"The root of the word 'create' or 'creativity' essentially means 'to grow.' That is probably what lies at the heart of what patients really want; they want to grow in terms of their relationships, their abilities, their passions and interests, their health, and in terms of whatever dreams they want to achieve personally in their lives." Cognitive Behavioral Therapy SPECIAL REPORT: CREATIVITY & PSYCHIATRY THE BECK INSTITUTE Can creativity play a role in psychiatric treatment? Studies have shown that music and art therapy can be helpful for patients with schizophrenia, depression, dementia , and other mental disorders. 1-4 Creativity can also enhance the therapeutic alliance. 5 Norman Cotterell, PhD , senior clinician at the Beck Institute for Cognitive Behavior Therapy, is no stranger to leveraging creativity when supporting patients. His interest in the arts stem back to his school days, when he was in the drama club, the Princeton University Gospel Ensemble, and the Princeton Inn Theatre. To help clinicians cultivate creativity in clinical practice, Cotterell shared insights with Psychiatric Times . Psychiatric Times: It is often said that psychotherapy combines science and art. Where does the art come into play in your daily work with patients? Norman Cotterell, PhD: It comes on the fly. I’m usually thinking of ways I can help the patient get to where they want to go in life, and that is much more personal than science. I suppose the science comes into play in the empirically validated tools we have, but the art comes in terms of relating to a person one-on-one. PT: Do you think being a creative person helps clinicians better support patients? Cotterell: I have patients who come to me because I share their enthusiasm for art, music, literature, and theater. I share in the enthusiasm that they bring to whatever artistic pursuit they might have. I had a patient who thought visually and recorded her thoughts in pictures. If she could sketch out her negative thoughts, it wasn’t too much of a stretch to have her sketch her positive responses to those thoughts. She sketched responses that displayed her hopes, dreams, and aspirations. She sketched out the best that she saw in herself, the best that she saw in those around her, and the best that she saw in what the future might bring to her. Having her sketch that out in visual terms was incredibly powerful. Another patient of mine thought in terms of music. She created a mixtape that represented those hopes, dreams, and aspirations in musical form through other people’s work. There’s room for that. There’s room in sessions for clients to bring their creative, artistic pursuits into therapy. But it has to serve the nature of their goals for therapy; what they want to accomplish in life outside the session. PT: How can clinicians leverage metaphors, anecdotes, and humor to improve therapy and the patient-clinician alliance? Cotterell: Metaphors and anecdotes can be especially powerful, particularly in helping patients see that what can be an obstacle in one situation could be an opportunity in another. I sometimes use the example of [former] President Franklin D. Roosevelt. Many assume that being in a wheelchair would have been an obstacle to the presidency, but there is some indication it was an opportunity. Prior to polio, Roosevelt was a rich kid who was perceived as never having had to struggle a day in his life. After polio, he had something in common with people who were struggling through the Great Depression. So there is some thought that it increased his chances for the presidency, because he had something in common with voters who were struggling. I say to patients, “Well, you can’t walk. What can you do? You can lead your country in the highest office in the land.” Often, what can be an obstacle in one frame of mind can creatively be turned into an opportunity in another frame of mind. That might be what we do in therapy: turn obstacles into opportunities. We turn obstacles in terms of internal experiences, thoughts, feelings, sensations, and urges into opportunities to live life well. Humor is another powerful tool when used correctly. I have seen stand-up comedians in sessions, and they naturally think in humorous terms—for better or for worse. Often, the use of humor has a therapeutic impact. One patient told me that for him, doing stand-up comedy was tantamount to therapy. It’s just one form of language and one form of a coping strategy that helps patients. But it depends on the person. For some patients, humor is really important. It’s the way they speak, think, and cope. But some patients don’t have the same need or desire, so tread gently when it comes to humor. This is an area in which I would really let the patient take the lead, because individuals differ on what they find funny and on what kind of humor is therapeutic for them. PT: Can you give specific examples of creativity within the cognitive behavioral therapy (CBT) framework? Cotterell: The root of the word create or creativity essentially means “to grow.” That is probably what lies at the heart of what patients really want; they want to grow in terms of their relationships, their abilities, their passions and interests, their health, and in terms of whatever dreams they want to achieve personally in their lives. It is the old button-pushing question from David Burns: What kind of life would they be leading if they pushed a magic button and were totally, permanently healed? If they pushed the button and therapy was a smashing success, what would change on a day-to-day basis? What would they be doing? I have them create in their own minds a vision of that life. If they were healed, what would they do in the next 7 days? If they felt great about themselves, their world, their future; if their anxiety was no longer a problem; and if they were able to take steps toward what’s important and valuable and meaningful in their lives, then what would they do for the rest of today? Tomorrow morning? Tomorrow afternoon? Tomorrow night? The creative aspect is enabling the patient to create a vision of the kind of life they want. I suppose the tools that we provide serve as fertilizer to enable their dreams and aspirations to grow, and to enable them to move in the direction of the life they seek. PT: What specific CBT interventions are especially well suited for utilizing a creative approach? Cotterell: Action planning. Action plans could include what the patient wants to do in the next week for pleasure, what they want to do in the next week that could engage their mind, or what they want to do in the next week for connection. It could be building relationships with those they care about. It could be something that gives them a sense of meaning and purpose; something they do for growth, for love, and to contribute to the well-being of those around them. I have them create that vision for the next week, then we figure out what kinds of thoughts, urges, or sensations inside their body would get in the way of doing those things. The intervention within the session is finding creative ways to get around, get through, or travel with those thoughts, emotions, urges, or sensations that otherwise could serve as obstacles to the things they want to do to lead their life in a more fulfilling and more meaningful way.

