Belinda retweeted
So much damage is done by the idea that there is a majority of people for whom life is straightforward. The world was designed for them, they effortlessly comply with societal demands and get over their life stresses easily. They never wonder whether there is something different about them, or criticise themselves for minor failings. They sail through school and work. They have meaningful relationships with only transient conflict. Their emotions are manageable and in proportion. They are round pegs in round holes.
The neurotypical
Some people look like this from the outside. Hardly anyone reports being like this from the inside. Yet more and more books and training programmes promote the idea that if you’re not like this, you must be neurodivergent. Wired differently.
We have pathologised the human condition.
Belinda retweeted
Someone told me that you can tell how a person felt about you by the way they treated you in the end, and I had to take a minute and process that one.
Belinda retweeted
A new study shows that ketchup and mustard are terrible for you.
The study was done by the Mayo Clinic.
Belinda retweeted
Professor Fonagy's final report recommends moving from a "diagnosis-dependent" to a "needs-led plus diagnosis" system for ADHD, autism and mental health.
In principle, I agree. And from my own practice, identifying need is the easier part.
In one private service I work with, I diagnose and treat neurodivergence and mental health conditions together, not in isolation. Alongside medication, I can recommend coaching or psychotherapy, so more of a person's needs are addressed. Collaboration with workplaces or schools can be arranged individually depending on needs and patients’ preferences. The downside is obvious: the fee. But a model like this could inspire the NHS. It is perhaps close to how the NHS used to work, before services became fragmented and many interventions were included in the "not commissioned" category, which removed them from routine CMHT practice and from training opportunities for staff.
In another service I collaborate with, which is free for patients, diagnosing, prescribing and drafting a needs formulation is straightforward. The hard part is finding free support to offer afterwards. Some areas have third-sector support groups; many offer only a psychoeducation website. So we may arrive at the most wonderful needs assessment but there is no service free for patients to deliver it.
So my question is:
Once need is identified, who provides and funds the support?
Identifying need is not the bottleneck. Resourcing it is.
Belinda retweeted
I liked it better when people didn't ask what their diagnostic label was and we could blow the question off as " inside shop talk" if they asked. When people started showing up for their first consultation with tabbed copies of " Driven to Distraction", or "An Unquiet Mind" or, heaven forbid, " Michelle Remembers" having already not only diagnosed themselves, but fully identified with a particular label, the whole endeavor was nearly hopelessly contaminated.
Belinda retweeted
We killed 92 of 94 new diagnoses suggested for DSM-IV.
The 2 we added (Aspergers/Bipolar 2) caused more harm than benefit.
I suggest no new disgnoses until we have solid biological tests.
Dumb new labels take on a dangerous life of their own
(see great description below).
Sometime before 2016, a psychiatrist started asking their late-diagnosed adult patients with ADHD whether they thought they were more sensitive to rejection and failure than other people.
They said that they were. He didn’t (as far as I can tell) do any comparison with people with mental health problems, or with those with social anxiety. He didn’t look at children or those diagnosed in childhood. He just asked his patients to self-compare with others.
There were no attempts to test out whether this was specific to ADHD, nor universal in those with ADHD.
In 2016, the psychiatrist, William Dodson, gave this a name - rejection sensitivity dysphoria - and started writing about it. It resonated with influencers who created content talking about their RSD. It quickly multiplied. Articles were written about it on official sounding websites. Qualitative research was done, asking people who had heard about RSD whether they experienced it and what it was like.
By 2024, Dodson was saying that RSD was neurological and genetic, not related to trauma and wouldn’t respond to psychotherapy.
By 2026, bestselling author Alex Partridge wrote a whole book about his RSD, pinning it squarely to ADHD and saying that RSD ‘explained my entire life’. He gave a convincing sounding brain-based explanation about ‘glitches’ in how the ADHD brain processes dopamine and nor-epinephrine, and how these lead to rejection feeling far more brutal than for people without ADHD. There is no evidence of this that I have found.
And in this way a psychological and emotional reaction was framed as a neurobiological symptom. Millions started to think that perhaps they had ADHD, because they were sensitive to rejection and failure. RSD spread, and soon people started saying it was part of autism too.
Why does that matter? Because when people think something is due to how their brains work, they think that it is set in stone and won’t change. They think that medication is their only option, and that psychotherapy has nothing to offer. Emotional sensitivity is a really common psychological symptom, and it hasn’t been shown that it’s uniquely part of ADHD. RSD is an example of how neurodivergence is expanding to incorporate emotional reactions, and in the process turning psychology into neurology.
With RSD, the most basic scientific questions haven’t been answered, but you’d never know that from what you see online. There, it all seems so certain and clear.
It’s not.
Belinda retweeted
Sometime before 2016, a psychiatrist started asking their late-diagnosed adult patients with ADHD whether they thought they were more sensitive to rejection and failure than other people.
They said that they were. He didn’t (as far as I can tell) do any comparison with people with mental health problems, or with those with social anxiety. He didn’t look at children or those diagnosed in childhood. He just asked his patients to self-compare with others.
There were no attempts to test out whether this was specific to ADHD, nor universal in those with ADHD.
