DSM Disorders Disappear in Statistical Clustering of Psychiatric Symptoms (2024)
14 comments
·September 22, 2025gsf_emergency_2
For nerdsnipers who would like see if DSM-IV is "better" the wiki is
https://www.ncbi.nlm.nih.gov/books/NBK519711/
Going back to DSM-III TFA has a good link
https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2...
>This is unproblematic as long as DSM criteria are understood to index rather than constitute psychiatric disorders.
With "index" taken to mean:
>a pragmatic and well-validated way to identify [a] syndrome
I.e. "Do DSM Compress?"
andoando
Ive been saying this forever. Even with single disorder like ADHD, per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD. So if someone has 6 symptoms how do you know theyre not all independently caused? Given a large enough population it's a guarantee
oofbey
The paper described makes a statistically rigorous attempt to recover common psychiatric diagnoses (like major depressive disorder MDD) from raw unbiased data about people’s experiences. And seems to conclude that the Venn diagram for common presentations of these conditions doesn’t line up well with the official diagnoses. Not that the conditions don’t exist. But that we are grouping together distinct conditions under the same name. They give examples of anhedonia and suicidality as distinct clusters in their data even though both would be considered MDD under the DSM.
To me this begs the question of whether the DSM authors might actually know something real and useful that the data don’t show. For example that anhedonia often progresses to suicidality even though the two might not coexist in the same person often. (Doesn’t sound right to me, but that’s how I read the article.) I think it’s plausible that the direct implication of this research is actually wrong. The obvious conclusion is that the DSM is full of it and doesn’t match real people’s experiences. But I suspect it might be that the DSM captures useful correlations and progressions that this method didn’t collect. Perhaps because the data here are from a single point in time, not a progression.
jppope
wow. thats mind bending right there... I'd love to see it with some additional dimensions to it. even a 3D graph would be super interesting no doubt
oofbey
The raw data are in hundreds of dimensions. To visualize it meaningfully I think you’d need to run a t-SNE clustering, which would be fine in 2D. Raw PCA or anything like that which preserves the original structure probably wouldn’t show much even in 3D. But it would be fun to see the clusters more directly.
skissane
Another paper I like which reaches similar conclusions, but with a rather different methodology - https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/ - looking at the biological validity of the ASD-vs-ADHD-vs-OCD distinction in children and adolescents - it concludes the boundaries between the three disorders (and between the disorders and “normality”) are a poor model of what is really going on
SV_BubbleTime
That’s interesting. Aren’t there some social contagions that are listed in DSM? I would think those basically require large groups of varying symptoms.
kennywinker
Not an expert, but I don’t think - and cursory googling seems to agree - there are any “social contagions” in the dsm. The concept is not exactly proven science, and it’s worth mentioning that it’s also a bit of a dogwhistle term used to undermine a lot of queer and gender identities.
Fwiw I think it’s patently obvious behaviors can influence people, but in my mind they influence the avenue of expression - they don’t create disorders from scratch. So like e.g. body image would be the underlying disorder, and if it expresses as bulimia or anorexia or cutting could be somewhat “socially contagious”.
Wendycutler06
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s5300
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tcj_phx
In 2022 psychiatrist Chris Palmer MD [0] published Brain Energy [1], which shares his discovery of the 70+ years of science establishing that the behavioral/mental symptoms traditionally given 'psychiatric' labels are caused by metabolic problems. When you fix the body's metabolism the symptoms go away.
Dr. Palmer recommends the ketogenic diet, but not all people need this specific intervention to improve their metabolism. I think the best place to start for most people is simply eliminating their consumption of white flour, or at the least, fortified white flour [2].
Dr. Palmer tweeted about anemia and Vitamin B-12 deficiency [3]. Many patients are prescribed synthroid (T4) for their thyroid, but they often still have all the symptoms of hypothyrodism because their body doesn't activate T4 -> T3. Adding a source of T3 to patients' Synthroid treatment can make a big difference in their behavioral symptoms.
I have a book by some psychiatrists who were active in the 1940's -> 1950's, which is before the first 'psychiatric' medications were released. I didn't know this book was compiled by psychiatrists when I ordered it - I thought it was going to be a general book about the pro-metabolic intervention.
It's unfortunate that the prescription drug industry never figured out why some of their chemicals help with the symptoms labeled 'depression'. The MAOIs were reasonably-effective at helping acutely-depressed people out of bed. Each generation of antidepressants was less effective than the previous, until the SSRI's arrived. Now we're stuck with antidepressants that have always been known to cause people to commit suicide. At least the psychiatrists are now revisiting MAOIs as an option for people who don't respond well to the suicide pills (SSRIs).
Antipsychotics are a tragedy: anti-dopamine drugs make patients feel terrible. The one exception to the anti-treatment received by psychotics is an anti-serotonin drug approved for parkinsons psychosis [4].
[0] https://www.chrispalmermd.com/ https://twitter.com/ChrisPalmerMD/
[2] Flour manufacturers tend to use the cheapest fortifications possible. For example, the type of iron used for fortification is usually simply 'iron shavings', which usually becomes rust by the time it's absorbed.
[3] https://twitter.com/ChrisPalmerMD/status/1903071654328111413
Aurornis
There are countless examples of past doctors claiming that psychiatric disorders are caused by some simple dietary issue. You can find people claiming that everything can be fixed by ketogenic diets, vegan diets, carnivore diets, Vitamin B12, niacin, magnesium, fish oil, you name it. For any vitamin or diet there is someone out there making passionate claims that it solves everything.
None of these hold up under actual studies. It’s the domain of wishful thinking that sadly preys upon people desperate for answers. Some times the placebo effect works for a while, but usually people just end up with a cabinet full of supplement bottles and a history of fad diets with no progress on their condition.
I'm happy to see such results be "properly" recognized. The DSM is imo helpful only as a baseline, especially in contexts where without it, doctors might have (significant) personal bias. And... this might ruffle some feathers with the "live and die by the book" crowd, but a good, perceptive doctor doesn't need the DSM to diagnose anything.
I've had video calls with a doc who took maybe 5 minutes at most of hearing subjective experiences to confidently reach a conclusion. I've also had a 45 minute "by the book" DSM-based session where boxes were being ticked... and the questions were f---ing *terrible*, if you pardon my French. "Do you have trouble concentrating" is terribly vague and can always be justified either way. Not to mention, it takes maybe a few moments to "catch on" on how to answer which questions; which seems to be a terrible way of introducing bias into the answers (as also mentioned in the article). Having someone describe their personal life is in many ways much better because it cannot be a rigid yes/no question.
And all this talk is without mentions of other aspects that also need addressing, like the continuous spectrum of many conditions...