After experiencing severe trauma and neglect, the path from victim to survivor or conversely, staying in a cycle of suffering is driven by a complex interplay of internal coping mechanisms and external support systems. Factors for Becoming a Survivor: Transitioning to a survivor requires establishing physical safety, receiving social support, and reclaiming one's life story, allowing the individual to integrate the trauma rather than being ruled by it. Survivors often develop a strong internal locus of control, seeing adversity as a catalyst for growth and taking responsibility for their healing journey. The "Super Empath" Scapegoat: Individuals who were the family scapegoat often develop high empathy as a survival mechanism, learning to read others to predict danger. While this makes them highly intuitive, they are vulnerable to being targeted, blamed, and "doubly abused" (re-victimized). They may be called "too sensitive," but this sensitivity is a sign of needing to process pain in a toxic environment. Cycle of Victimization & Addiction: Those who stay in a "victim" role often do so because they are in ongoing traumatic circumstances or have not reached a state of stability. This often involves chronic shame, which keeps the trauma buried, leading to coping mechanisms like addiction or being re-victimized by new perpetrators. Suffering as Fuel vs. Cycle: Both paths stem from trauma, but differ in response: Fuel (Survivor): Uses pain to develop resilience, empathy, and a "mindful warrior" mentality to protect their well-being and set boundaries. Cycle (Victim): Uses suffering as an identity, often in a "freeze" state, focusing on blaming others and experiencing helplessness, which prevents healing. Narcissism and Trauma: While not all survivors become narcissists, narcissism can develop as a rigid defense mechanism against overwhelming vulnerability, guilt, or fear. Optimism, Empathy, and ADHD: A survivor who is both highly empathetic and has ADHD might use their intense focus (hyperfocus) and emotional depth to process trauma deeply and find meaning. Their optimism is often a conscious choice to focus on growth rather than the abuse, using empathy to create connection, provided they have learned to set firm boundaries to protect themselves from exploitation. Key Factors for Moving Forward: Safety First: Survivorhood begins only after safety is secured. Validation: Finding people who validate their experience helps break the shame cycle. Processing Pain: Moving beyond the victim mentality requires working through, rather than suppressing, the pain and grief. Interpersonal and external factors significantly influence whether a survivor of trauma and neglect "thrives" or remains stuck in a cycle of suffering, which can include chronic addiction and further victimization. Key Factors Leading to Resilience and Survival Resilience is often described as the process of adapting well in the face of adversity and is influenced by several psychosocial factors: Supportive Social Networks: Having a caring, non-abusive person such as a mentor, teacher, or friend is the primary predictor of resilience. Active Coping Skills: Successful survivors tend to use "active" coping (problem-solving) rather than "passive" or "avoidant" coping (withdrawal or numbing). Cognitive Flexibility: The ability to positively reframe or find meaning in a tragedy (e.g., "this pain made me stronger") helps survivors move past victimhood. Personal Moral Compass: Survivors who maintain a sense of purpose or a personal moral code often use their suffering as "fuel" for personal growth or helping others. The "Super Empath" vs. Narcissist Response Both empaths and narcissists are often born from traumatic childhoods where love felt inconsistent or conditional, but they adapt differently: Empaths (often Scapegoats): They survived by "feeling more" scanning the environment to anticipate needs and keep others happy for safety. While this can lead to being an "empath," it also risks Complex PTSD (C-PTSD) and chronic self-doubt. Narcissists: They survived by "feeling less" shutting down vulnerability and building walls to prevent being hurt again. Trauma is a significant contributor to narcissistic traits, particularly the "vulnerable" type characterized by high sensitivity and fragile self-esteem. The Scapegoat Role: Being the "black sheep" causes profound invalidation, often leading to C-PTSD. Survivors may struggle for years with "toxic shame," which keeps them in a cycle of victimization or addiction if not treated through a trauma-informed lens. The Victim Cycle: Addiction and Victimization Many stay in a cycle of suffering due to external and internal barriers: Re-victimization: Those who were traumatized in childhood often internalize that they "deserve" abuse, leading to a pattern of second and third abusive relationships. Drug Addiction: Substance use is often a maladaptive way to "mask" or "bandage" deep psychological wounds and emotional numbness. Shame and Alienation: Traumas that generate high levels of shame cause survivors to feel like "damaged goods," making them less likely to seek the support necessary to break the cycle. Empathy, ADHD, and Optimism High empathy combined with ADHD can create a unique profile for a survivor: Optimism as a Shield: Resilient individuals use optimism to maintain faith that they will prevail despite the "brutal facts" of their reality. Empathy and Connection: For those with high natural empathy, the ability to connect with others and perform altruistic acts (helping others) provides a sense of purpose that can act as a powerful engine for recovery. ADHD's Role: While research specifically linking ADHD to trauma resilience is nuanced, the "energy" or "hyperfocus" common in ADHD can sometimes be channeled into active coping and passion, though it may also increase impulsivity and risk-taking if unmanaged.

Complex Post-Traumatic Stress Disorder (CPTSD) and Autism Spectrum Disorder (ASD) often overlap in observable behavior, particularly in social settings, though their internal motivations differ significantly. Individuals with extensive CPTSD may identify with autism to normalize their difficulties connecting with others, as it frames these challenges as a fundamental difference in "wiring" rather than just a response to injury. Reasons for Identification Symptom Overlap: Both conditions feature emotional dysregulation, sensory sensitivities (e.g., overwhelm from loud noises), and social withdrawal. Normalization: Identifying as neurodivergent can provide a less stigmatizing framework for why a person feels "different" or "broken," shifting the narrative from being "damaged" by trauma to having a naturally different brain. Shared Coping Mechanisms: Strategies like stimming (repetitive self-soothing behaviors) and a need for strict routines are core to autism but also common in CPTSD as ways to manage a constantly hyperaroused nervous system. Co-occurrence: Autistic individuals are significantly more likely to develop PTSD or CPTSD due to increased vulnerability to bullying, social rejection, and sensory-related trauma. Differences in Clinical Observation PTSD and autism are independent disorders, each with its own causes, diagnostic criteria, and clinical course. Autism is a neurological condition that begins in early childhood and shapes how a person perceives, processes, and interacts with the world. PTSD, on the other hand, is a trauma-related disorder that develops as a result of being exposed to overwhelming or potentially fatal situations. While their underlying mechanisms differ, common characteristics such as sensory sensitivity, social isolation, emotional regulation issues, and increased stress reactions can make classification difficult. While behaviors look similar on the surface, the underlying causes are distinct: Feature CPTSD Observation Autism (ASD) Observation Social Origin Often driven by fear, mistrust, or hypervigilance after trauma. Driven by an innate difficulty processing social cues and unspoken rules. Communication Avoids sharing emotions because it feels unsafe or shameful. Struggles to communicate emotions because they don't know how to express them. Routine Used to avoid triggers and maintain a sense of control over a scary world. Used for internal comfort and predictability; change feels neurologically jarring. Sensory Issues Often fluctuating and tied to specific trauma triggers (e.g., a specific smell). Typically lifelong and consistent neurological sensitivity to input. Theory of Mind Generally understands what others think but chooses to stay away for safety. Often struggles to intuitively comprehend others' thoughts or perspectives. Diagnosis Challenges in 2026 Modern clinical practice recognizes CPTSD as a form of acquired neurodivergence because prolonged trauma physically rewires the brain’s executive function and emotional centers. However, accurate differentiation is vital because treatment for CPTSD focuses on healing relational wounds, while support for autism focuses on accommodation and acceptance. Importantly, autistic people may be more vulnerable to trauma and exhibit PTSD symptoms in unusual ways, increasing the likelihood of misdiagnosis or underdiagnosis. Recognizing both diseases accurately is critical for providing effective, compassionate care. Rather than interpreting similarities as proof of the same condition, physicians and the general public must grasp how autism and PTSD can coexist, interact, or be confused for one another. Clear diagnostic assessment and trauma-informed, neurodiversity-affirming techniques guarantee that individuals receive care tailored to their specific needs rather than confusing two fundamentally different diseases.

