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Several writers have suggested that the increase is largely spurious, reflecting misdiagnosis and iatrogenesis (24-26). Others have wondered whether the disorder's preyalence has increased, whether diagnostic criteria have changed, whether the diagnosis is now made more astutely, or whether a small number of clinicians are contributing a disproportionate amount of current cases (27). There is general curiosity and considerable consternation about why a condition thought to be rare, if not extinct, is entering the psychiatric mainstream at this point in history. 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