The Problem With Overdiagnosis in Psychiatry
At PCH, we witness the problems caused by overdiagnosing mental issues on a daily basis. Here’s what those problems look like and what we’re doing to solve them.
What Is Overdiagnosis?
Overdiagnosis in psychiatry describes the trend of using diagnostic labels derived from the DSM-5 to assign a mental disorder that never caused the symptoms or problems in the first place, often because the diagnosis is based exclusively on a list of symptoms rather than a holistic biopsychosocial understanding of the individual. Overdiagnosis is one of the core problems with the DSM-5.
Evidence for Overdiagnosis in Psychiatry
How do we know overdiagnosis is happening? We’ve selected a handful of studies showing preliminary evidence that overdiagnosis is more prevalent than many think.
- Multiple studies have consistently shown that only 30% to 40% of individuals diagnosed with bipolar disorder actually meet the criteria for the condition.
- Johns Hopkins Medicine researchers found that about half of people referred to a clinic with a schizophrenia diagnosis didn’t have schizophrenia.
- Johns Hopkins Bloomberg School of Public Health also discovered that only 38.4% of adults with clinician-identified depression met the 12-month criteria for depression, despite most participants being prescribed and using psychiatric medications.
- Another study found that as many as half of obsessive-compulsive disorder cases are misdiagnosed.
Note that the evidence for overdiagnosis in psychiatry is by no means limited to these studies, but they provide an accessible entry point to understanding the scope of the issue. As always, we encourage you to do your own research before reaching any conclusions.
How Can Psychiatric Labeling Be Misused?
The tendency toward overdiagnosis in the field of psychiatry is highlighted in this 2015 study examining the trend:
“Diagnoses are made rapidly—and often inaccurately. Instead of listening, and asking about current circumstances, psychiatrists focus on a checklist of symptoms, a kind of parody of the criteria listed in the DSM manual. Based on the answers to these questions, prescriptions will be written for almost every problem—and ‘adjusted’ every time a patient comes in feeling distressed.”
The evidence and causes behind the pattern of overdiagnosis in psychiatry raise serious questions about the consequences it can bring about.
Do you think you or someone you care about may have been inaccurately diagnosed with a mental issue? Our team can help. Let’s Talk
The Three Consequences of Overdiagnosing Mental Issues
Every day at PCH, we see how overdiagnosed mental issues impact the lives of our clients. In our experience, these are the three things everyone should remember:
1. These Labels Never Truly Go Away
We focus on treating OCD, anxiety, depression, bipolar, schizophrenia, and PTSD, all of which are considered lifetime diagnoses. When someone is diagnosed with one of these issues, they have to confront that they’ll have to deal with these challenges for the rest of their life because there is no “cure” for them. With guidance, individuals can learn to better manage symptoms and patterns, but there is no quick fix to make them “go away.”
Misdiagnosing a lifetime diagnosis can be particularly harmful for someone whose challenges and suffering are, in reality, tied to another issue. These diagnostic labels ultimately dictate treatment programs, so when someone ends up in a program for a diagnosis they don’t actually have, they rarely make progress. They may even regress or grow disillusioned with the ineffectiveness of professional treatment altogether.
Since many mental issues are lifetime diagnoses, it’s particularly challenging to get someone to see themselves as anything other than what they’ve been repeatedly told they are. The language our society uses to describe these issues also plays a significant role here. Individuals are regularly told, “You’re bipolar,” “You’re schizophrenic,” or “You’re depressed,” as though this statement is the defining feature of their identity, and many start to believe it. In reality, every person is much more than that, no matter their diagnosis.
Getting someone who has been told they’re bipolar for years to acknowledge that they’re not actually bipolar can be as challenging—if not more so—as getting someone to reach out for help in the first place, but by then, much of the damage has already been done. They may even begin to question the usefulness of professional guidance and instead regress or turn to maladaptive self-coping mechanisms.
(For more on this, here’s why emotional dysregulation is frequently misdiagnosed as bipolar.)
2. Overdiagnosis Leads to Mismedication
Treatment programs aren’t the only thing designed around and informed by diagnostic labels—medication regimens are as well. As a result, overdiagnosing mental issues is a common cause of mismedication. When someone is medicated for an issue they don’t have, their challenges and symptoms often worsen. These medications may come with adverse side effects, exacerbate symptoms, or, as discussed above, cause an individual to give up on professional treatment altogether. Ultimately, mismedication due to overdiagnosis can do more harm than no medication at all.
3. Overdiagnosis Feeds Social Stigmas
Overdiagnosing mental issues fuels social stigmas around the challenges and experiences of people struggling with them. Have you ever heard someone claim that they’re “a little OCD” because they like things in a specific order? Having an eye for detail or preferring that something be a certain way is in no way an indication of obsessive-compulsive disorder, yet social misperception often leads people to trivialize the reality of living with OCD.
When an individual is misdiagnosed (often based on symptoms alone), symptoms like these become the focus of the issue rather than the person dealing with them. In turn, mainstream society focuses on lists of symptoms instead of the ways mental issues affect normal people in their everyday lives. As a result, people struggling with them are viewed as different, less than, or outsiders, and many are afraid to seek help because they don’t want to be viewed in this light.
When Are Diagnostic Labels Beneficial?
When accurately applied, diagnostic labels can be helpful for individuals and medical professionals. They provide a shared reference point to talk about the inherent challenges, patterns, and shared perspectives that come with specific mental issues. At the same time, these labels can help individuals put words to what they’re experiencing. It’s when these diagnostic labels overshadow the individual that they do more harm than good.
The PCH Approach to Overdiagnosis
At PCH, we strive to destigmatize mental issues, connect past trauma to present problems, and emphasize the importance of holistic treatment. A lot of the work we do in these areas involves undoing the damage caused by overdiagnosed—or misdiagnosed—mental “disorders.” While we recognize that diagnostic labels can be helpful when used responsibly, we also witness the damage overusing them can do to an individual’s psyche. Looking beyond the individual, overdiagnosis leads to misunderstanding and misrepresentation of mental diagnoses, feeding the dissemination of negative connotations across every segment of our society.
When we say, “We want to know what happened to you, not what’s wrong with you,” what we’re really trying to say is that we view everyone who comes through our doors as more than a diagnosis. We’ve witnessed the harm overdiagnosis can do firsthand, and we’re committed to solving the problems it creates. One way we achieve that is by first validating an accurate diagnosis for everyone who walks through our doors, even if they’ve been previously diagnosed elsewhere. The fact that we have to do this is a testament to how common overdiagnosis has become in the medical community and how we’re working to solve it.
If you suspect you or someone you care about may have been misdiagnosed with a mental issue, reach out to the PCH team today.