Positivity – soon to be classified as an illness?

Radio presenter and psychiatrist Assoc Prof Steve Ellen has informed listeners that the American Pschological Association is considering inclusion of Excitable Optimism (EO) as a mental disorder. The Diagnostic & Statistical Manual (DSM) draft has been circulated, as was the case with DSM-5, and evaluation will include prevalence and burden assessments. Steve said “My wife finds my intolerable cheerfulness to be just that, but if the proposed change in DSM-6 goes ahead then it’ll validate my illness, and remove that stigma from other sufferers”. Steve’s upbeat persona might seem invaluable in his role as a director at Peter MacCallum Cancer Centre, but its intrusiveness into personal relationships led him to study the condition through Monash Alfred Pschiatry research centre.

Steve runs a selfie-help group

Steve runs a selfie-help group

A formal diagnosis of EO will require more than just positivity, the discriminant being a manic aspect of excitement on top of delusional belief in things getting better. EO is mooted to join ADHD in the standalone category formed in DSM-5, having both cognitive and behavioural domains (Coghill & Seth, 2011). The plan has already been bookmarked in the International Classification of Disease (ICD) update at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2017/ where ADHD is renamed HyperKinetic Disease, and sits alongside HyperAffective Disorder (HAD) – an extended definition of the previous ICD coding for Death & Injury Resulting from Terrorism.

These examples are the first application of ideas about endogenous disease affecting others globally, although the association between EO and ADHD isn’t new, indeed being well documented. What isn’t known, but is being keenly investigated, is the contribution of nature or nurture in positivity. “Shared environmental influences on low extreme ADHD traits may reflect passive gene-environment correlation, which arises because parents provide environments as well as passing on genes”, said behavioural geneticist Dr Corina Greven from the Dept of Cognitive Neuroscience at Radboud University.

The proposal reflects growing divisions within Psychology due to the increased adoption of Eastern Buddhist traditions into therapy, most obviously arising from mindfulness in treating disorders. “Positive Psychology is plagued with problems of confusing directionality, and submerged in a lack of rigorous science.” writes psychologist Michael Booth from the Science-Based Medicine organisation. “Mindfulness introduces many things that cannot be refuted or invalidated, and can be used as an ad hominem against an individual. For example: you aren’t meditating correctly, which is why we did not obtain the promised result.”

Results are much clearer in clinical trials. Of the 16 persons reporting persistent high-intensity backpain in a two-year community study, negativity was strongly associated. Positivity affect from family and peers was also associated, but not significantly so. “This is a statistical limitation of the small numbers of participants, with a tripling of study size the p value of 0.08 would have decreased and achieved significance”, author Assoc Prof Anita Wluka advised. “Larger investigations are warranted, to show that pathological optimists are literally a pain in the backside”. The Monash team already has an application in for funding to trial amitriptyline in households with a chronic pain patient where an EO sufferer also resides. Medicating persons other than the patient is controversial, with few precedents being available. Director of NHMRC grants, Saraid Billliards declined to comment, due to the matter still being under review. Further details are available on the clinical trials registry under ref ACTRN12612000131853.

In the immediate term if you, or a person you know has been affected by HAD, the Australian Government has a support line: 1800 123 400

 

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