The Most Misdiagnosed Condition In Mental Health (Cognitive Disengagement Syndrome)

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**Dr. Alok Kanojia** (0:23)
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**Dr. Alok Kanojia** (1:03)
Hey chat, welcome to the Healthy Gamer GG podcast. I'm Dr. Alok Kanojia, but you can call me Dr. K.
I'm a psychiatrist gamer and co-founder of Healthy Gamer.
On this podcast, we explore mental health and life in the digital age, breaking down big ideas to help you better understand yourself and the world around you. So let's dive right in.
Today, we're going to talk about one of the most misdiagnosed conditions, cognitive disengagement syndrome, which used to be known as sluggish cognitive tempo. Now, the reason that these are so misdiagnosed is because many people who have these things get diagnosed with ADD or ADHD. And these conditions are sort of characterized by an internal drifting. So, people have difficulty paying attention because they daydream too much. They have difficulty completing tasks because they have a lot of difficulty getting started. They have difficulty with motivation. So these are conditions that are characterized by sluggishness overall and hypoactivity. The reason they get misdiagnosed for ADHD is because they create a lot of the same symptoms on the surface.
So, if we look at an ADHD kid, this kid has difficulty paying attention, right? So, if they're in school, the teacher is talking and they're easily distracted. They're paying attention to what somebody is moving their leg over there. There's a bird that flies out the window. So, they're unable to sustain focus because their mind is going in a thousand different directions. Cognitive disengagement syndrome is an inability to maintain focus, but for an opposite reason. Whereas, the ADHD kid is highly distractible by things outside of them. The kid with cognitive disengagement syndrome is highly distractible by a thing inside of them. So, their mind tends to drift, their mind tends to wander, they get described as very spacey. And so, I want you all to understand this is like kind of the same problem, right? So, in both cases, I can't pay attention to the teacher.
But the mechanism for why I can't pay attention is actually the exact opposite. One is externalized and associated with hyperactivity, and one is internalized and associated with hypoactivity. Another key feature of cognitive disengagement syndrome is hypoactivity. So, when we look at ADD or ADHD, the H in ADHD is hyperactivity. So, these kids tend to be very, very active, they're restless, they move around a lot, they have difficulty sitting still, they get excited easily, they run around a lot. Whereas someone with cognitive disengagement syndrome is hypoactive. They have difficulty moving around, it's hard to get out of bed, it's hard to get up and start doing things. We'll get into this a little bit more, but they also just have a basic motivational block. Okay?
So, in both cases, we see the same result, which is like in ADHD, people have difficulty completing tasks, right? And so, when we look at ADHD, why do they have difficulty completing tasks? Well, they have difficulty getting started. They have difficulty staying on task. But the reason they have difficulty getting started is because they're too distracted. It's hard for me to sit and focus on this because I'm thinking about this, thinking about this, thinking about this. In cognitive disengagement syndrome, it's actually the opposite. I have difficulty getting started, but that's because my mind is so wandering away that it's hard for me to focus on this. In terms of sustained focus and task completion, once again, ADHD has distractions, right? So I start to work, I work for 15 minutes, and then my mind wanders away, starts thinking about this, thinking about that. In cognitive disengagement syndrome, the mind sort of drifts away from the task and flows into sort of a daydreaming kind of state. And so the three key features of cognitive disengagement syndrome are daydreaming, mental confusion and hypoactivity.