Keypoint: The government has always played an important role in health care. Recent changes, however, are actively altering the practice of medicine and are posed to have a deep and lasting psychiatric impact on patients. Learn more here. The government has always played an important role in health care: it has established agencies to ensure drug safety, created Medicare and Medicaid to improve access, etc. Recent changes, however, are actively altering the practice of medicine and are posed to have a deep and lasting psychiatric impact on patients. Although this is a rapidly evolving situation, here is a closer look at the facts as this issue went to press. Cuts to Top Health Agencies In early 2025, the US Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA), Veterans Administration (VA), and other organizations experienced huge slashes to their budgets and staff.1 Additionally, on January 20, President Donald J. Trump issued an executive order freezing government hiring.2 Elon Musk, formerly a leader of the Department of Government Efficiency (DOGE), was directed to “dismantle government bureaucracy, slash excess regulations, cut wasteful expenditures, and restructure federal agencies.”3,4 The sudden cuts, as well as terms like wasteful, have startled experts like Robin Weiss, MD, a past president of The Maryland Psychiatric Society and psychiatrist who has worked for the National Academy of Sciences, a federal advisory panel, and in private practice. “It’s exhausting and demoralizing to find that every day, the institutions one holds dear are not just being defunded but also slandered,” Weiss told Psychiatric Times. “I am 75 years old, and I worked for the National Academy of Sciences in the 1980s during the early years of the HIV/AIDS epidemic. There was plenty of warranted controversy about our country’s response, but I also got to know many public servants during those years. So many people who choose to devote themselves to public service have amazing expertise, and they often forfeit the opportunity to earn more in the private sector in exchange for meaning. They care about us—the public—and they have devoted their careers to serving us, so to watch them be treated shabbily, and their expertise dismissed, is heart-wrenching.” With much discussion on both sides, what are the actual numbers? FDA Budget: The “FDA’s budget request reflects the Agency’s support of the Make America Healthy Again (MAHA) agenda in key areas of importance for human and animal health… [which includes] $234. million... to address the nation’s chronic disease epidemic, restore trust in our food system, and strengthen America’s nutritional and food safety.” Official documentation lists a $6.8 billion budget for 2026, which represents a decrease of about $270 million compared with the FY 2025. This includes a 4% increase in user fees, now sitting at $137.3 million. Layoffs: The FDA lost 3500 full-time staffers to layoffs, including Brian King, PhD, MPH, the chief tobacco regulator, and his fellow deputies, along with Peter Marks, MD, PhD, who led the development of the COVID-19 vaccine. Even more resigned after being offered reassignment in distant US locations. Impact: The expansive staffing cuts are expected to slow public notices about recalls and product safety issues, as 130 members of the communications team were part of the layoffs. Additionally, thus far, notices that have been released contain more mistakes and less plain language, which experts fear could lead to delays in the delivery of critical information. CDC Budget: The CDC experienced significant cuts to its budget, including the rescinding of $11.4 billion in grant funding to state and local health departments, largely related to COVID-19. Layoffs: Approximately 2400 staffers from various departments and programs were laid off. Layoffs fell predominantly in areas involving deaths and injuries, apart from infectious diseases, such as programs focused on the prevention of asthma, smoking, gun violence, climate change, and more, many of which impact patients with mental illness. Also cut were the Freedom of Information Act team, the Division of Violence Prevention, and laboratory teams testing antibiotic resistance. Additionally, the research center focused on protecting worker health was almost entirely eliminated. Lastly, at least 9 high-level directors were placed on administrative leave and offered reassignment to another US Department of Health and Human Services (HHS) agency. Impact: The administration has shared that the CDC will now “focus on returning to its core mission of preparing for and responding to epidemics and outbreaks.”1 However, workforce reduction has key opinion leaders concerned that the remaining “skeleton staff” may be “capable only of performative gestures toward the work mandated by law and congressional budgets.” David Fleming, MD, who chairs the advisory committee to the CDC director and previously served as acting CDC director in 2002, expressed his concern in a recent JAMA report: “It is resulting in a federal agency that is not going to be able to function effectively." Weiss echoed this concern, sharing with Psychiatric Times that those who remain employed may be feeling traumatized by the loss of their peers. “I see a patient whose funding comes from the CDC. Some of it is now tied up in the lawsuit that the states brought against the federal government, so for right now, it isn’t cut. But there is worry that their core funding from the CDC will be cut completely in the 2026 budget. This patient coined a tragically apt term in our session: Pre-TSD, or pretraumatic stress disorder. They go to work every day and wait for the other shoe to drop. So many state and federal workers are in similar positions. It’s like a mass trauma.” Furthermore, this may impact disease prevention worldwide. The CDC maintains a repository of data for research references, and laboratories globally submit biological samples and data for historical filing; now, there are very few staff left—if any at all—to receive such information, damaging critical research infrastructure. NIH Budget: The administration has canceled hundreds of NIH grants. Furthermore, a draft of the budget for the HHS proposes a $20-billion cut for the NIH in 2026, which equates to an approximate 40% reduction. According to a recently released Senate Committee on Health, Education, Labor, and Pensions minority staff report, $2.7 billion in NIH funding for research has also been cut. Additionally, the number of new research grants hit its lowest point in more than a decade. Layoffs: The NIH lost more than 1000 employees in an initial round of firing, followed by at least 1200 jobs in April. Other dismissals included scientists involved in research on the brain, computer specialists, and nearly the entire communications staff. At least 5 directors of the NIH’s 27 institutes and centers were put on administrative leave or removed, including Eliseo J. Pérez-Stable, MD, from the National Institute on Minority Health and Health Disparities; Diana Bianchi, MD, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; Shannon Zenk, PhD, MPH, RN, FAAN, from the National Institute of Nursing Research; Vence Bonham, Jr, JD, the acting deputy director of the National Human Genome Research Institute; and Jeanne Marrazzo, MD, MPH, from the National Institute of Allergy and Infectious Diseases. Impact: Approximately $68.8 million in NIH grants related to mental and behavioral health were terminated. Because of canceled grants and loss of funding, many research labs have come to a halt, including in key research areas like Alzheimer disease. One researcher, who previously received a grant of approximately $6 million from the NIH to research the underlying mechanisms of neurodegenerative diseases, claimed, “It is not an exaggeration to say that the true cost of the NIH’s decision may be that thousands of American lives are needlessly degraded or sacrificed.” SAMHSA Budget: Approximately $1 billion in appropriated SAMHSA funds slated to help reduce the overdose crisis have been rescinded. Additionally, state and county public health departments are facing abrupt cancellations and revocations of approximately $11.4 billion in COVID-19–era funding for grants connected to addiction and mental health. Layoffs: Under the restructuring of the HHS, SAMHSA will become a part of the new Administration for a Healthy America (AHA). This restructuring announcement followed the reduction of the HHS by 20,000 employees. SAMHSA began the year with approximately 900 employees, but up to 50% of them may be part of the cuts. In a recent statement, an HHS official said, “The reorganization of SAMHSA into AHA is part of ongoing efforts to improve the efficiency and effectiveness of public health programs. By consolidating SAMHSA’s operations under AHA, we aim to streamline resources and eliminate redundancies, ensuring that essential mental health and substance use disorder services are delivered more effectively. This restructuring will enhance the ability to address public health needs by fostering a more coordinated approach to prevention, treatment, and recovery services.” Impact: SAMHSA has made profound recent improvements in addressing the mental health, substance use, and suicide crises in America. The 988 Suicide & Crisis Lifeline has helped more than 16.5 million individuals since its launch in 2022. In the past year, overdose deaths have decreased by 24%. Leaders of psychiatric organizations are deeply concerned by these new cuts and how they may undo this progress. “I am most concerned about federal cuts to agencies like SAMHSA that provide vital funding for community mental health programs, crisis services, and workforce development. These aren’t abstract line items—they’re the foundation of care for patients with serious mental illness, particularly in underresourced areas. Disrupting these supports at a time when our mental health system is already strained will deepen disparities and increase suffering. I also believe that