In 2016, the psychiatrist, William Dodson, gave this a name - rejection sensitivity dysphoria - and started writing about it. It resonated with influencers who created content talking about their RSD. It quickly multiplied. Articles were written about it on official sounding websites. Qualitative research was done, asking people who had heard about RSD whether they experienced it and what it was like.
By 2024, Dodson was saying that RSD was neurological and genetic, not related to trauma and wouldn’t respond to psychotherapy.
By 2026, bestselling author Alex Partridge wrote a whole book about his RSD, pinning it squarely to ADHD and saying that RSD ‘explained my entire life’. He gave a convincing sounding brain-based explanation about ‘glitches’ in how the ADHD brain processes dopamine and nor-epinephrine, and how these lead to rejection feeling far more brutal than for people without ADHD. There is no evidence of this that I have found.
And in this way a psychological and emotional reaction was framed as a neurobiological symptom. Millions started to think that perhaps they had ADHD, because they were sensitive to rejection and failure. RSD spread, and soon people started saying it was part of autism too.
Why does that matter? Because when people think something is due to how their brains work, they think that it is set in stone and won’t change. They think that medication is their only option, and that psychotherapy has nothing to offer. Emotional sensitivity is a really common psychological symptom, and it hasn’t been shown that it’s uniquely part of ADHD. RSD is an example of how neurodivergence is expanding to incorporate emotional reactions, and in the process turning psychology into neurology.
With RSD, the most basic scientific questions haven’t been answered, but you’d never know that from what you see online. There, it all seems so certain and clear.
It’s not.
Belinda retweeted
One of the effects of the online conversation around autism and ADHD is that everything is becoming more similar. New concepts are being added onto ADHD - emotional regulation, rejection sensitivity. New concepts are being added onto autism - burnout, masking, AuDHD. People describe their experiences and say ‘this is because I am autistic’, others see it and follow suit.
These are experiences which are part of many people’s life experience. They were previously seen as part of mental health which meant they were open to change. Now they are seen as neurodivergence which generally means they are not.
Neurodivergence is expanding and boundaries are being blurred. The way we talk about autism becomes more similar to the way we talk about ADHD which becomes more similar to the way we talk about any distress.
It’s called convergence, and researchers have shown it’s happening online. The way we talk about autism and ADHD is changing, and they are becoming both broader and more similar to each other. Less distinct. Less, one might say, helpful to predict what would happen next.
Where is this going to take us?
Kang J, Haslam N, Conway M (2025i Converging Representations of Attention-Deficit/Hyperactivity Disorder and Autism on Social Media: Linguistic and Topic Analysis of Trends in Reddit Data
Journal of Medical Internet Research;27:e70914
doi: 10.2196/70914
Belinda retweeted
In 2020, a student heard about object permanence in his undergrad psychology course. Object permanence is an early developmental stage when children come to understand that an object is still there, even when they can’t see it. It is acquired around the age of 18 months. Without it, we’d be profoundly disabled. Dogs have object permanence - if they didn’t, they would not chase after balls.
That student made a TikTok video, claiming that object permanence was actually a symptom of his ADHD. He said when he couldn’t see things anymore, it was like they did not exist for him. Others picked it up and more videos appeared. It spread. Blog posts were written which described fairly typical forgetfulness, and called it object permanence. Walk into a room and forget what you came for? Perhaps you lack object permanence, and therefore have ADHD. The more it was talked about, the wider it spread. Infographics appeared. Losing your keys could, apparently, be a sign of poor object permanence.
By 2025, parents were telling me that their teens had poor object permanence, and that’s why they couldn’t keep up with friends.
By 2026, author and influencer Alex Partridge wrote in his bestselling book that object permanence was a symptom of ADHD.
Object permanence went from one undergraduate’s TikTok video to mainstream acceptance within a few years. Most people now have no idea where it came from, or what the original concept of object permanence was. It’s become part of ADHD.
And that’s how new ideas are emerging and gaining credibility in neurodivergence. No science, no scrutiny - all it takes is a TikTok post and a catchy name.
Owen Chevalier tracked the evolution of object permanence in his paper, referenced below.
Are there other terms like this that you’ve noticed emerging?
Chevalier, O. (2024). "It starts on TikTok": Looping effects and the impact of social media on psychiatric terms. Philosophy, Psychiatry, & Psychology, 31(2).
Belinda retweeted
Don’t be misled by the careful academic language.
This is one of the most important papers I’ve ever written, and I’m deeply grateful to the British Journal of Psychiatry for inviting such a critical argument into the heart of mainstream psychiatry (ranked among the top 4% of journals in Psychiatry 😮).
My new Feature identifies five major challenges psychiatry will need to confront before the next DSM if we want to preserve a meaningful boundary between normal human variation and pathology, and reduce medicalization and overprescription.
I genuinely recommend reading it slowly, from beginning to end, the way we used to read papers before GPT.
I wrote this one almost the old-fashioned way, so that its dramatic implications could emerge naturally, without shouting headlines, simply from the evidence and from some basic principles of the philosophy of science and mental health.
doi.org/10.1192/bjp.2026.107…
