms of two domains, the social communication domain and the RRBI+sensory domain. And the DSM-5 says that a diagnosis should provide a level number from 1 to 3 for each of those two domains, and in principle you could have a different level in each domain. (That said, my personal impression is few clinicians actually do that in practice.)
ASD is not unique in being a "spectrum". There is also the schizophrenia spectrum (DSM-5 has a whole section called "schizophrenia spectrum and other psychotic disorders"), the obsessive-compulsive spectrum (DSM-5 didn't end up including that concept in its main text, although it was being considered for inclusion, a fact which the front-matter of the DSM-5 briefly alludes to), the bipolar spectrum (not mentioned in the DSM-5, but widely discussed in the literature), among others. In fact, for many different psychiatric/neurodevelopmental disorders, you'll find people in the literature adopting a spectrum-approach to them. But in the popular consciousness, the word "spectrum" gets treated as something specific to ASD rather than the much more general psychiatric/psychological concept which it is.
> I have similar worries about the idea of a hard boundary between ASD/non-ASD, mostly because I believe that the concepts of "neurotypical" and "neurodiversity" are social constructs we have created because the majority of people behave in a similar way, and everyone who does not is an outlier. We gave the majority behavior a name "neurotypical" and that created an "us vs them" polarization.
I agree with you, but I have another concern as well – the evidence for the "neuro" part just isn't there. The distinction between the "neurotypical" and the "neurodiverse" is actually clinical – it is based on the presence or absence of clinically significant dysfunction, in other words it is based on how well you function in contemporary society, not on any individualised study of brain structure. There is actually genuine neurodiversity among "neurotypicals". For example, most right-handed individuals activate left perisylvian regions of the brain during language processing, but a small minority of right-handed individuals activate right perisylvian regions instead. That small minority are an example of genuine biological neurodiversity. But nobody is going to call them "neurodiverse" unless they have some clinically significant problems with functioning in society, and that example of neurodiversity has no known clinical significance. (Indeed, almost nobody in that small minority would know they are in it, because unless you get someone to do language tasks under MRI, you can't tell whether they belong to it.) The "neurotypical"/"neurodiverse" distinction is fundamentally a clinical distinction masquerading as a neuroscience one. Hence I worry that the us-vs-them polarisation that you mention is both socially harmful and scientifically illiterate
Exactly, the problem with being blind is that you can't see, not that people use the word jokingly, or as an accusation. Even if we completely stop doing those things, and keep coming up with new euphemisms for blindness ("differently sighted" anyone?) the main issue will remain: some individuals are not able to see.
People who say “I’m so ocd” aren’t making a joke though. They think that is what ocd actually is, quirky and cute.
WSB is using the term autist ironically and it’s completely self aware.
WSB is using the term autist ironically and it’s completely self aware.
For what it's worth, banana peels were a serious matter too
https://www.atlasobscura.com/articles/can-you-slip-banana-pe...
https://www.atlasobscura.com/articles/can-you-slip-banana-pe...
I don't know if many people here would have ever heard about the concept of Broad Autism Phenotype (BAP). People who have BAP have significantly more autistic traits than the average person, but not quite enough to merit a diagnosis of ASD. BAP is the subclinical manifestation of ASD. It is common in close blood relatives of people diagnosed with ASD (such as parents and siblings.) It also occurs at a quite elevated rate in STEM professions. Probably a lot of people here have it. It is worth pointing out that it is not a disorder, it is a phenotype. The fundamental difference between BAP and ASD, is that in ASD the autistic traits impair functioning to the point that they become the legitimate focus of clinical attention, in BAP they don't reach the point of being impairing (or else, the impairments are so mild they are not worthy of clinical attention.) The boundary of whether ones functioning is so impaired as to be worthy of clinical attention is inherently a bit of a subjective judgement call, and is going to vary from clinician to clinician; BAP and ASD are on a continuum with each other, and there is no precise boundary between the two.
But actually other disorders have subclinical manifestations, not just ASD. Some researchers study subclinical ADHD, which has a similar relationship to ADHD as BAP has to ASD. Other study subclinical schizophrenia. And there is also study of subclinical OCD. (One big difference is that subclinical ASD has a distinctive name, whereas I don't think the subclinical manifestation of any other disorder has been given a distinctive name.)
Many people see ASD traits in themselves, even to the point of engaging in self-diagnosis, even if they don't actually meet the criteria for formal diagnosis. Yet, most of these people probably actually do have BAP, they just don't understand the BAP-vs-ASD distinction. Well, you could make the exact same point about OCD – many of the people who claim (even if somewhat light-heartedly) that they have OCD, but don't actually do so, may well actually have some degree of subclinical OCD, but they don't understand the subclinical vs clinical distinction.
But actually other disorders have subclinical manifestations, not just ASD. Some researchers study subclinical ADHD, which has a similar relationship to ADHD as BAP has to ASD. Other study subclinical schizophrenia. And there is also study of subclinical OCD. (One big difference is that subclinical ASD has a distinctive name, whereas I don't think the subclinical manifestation of any other disorder has been given a distinctive name.)
Many people see ASD traits in themselves, even to the point of engaging in self-diagnosis, even if they don't actually meet the criteria for formal diagnosis. Yet, most of these people probably actually do have BAP, they just don't understand the BAP-vs-ASD distinction. Well, you could make the exact same point about OCD – many of the people who claim (even if somewhat light-heartedly) that they have OCD, but don't actually do so, may well actually have some degree of subclinical OCD, but they don't understand the subclinical vs clinical distinction.
A meta note on language: Everyone has a pet language peeve(s) and would like everyone else to adhere to it. But when people need to express an emotion and can't grasp a ready word, they make do with a similar one. Some of these make-dos end up infuriating a small subsection.
My pet-peeve is disclosure vs disclaimer (why would you want to discredit what you're saying when all you want to do is call out potential bias!).
All of this to say I can empathize with the article author's stand, but I don't recall the last time a word went into disuse because someone complained.
My pet-peeve is disclosure vs disclaimer (why would you want to discredit what you're saying when all you want to do is call out potential bias!).
All of this to say I can empathize with the article author's stand, but I don't recall the last time a word went into disuse because someone complained.
I don't know if I have OCD (I never considered my behaviour debilitating anyway) but I do have these ridiculous rituals before going to bed that take a considerable amount of time (checking if the oven is turned off, checking for open doors, windows, electrical plugs, etc). When travelling, I take pictures of plugs, appliances, taps, etc so that during the flight I can check them, if unsure.
And although I never said out loud "I have OCD" or gave it too much thought, I noticed that many people I know will gratuitously say "I have OCD" when what they mean is "I'm a perfectionist" or "I like paying attention to details".