health care funding cuts, in groups under so much strain, will also impact health care professionals who care for them and increase the moral injury they experience in the field,” Jhilam Biswas, MD, FAPA, told Psychiatric Times. Biswas is director of the Psychiatry, Law, and Society Program at Brigham and Women’s Hospital and president of the Massachusetts Psychiatric Society (MPS). VA Budget: The VA maintains a vast network of contracts that equate to $67 billion annually. In February, DOGE instructed the VA to cancel approximately 875 contracts; this number was later reduced to 585 “non–mission critical or duplicative” contracts worth $1.8 billion. Layoffs: At least 2400 VA probationary employees have already been laid off. Many of those eliminated were veterans; some could be reinstated following pending court actions. However, the administration has shared plans to eliminate 80,000 more jobs and review thousands more contracts. Impact: A decrease in staff could equal a decrease in services, with longer wait periods, fewer appointment options, and fewer services for veterans. Studies involving veteran participants and experimental treatments have been disrupted; approximately 200 research staff members involved in 300 or more trials were affected by the changes, affecting treatment for nearly 10,000 veterans. “What I think is most important for mental health clinicians outside of the VA to know is that their fellow mental health practitioners and their leaders in VA mental health are demonstrating enormous courage and integrity in fulfilling their commitment to high standards of care for veterans despite facing unprecedented challenges,” an anonymous source shared with Psychiatric Times. Terminology Under Scrutiny Although there is no official documentation, agencies and news sources have reported and compiled a list of more than 350 words that have been flagged per directives and guidance issued by the federal government (Table). These words have been eliminated from government websites and documents, and their mention can result in the cancellation of research grants or other agreements. However, the list continues to grow, and it is unclear which words are outright banned vs which should be avoided, as the directives are vague and inconsistent across agencies. “The assault on our science and on our terminology is a fundamental assault on our knowledge and our profession. We are nothing if we cannot explore all that our science and our values point us to. I would point to an example from the Reagan administration. It ruled that the word social be stricken from all federal grants and set American psychiatry back for almost 40 years. The current list of banned words and related concepts is much more extensive, and the costs in terms of progress will be substantial,” Kenneth Thompson, MD, a public service psychiatrist, told Psychiatric Times. Researchers are scouring existing grants using lists of flagged words and self-censoring future work in the hopes of improving grant likelihood. Others are moving toward safer topics to ensure they can finish their advanced degrees and move into academia. Some may leave academia altogether. “The cuts to research funding will have devastating impacts and will undoubtedly stall career pathways for many promising early-career scientists,” said Steve Koh, MD, MPH, MBA, DFAPA, chief of the General Psychiatry Division and director of the Community Psychiatry Program at the University of California, San Diego. “Restricting the language clinicians and researchers can use—whether implicitly or explicitly—has far-reaching consequences. If we cannot name the realities of public health, trauma, inequity, or systemic risk, we risk creating blind spots in care and innovation. We must not allow fear or politics to erode scientific inquiry or silence clinical truth,” Biswas said. H. Steven Moffic, MD, an award-winning psychiatrist, longtime activist, and Psychiatric Times columnist, believes these banned words are an attack on the very core of the field. “Psychiatry, at its essence, is based on word interchanges. Starting way back with Sigmund Freud, patients need to feel comfortable in expressing anything, while we have to say the right things at the right time to help patients through very uncomfortable problems that they would rather repress. All of us in mental health care and our connected organizations have to do some soul-searching about how we will react to banned words and books. This list reminds me of the book 1984. One strategy I would not recommend is just ignoring the whole matter,” Moffic said. By limiting the ways in which research can be communicated, scientific integrity is threatened, and the evidence base that informs public health policy becomes skewed. This ultimately harms minoritized populations. “Banning specific words in clinical research and health care will not erase the realities and needs of the individuals those words represent. These bans only create obstacles to studying the very populations they aim to obscure, which further emphasizes the underlying political motives behind them. Given how long the list of words is, there comes a point in time when one must ask: Which words aren’t banned? Ironically, banning words that represent minority experiences actually hurts everyone. Neglecting the distinct influences of race, gender, ethnicity, sexual orientation, and/or gender identity in research obscures vital insights that could improve health care outcomes for all,” said Scott Leibowitz, MD, a child and adolescent psychiatrist who worked in 3 academic pediatric gender clinics and is a board member at-large for the World Professional Association for Transgender Health. Many clinicians are expressing particular fear for LGBTQ+ individuals, specifically transgender individuals, who seem to bear the brunt of research censorship initiatives. “Recent actions by the federal government have completely decimated research that aims to improve the health of LGBT people. We are likely to lose an entire generation of researchers who had dedicated their careers to supporting this population, which experiences dramatic mental health disparities,” said Jack Turban, MD, a pediatric psychiatrist, author of the book Free to Be: Understanding Kids & Gender Identity, and Psychiatric Times advisory board member. “Perhaps even more insidious is that recent anti-LGBT laws and other government actions are likely worsening the health of these populations, but we will not be able to study or document these impacts to protect future generations. LGBT people already suffer from dramatic disparities in terms of both mental and physical health. These will undoubtedly worsen as we lose our ability to study and support the health of this population.” This panic has trickled down to patients and their caregivers as well, as shared by Weiss. “I have patients who are fearful: one with a transgender kid who worries that the country’s mood is turning against her child; a lesbian in a gay marriage who fears that, in an economic downturn, things could get ugly for them; others who feel defeated because there’s hate in the air.” A White House spokesman claims that this compiled list is an error and that the only words that do need to be prohibited revolve around “gender ideology”: gender, inclusion, identity, diversity, inter, intersex, equity, equitable, transgender, and trans. However, the list of banned words circulating at the National Science Foundation includes several other words that raise red flags, such as women, disability, bias, status, trauma, Black, Hispanic, socioeconomic, and ethnicity. “Many researchers in this area will try to find research funding from nongovernment sources, but there simply are not enough private foundations to compensate for this massive loss of research funding,” Turban told Psychiatric Times. Concluding Thoughts In the wake of change and uncertainty, mental health clinicians are banding together and relying on community to help navigate the new reality. “At MPS, we are actively listening to our members across the state to understand how these policy shifts are affecting their work on the ground. Our strategy is to advocate clearly and collaboratively—with legislators, community stakeholders, and other medical organizations—to protect research integrity and patient-centered care. Clinicians and researchers should know they are not alone. We must stay informed, speak up, and support our professional voice and solidarity through these uncertain times,” Biswas said. Psychiatric clinicians believe a united front is the best way to communicate the importance of mental health care for all. “It is of paramount importance to ensure that we maintain scientific integrity and keep patients at the heart of all the research work that we do. Regardless of changes from the federal government, our commitment to our patients will remain our top priority. We will continue to value and treat all patients with equal regard and respect. Some words may change but our research initiatives to seek the truth and to improve patients’ lives will not change. We encourage our colleagues to focus on our truth north of continuing to advance our knowledge and improvements to care for our patients,” Koh said. “The attacks on the funding and the direction of federal health and mental health policy will injure all populations who depend on federal policy and federal resources. All marginalized communities will feel the brunt, including communities of color and sexual minorities. Psychiatry must respond by unfalteringly continuing to build a diverse workforce that reflects the people of the nation. It must advocate for communities in need, and it must oppose the inhumane, antihuman rights initiatives of this regime,” Thompson said. “We have a hard fight before us. The questions will be: What side did psychiatry take in the struggle—for democracy or against it? For human rights or against them? For a humane, caring society or against it?” Note: This article originally appeared on Psychiatric Times .

