Diagnosing Personality Disorders (Psychopathy), Depression and Anxiety in Youth

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As a psychotherapist and a crisis counsellor, it seems that there’s a constant, unceasing background argument that mental health disorders (particularly autistic and conduct disorders) is on the rise.

Evidence that mental health disorders amongst adolescent youth and children is “on the rise” seems spotty at best.

Thoughts and expert opinion differ on whether mental health problems amongst youth are on the increase.

“Popular media tends to perpetuate the idea that the prevalence of mental disorders is increasing,” writes Dr. Ian Colman, Canada Research Chair in Mental Health Epidemiology and associate professor at the University of Ottawa, Ottawa, Ontario, with coauthors. “However, research supporting this position has been inconsistent.”

Dr. Colman’s article, “Most mental health disorders not increasing in children and youth: Suicidal thoughts and attempts on decline,” was published in the Canadian Medical Journal in November of 2014.

The diagnosis of autism and ASP (autism spectrum disorders) is certainly on the rise, but not to the extent I’ve heard from laypeople around me.

The other day I heard a teacher friend confidently announce that “within 10 years, 50 percent of children will be on the spectrum (according to “some” media source)”.

In actuality, the CDC puts that number at 1 in 150 youth (1 youth in 150 will be ASP, an increase).

There is an increase in some areas, though, and it’s been chronicled in reputable journals.

Psychosocial problems have been steadily increasing for decades now, according to Collishaw et al (2004). This study, in particular, showed a rise in adolescent conduct disorders across both male and female cohorts regardless of social circumstances.

The most controversial types of diagnosis are those classified as personality disorders, though. These are cluster A-C disorders in the DSM that range from things like Histrionic Personality Disorder, right down through to the much more troubling cluster B personality disorders – those customarily thought of as “criminal” disorders.

These findings are tempered by the CDC who list “official” diagnostic numbers of disorders like “Behavioral or Conduct” problems at (3.5%), Anxiety at (3.0%) and Depression at (2.1%).

Most alarming, at least on the surface, is diagnosis of Psychopathy in youth.

To be clear, this is not “on the rise” – it can’t be. It’s never been done before.

This article, by the MacArthur Foundation, investigates this notion further; warning that the diagnosis alone “is a serious charge, and should be done so (diagnosed) with caution.”

We should take any “increase” in the diagnosis of psychopathy with a grain of salt, because this disorder is really only in its infancy in terms of being understood even on the adult level.

The standard tool for diagnosing Psychopathy is called the PCL-R; a 20-item test originally developed by the seminal work of Canadian psychologist Robert Hare.

The test is by no means full proof: It’s administered in a subjective way … the psychologist must use wile and interpretive judgments in scoring it. Often times the psychopath being “scored” knows full well the “game” being played.

It’s also incredibly important that we keep our eyes open, as a society, at the rate of youth/adolescent suicide. This is an entirely separate issue, though, that I’ll discuss in more depth in a future article. A vast literature review could be done on the subject, but the consensus (both anecdotally and statistically) seems to be that it’s on the rise internationally. One source supporting that conclusion is this article by the National Bureau of Economic Research (of all places).

Blog Friends: Please notify me of any mistakes in my citations/links, as this is a very important subject.

-Michael Todd, April 22 2015