ADHD (Attention-Deficit/Hyperactivity Disorder) and Autism Spectrum Disorder (ASD) frequently co-occur (often referred to as AuDHD), with 50-70% of autistic people also having ADHD. While they are distinct neurodevelopmental conditions, they share significant overlaps in traits and often appear together, creating unique strengths and challenges. Advantages of Having ADHD and/or Autism (AuDHD) When occurring together (AuDHD), the combination can create a unique balance between the craving for novelty (ADHD) and the need for structure (Autism). Hyperfocus and Deep Expertise: The ability to intensely focus on specific areas of interest (Autism) combined with high energy (ADHD) can lead to remarkable achievements, deep knowledge, and expertise in chosen fields. Innovative Problem-Solving: AuDHDers often excel at combining rapid, expansive, divergent thinking (ADHD) with a meticulous, detail-oriented approach to patterns (Autism). Creativity and Originality: Both conditions are associated with "outside-the-box" thinking, high energy, and passion. Resilience and Adaptability: Navigating a world not designed for their brains often fosters deep compassion, tenacity, and the ability to find new pathways where others see obstacles. Unique Social Perspective: While social challenges exist, many have a high capacity for sincerity, honesty, and intense, loyal relationships. Do People with ADHD Have Autistic Traits (and Vice Versa)? Yes. There is a high degree of overlap in traits, even if a person does not meet the full diagnostic criteria for both. Shared Traits: Both frequently experience executive dysfunction (planning/organization issues), sensory processing differences, emotional dysregulation, and intense, specialized interests. Autism in ADHD: A study found 30-65% of children with ADHD have significant autistic traits. ADHD in Autism: Estimates suggest 50-70% of autistic people also have ADHD. Key Differences: ADHD typically involves a search for novelty and impulsivity, whereas autism often involves a preference for routine, sameness, and predictable environments. Are People with ADHD (or Autism) Savants? No. While savant syndrome (extraordinary, exceptional abilities in specific areas) is sometimes associated with autism, it is not a defining characteristic of autism, nor is it a feature of ADHD . Autistic Savants: A small minority of individuals on the autism spectrum (sometimes with accompanying intellectual disability) exhibit profound, specialized abilities (savant syndrome). ADHD/Autism Strengths: More commonly, people with ADHD and/or Autism experience "hyperfocus," which is an intense, deep, and sustained interest that allows for high productivity in specific areas, but this is distinct from the, often innate, "savant” syndrome. Someone with both ADHD and Autism is often colloquially referred to as having AuDHD. While "hunter" (ADHD) and "specialist" (Autism) are metaphorical frameworks, the reality of having both is a complex interplay of conflicting needs and biological overlaps. What is Someone With Both Called? AuDHD: This is the most common non-clinical term used by the neurodivergent community. Dual Diagnosis: Clinically, until 2013, doctors were not allowed to diagnose both simultaneously; however, modern standards recognize that 50–70% of autistic people also meet the criteria for ADHD. Do You "Act More Autistic"? Living with AuDHD often feels like an "internal tug-of-war" because the two conditions frequently have opposing needs: Competing Needs: The autistic side may crave strict routine and predictability, while the ADHD side may become quickly bored by it and crave novelty. Masking and Visibility: Often, ADHD symptoms (like talkativeness or impulsivity) can "mask" autistic traits (like social withdrawal). If the ADHD is treated with medication, the person may feel "more autistic" as the underlying need for sensory regulation and routine becomes more apparent. Amplification: Shared traits like hyperfocus and sensory sensitivity are often amplified, leading to more intense "deep dives" into interests or faster sensory burnout. Biological Overlap vs. Chemical Differences The overlap exists in the architecture (the genes and pathways), while the differences are in the regulation (how chemicals like oxytocin and dopamine are used). Genetic Overlap (The Blueprint): Research shows a 50–72% overlap in the genetic factors contributing to both conditions. They share "truncating mutations" that affect the same sets of genes involved in brain development and synaptic connectivity. Brain Structure (The Wiring): Both show altered connectivity in the prefrontal cortex and striatum, which manage executive functions like planning and emotional regulation. Chemical Differences (The Fuel) Oxytocin: Autistic children often show significantly lower blood oxytocin levels, which are linked to social communication difficulties. In contrast, some studies show children with ADHD also have lower oxytocin than neurotypical peers, but for different reasons—possibly related to stress regulation or comorbid conduct issues. Dopamine: ADHD is primarily linked to dopamine dysregulation (seeking reward and stimulation), whereas in autism, dopamine differences are more tied to social motivation and repetitive behaviors. Interactions: Oxytocin and dopamine interact; for instance, oxytocin can influence how much dopamine is released in response to social interaction. In AuDHD, these systems may conflict, where the person is driven to seek new social stimuli (dopamine/ADHD) but lacks the chemical "reward" or social ease typically mediated by oxytocin (Autism).

In evolutionary terms, neurodivergence is often viewed not as a collection of "errors," but as adaptive variations that ensured the survival of early human groups through cognitive specialization. Evolutionary Origins and Roles Evolutionary theories suggest these conditions persist because they offered specific benefits to the collective "cognitive ecology" of a tribe or clan. ADHD (The "Hunter" Role): Traits like hyperactivity and rapid attentional shifts were advantageous for nomadic societies. Individuals with ADHD could act as "scanners," quickly detecting predators or spotting new food sources while others were focused on specific tasks. Autism (The "Systemizer" Role): Traits like intense focus and pattern recognition were crucial for precision tasks. Autistic individuals likely excelled at tracking animals, recognizing seasonal botanical patterns, and pioneering technical tools or agricultural innovations. Intellectual Disability (ID) and Developmental Delay: While not always linked to a specific "task" role, these conditions played a vital role in social evolution. Caring for vulnerable members boosted early humans' social and emotional intelligence, fostering the high levels of group cooperation and empathy that define our species. Other Conditions with Evolutionary Roles Bipolar Disorder: The intense energy and creativity associated with this condition are thought to have driven social and artistic innovations, helping groups bond and develop shared cultural identities. Schizophrenia-linked traits: Some researchers suggest that individuals with altered perceptions may have filled roles as spiritual or cultural leaders, offering unique insights that pushed the boundaries of early philosophical and religious thought. Condition Evolutionary/Modern Advantages Disadvantages (Often "Mismatch") ADHD High energy, risk-taking, creativity, quick decision-making, and "outside-the-box" problem-solving. Difficulty with modern structured environments (like school or office work) that require sitting still and sustained focus. Autism Exceptional attention to detail, strong long-term memory, pattern recognition, and specialized technical skills. Significant challenges in social navigation, sensory processing issues, and difficulty with sudden changes in routine. The modern perspective increasingly views the "disability" aspect of these conditions as an evolutionary mismatch where traits that were once survival assets become pathologized in modern environments not designed for them. The Role of Oxytocin and Dopamine Oxytocin & Autism: While sometimes called the "love hormone," oxytocin's role is complex. Research indicates that many children with autism have lower peripheral oxytocin levels, which may contribute to difficulties in social "wanting" or bonding. This biological difference can make social interaction feel less rewarding, leading to the perception of being "more" neurodivergent compared to societal norms. Dopamine & ADHD: ADHD is strongly linked to dysregulation in the dopamine-based reward system. This often leads to "dopamine seeking," where individuals pursue immediate stimulation. While ADHD may seem more "normalized" due to its prevalence, poor parenting or lack of support can exacerbate these traits, leading to higher risks of behavioral issues or substance misuse. Autism and Addiction Yes, individuals with autism struggle with addiction, often in ways that differ from those with ADHD: Self-Medication: Many autistic individuals use substances to cope with social anxiety, sensory overload, or the exhaustion of "masking". Increased Risk: Research, including a major Swedish study, found that autistic individuals with average or above-average intelligence are more than twice as likely to develop addiction compared to the general population. Sensory Seeking: High levels of "sensory seeking" are specifically associated with hazardous drinking behaviors in autistic adults. Co-occurrence: If an individual has both autism and ADHD (AuDHD), the risk of substance use disorders is significantly higher than having either condition alone.

In 2026, the misdiagnosis of Complex Post-Traumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD) as Bipolar Disorder remains a significant issue in adult psychiatry. This frequently occurs due to overlapping symptoms, institutional barriers, and a lack of trauma-informed training among medical professionals. Why Misdiagnosis Occurs Symptom Overlap: Symptoms of hyperarousal in CPTSD—such as irritability, racing thoughts, and insomnia—closely mimic the hypomania seen in Bipolar II. Similarly, the rapid emotional shifts in BPD can be mistaken for the mood cycles of bipolar disorder, though BPD shifts typically occur much faster (minutes/hours vs. days/weeks). Diagnostic Classification (DSM-5): In the United States, the DSM-5 does not officially recognize CPTSD as a distinct diagnosis. Because psychiatrists often need a DSM code for insurance reimbursement, they may select Bipolar Disorder as a "best fit" even when trauma is the primary driver. Lack of Trauma Training: Many psychiatrists focus on symptom management through medication rather than developmental history. Some are reluctant to discuss trauma, fearing it might "re-traumatize" the patient or because they lack the specific skills to manage the intense emotions that follow such disclosures. The Impact on Patients Inappropriate Treatment: People misdiagnosed with Bipolar Disorder are often prescribed mood stabilizers or antipsychotics that do not address underlying trauma. Conversely, antidepressants (often used for PTSD) can actually worsen symptoms if the person truly has Bipolar Disorder, leading to a dangerous cycle of trial-and-error. Stigma and Self-Blame: Misdiagnosis can leave survivors feeling alienated or as though their condition is "inherent" rather than a response to what happened to them. Worsening Outcomes: Studies show that when comorbid trauma is unrecognized, individuals experience more frequent hospitalizations, higher rates of suicide attempts, and a lower overall quality of life. Another major distinction is between identity and self-concept. People who have CPTSD frequently experience chronic shame, emotional dysregulation, and a fragmented sense of self as a result of long-term trauma. Their emotional responses may appear overpowering, yet they are generally reasonable when examined through the prism of previous experiences. In Bipolar Disorder , however, a person's sense of self is typically more stable between episodes, with significant changes occurring only during mood episodes. Seeking Accurate Care If you suspect a misdiagnosis, consider these resources: Trauma-Informed Professionals: Look for clinicians trained in Eye Movement Desensitization and Reprocessing (EMDR) or Dialectical Behavior Therapy (DBT) . International Standards: Refer to the World Health Organization's ICD-11, which officially recognizes CPTSD. Patient Advocacy: Organizations like the CPTSD Foundation provide education on navigating these diagnostic challenges. Understanding these distinctions is critical, as misidentifying trauma responses as bipolar mood swings can result in ineffective treatment and missed opportunities for trauma-focused therapy. While both disorders are serious and treatable, a precise diagnosis enables interventions that target the underlying cause, whether it is mood stability in Bipolar Disorder or nervous system control and trauma processing in CPTSD .

Dissociative Identity Disorder (DID) typically develops as an extreme survival mechanism in early childhood . In the case described, the "bold guardian" and "weak depressed" parts likely formed due to severe developmental pressure in a high-stakes, punitive environment. Why DID Developed This Way The "Guardian" Part: Often called Protectors or Caretakers, these identities emerge to handle situations the child (the "host") cannot endure. In a hyper-religious, punitive household, a child may need a "perfect" or "bold" persona to avoid punishment or a "guardian" to provide the protection they are not receiving from their parents. The "Weak" Part: The primary identity (host) often carries the weight of the depression and helplessness. This part is frequently passive and dependent, while the trauma and anger are sequestered into other identities to allow the person to continue functioning and being "accomplished" in daily life. Hyper-religious Upbringing: Authoritarian and rigid parenting styles are significant risk factors for DID. The extreme pressure to meet impossible standards can lead a child to "split" off parts of themselves that don't fit the religious mold, such as their own anger or "sinful" thoughts. Why the Parenting is "Lax" During Treatment Dysfunctional Dynamics: Parents in these families often struggle with their own emotional regulation or may have been the original sources of trauma. Denial and Deflection: They may act "lax" because they are dissociating from their own past behavior or feel burdened by the patient's current needs. Some families view the symptoms as "attention-seeking" rather than a legitimate crisis, leading to a lack of urgency even when the patient engages in dangerous behaviors like driving across states against medical advice. History of the Concept First Documented Case: The first detailed case matching modern DID symptoms was Jeanne Fery in 1584, though it was framed as demonic possession at the time. First Official Diagnosis: Louis Auguste Vivet was the first person officially diagnosed with "multiple personality" (then called double personality) in 1882. Pioneering Theorists: Pierre Janet and Morton Prince are credited with evolving the concept in the late 19th and early 20th centuries. Sándor Ferenczi was one of the first to explicitly link the "splitting" of personality to childhood abuse in 1932. Dissociative Identity Disorder (DID) is a complex condition that typically develops as a survival mechanism in response to overwhelming early childhood trauma . Development and Causes DID occurs when a child's personality fails to integrate into a single, cohesive identity due to severe stress. Trauma Survival: Children under the age of 6-9 often use "magical thinking" or imagination to cope with inescapable pain. By dissociating (mentally checking out), they distance themselves from the trauma, essentially creating a "not me" experience that eventually fragments into distinct identity states (alters). Disrupted Integration: Normally, a child’s various "self-states" (e.g., "hungry me," "playing me") merge over time. Chronic trauma prevents this natural fusion, leaving the states separate. Prevalence General Population: Recent data from 2026 continues to estimate DID affects approximately 1% to 1.5% of the general population. This is similar to the prevalence of schizophrenia. Clinical Settings: Prevalence is higher in psychiatric settings, ranging from 2% to 6% in outpatients and up to 5% to 20% in psychiatric inpatients. Risk Factors Primary Factor: Repeated, severe physical, sexual, or emotional abuse in early childhood (usually before age 6). Approximately 90% of people with DID in North America and Europe report such histories. Caregiver Issues: Neglect or "disorganized attachment," where a caregiver is both a source of fear and a source of comfort. Environmental/Biological: Exposure to war, natural disasters, or repeated early medical trauma. Some evidence suggests an innate, genetic capacity for high "hypnotizability" or dissociation. Why People "Fake" DID Cases where DID is simulated (malingering) or inauthentically presented (factitious disorder) are rare but documented for several reasons: Personal Gain: Seeking disability benefits, avoiding legal responsibility for crimes, or escaping military/work duties. Identity and Connection: Adolescents or people with a poorly developed sense of self may adopt the label to feel "unique," gain attention, or find a sense of belonging in online communities. Maladaptive Coping: Some individuals with other conditions (like Borderline Personality Disorder) may claim DID to avoid taking ownership of harmful actions, attributing them to an "alter". Misdiagnosis/Denial: Occasionally, a person with genuine DID might claim they were "faking" due to internal denial or a protective alter trying to hide the disorder from others. Distinguishing DID from "Different Personalities" (Identity Changes). While most people have different "sides" to their personality (e.g., how you act at work vs. with friends), DID is defined by dissociation, which involves: Amnesia: Unlike normal identity shifts, DID requires significant gaps in memory for everyday events or personal information that cannot be explained by ordinary forgetfulness. Lack of Agency: In DID, the individual often feels they have no control over their behavior or that a voice is "taking over" their head. Functional Fragmentation: Alters in DID have distinct ways of perceiving and relating to the world that are often entirely disconnected from one another.

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 was enacted to close a specific legal loophole that allowed "rogue" online pharmacies to dispense controlled substances without a physical medical exam. While the broader opioid epidemic involved complex issues with manufacturers like Purdue Pharma and in-person medical practices, the Ryan Haight Act targeted a new, unregulated frontier: the internet. Why Ryan Haight Was "Special" Ryan Haight was an 18-year-old high school honors student from California who died in 2001 from an overdose of Vicodin. The Circumstance: He purchased the drugs from a "rogue" online pharmacy after a simple online consultation with a doctor he never met in person. The Legislative Impact: His death became a rallying point for families and lawmakers because it exposed how easily children and addicts could bypass traditional medical safeguards using the internet. The Core Requirement: The Act mandated that at least one in-person medical evaluation occur before a practitioner could prescribe controlled substances via the internet. Extensions and Current Status (2026) While the law has been on the books since 2008, the requirement for an in-person exam was temporarily suspended during the COVID-19 pandemic to ensure continued access to care. Current Extension: As of January 2026, the DEA and HHS have extended these "telemedicine flexibilities" through December 31, 2026. Reason for Extensions: The extension aims to avoid a "telemedicine cliff"—a sudden loss of access to medication for millions of patients (including those with mental health or substance use disorders) who started treatment via telehealth and haven't yet seen their provider in person. Permanent Rulemaking: Regulators are currently using this extra time to finalize permanent rules that balance patient access with safeguards against drug diversion. Ongoing Challenges Despite the Act, issues with "wrongly prescribing" stimulants and opioids persist because: In-Person Exemption: The Ryan Haight Act only regulates online prescribing. It does not change the laws governing traditional, in-person medical practices where many over-prescribing issues began. Telehealth Growth: The rapid expansion of telemedicine platforms has created new challenges for the DEA in monitoring prescribing patterns for medications like stimulants (used for ADHD) and opioids. Regulatory Complexity: Federal laws must compete with varying state laws, and the DEA is still reviewing thousands of public comments to find a balance between preventing abuse and ensuring legitimate patients can get help.

While exact global counts of psychiatrists specializing in psychodynamic psychotherapy for 2026 are not available, specific trends highlight a growing shortage of these specialists despite their high efficacy in treating complex mental disorders. Specialist Availability and Efficacy Provider Landscape: Approximately 25% of psychotherapists currently utilize psychodynamic methods. Workforce Trends: As of 2026, the United States faces a significant shortage, with the total psychiatry workforce (roughly 40,000) projected to decrease further by 2030. Child Psychiatry Shortage: There are only about 8,500 child and adolescent psychiatrists practicing in the U.S., significantly below the projected need of over 12,000 required to maintain adequate service levels. Clinical Efficacy: Psychodynamic psychotherapy is statistically superior to standard care for complex mental disorders, showing significant improvements in personality and social functioning. Systemic Barriers and Misdiagnosis Diagnostic "Shotgunning": Coordination between primary care and behavioral health remains weak in 2026, leading to fragmented care and "gaps in follow-up" that can result in misdiagnosis or inadequate treatment. Financial Drivers: Current 2026 payment models, such as Medicare’s updated prospective payment rates for inpatient psychiatric facilities, often prioritize cost-efficiency over long-term outcomes. This focus on short-term "financial incentives" can improve initial treatment attendance but has shown little evidence for improving long-term patient health. Societal Consequences of Untreated Mental Illness Failure to provide accessible, high-quality psychodynamic care contributes to a downward societal drift: Crime and Incarceration: Losing access to mental health services is a primary driver in increased criminal involvement; studies indicate that robust access to these services directly reduces local crime rates. Substance Abuse: Approximately 50% of individuals with severe mental disorders are affected by substance abuse. In 2026, emerging threats like fentanyl and xylazine are further complicating treatment due to these co-occurring disorders. Systemic Downward Drift: Decades of underinvestment in social safety nets have exacerbated addiction, homelessness, and poverty. This cycle is often reinforced by "stigmatizing views" from professionals, which can discourage patients from seeking care. Are Psychiatrist not Real Doctors? As of 2026, psychiatry remains a marginalized field within the medical community due to historical, diagnostic, and systemic factors. While medical professionals frequently refer patients to other specialists, they often hesitate to refer to psychiatrists or treat mental health conditions themselves despite the associated risks . Reasons for the "Superiority Complex" and Stigma Perceived Lack of Scientific Rigor: Many physicians view psychiatry as less algorithmic and scientific than other specialties because it lacks physical diagnostic tools like MRIs or blood tests for most conditions. This leads to the misconception that it is "pseudoscience". "Lesser Physician" Label: Historically, psychiatry has been viewed as a specialty for medical students who were less capable of practicing "real" medicine, a stigma that persists in medical school training environments. Diagnostic Subjectivity: Other fields often criticize psychiatry for the subjectivity of its diagnostic process (e.g., DSM-5), which can lead to widely varying interpretations of the same patient symptoms. Why Non-Psychiatrists Attempt Mental Health Treatment Despite looking down on the field, many pediatricians and family practitioners manage mental health conditions themselves due to: Systemic Access Barriers: There is a severe national shortage of psychiatrists, especially for children, making referrals difficult to obtain. Overconfidence in Simpler Cases: Physicians with high self-reported knowledge or confidence in treating conditions like depression are statistically less likely to refer patients to specialists. Patient Preference and Stigma: Many patients or parents refuse to see a psychiatrist because they fear the social stigma of being "labeled" or "institutionalized," pressuring general practitioners to handle the care. Liability and Worsening Outcomes Misdiagnosis and "Diagnostic Overshadowing": General practitioners may wrongly attribute a patient's physical symptoms to a known mental illness, a phenomenon called "diagnostic overshadowing" that leads to substandard care and missed physical diagnoses. Major Liability Risks: The primary cause of malpractice suits in psychiatry is patient suicide. When non-specialists attempt to treat complex mental health cases without proper psychiatric oversight, they face significant liability risks if the patient's condition deteriorates. Other Fields with High Stigma or Misdiagnosis General Medicine: Faces the highest volume of misdiagnosis, with approximately 12 million victims annually. Vascular and Infectious Diseases: Conditions like stroke, sepsis, and pneumonia are the most frequently misdiagnosed in 2026, often due to vague initial symptoms. Obstetrics: High rates of medical negligence related to birth injuries.

Key points The Diagnostic and Statistical Manual (DSM) is an official list and definition of psychiatric disorders. A new version of the DSM is now being planned with the potential for substantial changes. Questions remain about whether the DSM can better reflect current science and remain practical for clinicians. Every decade or so, the official definitions of mental health diagnoses like bipolar disorder , schizophrenia, and ADHD, change, and that time is coming around once again. The mechanism through which these modifications happen is through a book, published by the American Psychiatric Association, called the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM. This book is often described erroneously as psychiatry’s “bible,” although “dictionary” would be a much more accurate comparison. The DSM provides the official list of psychiatric conditions and the specific criteria that must be met for someone to qualify for each diagnosis. We are now in the 5th edition of the DSM, which came out in 2013 and was gently revised a few years ago. What the DSM says has real consequences. Medical students, psychiatric trainees, and students of other mental health professionals are taught and tested on these disorders. Insurance companies also use it, and another system known as The International Classification of Diseases, in deciding what they will pay for. Pharmaceutical companies need to match their medications to specific DSM diagnoses. At the same time, the DSM has many limitations (many of which are acknowledged in the book) and has been a punching bag for the many critics of psychiatry who make fun of the ever-expanding number of diagnoses, the reliance on subjective history rather than more concrete evidence like lab tests or brain scans in making diagnoses, and some of its past mistakes that in today’s world look rather foolish like when being gay was considered a mental illness. Even daily consumers of the DSM harbor a lot of skepticism about it. As a psychiatrist in training, I was expected to learn it but also to take its content with the proverbial “grain of salt.” The more experience we gain, the more we understand how frequently the people who come to us for assessment and treatment don’t fit into these tidy boxes that the DSM creates. The diagnostic definitions are created by committees of experts. These experts rely on research and field trials as much as possible, but no one denies the degree to which politics, interpersonal dynamics, and tradition figure into the equation as well. Recently, a series of articles were published in the American Journal of Psychiatry , announcing some more substantive changes that will be considered as folks deliberate on the next DSM edition. These include the following: Changing the name from Diagnostic Statistical Manual to Diagnostic Scientific Manual. Having the DSM be more of a “living document” that exists primarily online and can be more easily modified. Getting input from a broader group of individuals, including those with lived experience. Including more about potential causes or evidence-based biomarkers in diagnostic formulations. Allowing for less-precise diagnoses in situations in which a more specific diagnosis is difficult (like in an emergency department). Having diagnoses be more context-dependent with regard to life experience, socioeconomic status, and a person’s individual view of their challenges. Giving greater weight to an individual’s quality of life and level of functioning when determining whether they meet criteria for a specific disorder. In some ways, some of this feels like the classic “going backward to go forward” scenario. Earlier editions of the DSM did provide more definition with regard to assessment of functioning and really old DSM editions included more about causes. However, other areas do seem to represent a true advance. It will be interesting to see how far the new DSM takes its hope to include more objective information, like lab tests, genetic markers, or neuroimaging data, into its framework. While the idea makes perfect sense theoretically and many of us have longed for this, we need to be careful about rolling this out prematurely. There are already products on the market that claim to help guide medication response by looking at specific genes. There’s also a well-known clinic chain that claims to be able to make more accurate diagnoses and treatment recommendations based on getting a specific brain scan. The evidence for some of these claims are pretty sketchy and often overhyped. I’m confident we’ll get there someday, but whether this is ready for primetime now is debatable. Relatedly, another thorny issue that keeps coming up has to do with the way that the DSM attempts to make diagnoses binary like, you either have it or you don’t when ever accumulating evidence shows that this is just not how most things work. With perhaps a few exceptions, most conditions, from ADHD to anxiety to autism, exist very much along a spectrum with no clear boundary between disorder and non-disorder. I often tell my patients that diagnosing someone with ADHD is like declaring that someone is “tall.” This dimensionality is likely one of the reasons it has been so difficult to find clear lab tests or brain scan benchmarks for psychiatric illness. Previous DSM editions got into big arguments about this issue, with many experts acknowledging the dimensionality of our conditions but being concerned about how to deal with this practically. Personally, I don’t think it is that impossible just look at some of the most common physical illness diagnoses, from hypertension to high cholesterol to diabetes, which are also highly dimensional in nature. Overall, there is wide agreement from both within and outside the psychiatric community that significant changes are needed in our diagnostic system and approach. I look forward to some substantive improvements with the next edition but won’t be holding my breath that DSM-6 (or whatever it will be called) will either fix all these problems or quiet its many critics. Note: This article originally appeared on Psychology Today .

The persistence of poor-quality psychiatric care in 2026, despite medication advancements, is driven by systemic, clinical, and biological factors. 1. Systemic and Business Drivers Modern psychiatric practice is often shaped more by healthcare system characteristics than by clinical needs. Time Constraints: The current business model often requires psychiatrists to see four patients per hour to remain profitable, leaving only 15 minutes per visit. This brief timeframe makes it nearly impossible to gather a detailed history of trauma or childhood. Provider Shortages: As of 2026, severe workforce shortages persist. In the U.S., only about 28% of the population's psychiatric needs are met. High caseloads lead to rushed evaluations and "diagnostic machine" mentalities. Insurance & Administrative Hurdles: Complex insurance billing codes and low reimbursement rates for "care coordination" discourage lengthy, holistic therapy. 2. Clinical Gaps and Mentalities Many adult psychiatrists focus on a narrow biological model that may inadvertently reduce empathy. Emotional Detachment: Medical training often encourages "professional detachment," which can evolve into desensitization toward patient struggles over time. Burnout affects up to 78% of psychiatrists, further lowering empathy levels. Neglect of Trauma: An over-reliance on the biomedical model often pathologizes normal human responses to psychosocial stressors, leading clinicians to overlook trauma or adverse childhood experiences (ACEs) in favor of quick diagnostic labels. Misdiagnosis Risk: Without objective biomarkers, psychiatrists rely on subjective self-reporting. Overlapping symptoms (e.g., bipolar vs. depression) lead to misdiagnosis in up to 76.8% of bipolar cases. 3. Biological Impact and "Liver Burden" Long-term use of psychotropic medications creates significant physical strain that can complicate treatment. Metabolic Syndrome & NAFLD: Prolonged use of antipsychotics and some antidepressants is linked to non-alcoholic fatty liver disease (NAFLD), weight gain, and insulin resistance. DNL Dysregulation: Medications can trigger de novo lipogenesis (DNL), causing fat accumulation in the liver even in the absence of obesity. Drug-Induced Liver Injury (DILI): While severe injury is rare, 0.5% to 3% of patients develop asymptomatic liver enzyme elevations, requiring careful monitoring that many "lax" clinicians may skip. 4. Comparison with Specialized Psychiatry Unlike some general adult practices, child and addiction psychiatry more frequently utilize technology and evidence-based practice (EBP) due to different funding and oversight.