The Myths And Realities Of Overdiagnosing Mental Health Conditions

The likelihood of overdiagnosing mental illness seems to have become a growing concern. Some argue that the rise in diagnosed cases points to a trend of overdiagnosis, particularly with changes seen after the release of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Yet, compared to past decades, increased access to mental health care may also need to be considered. 

In general, more people are attending therapy and using mental health resources, which may naturally lead to more diagnoses being made. Although it may increase the risk of overtreatment and labeling normal emotional responses as mental health disorders, this rise in mental health awareness and availability of services likely means more people are seeking help. If you believe you could be living with a mental health disorder, a convenient way to seek support may be to connect with a therapist online.

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What is overdiagnosis?

Overdiagnosis can occur when a mental healthcare provider tells someone they have a mental health condition that they do not have. Overdiagnosis usually differs from misdiagnosis, which can refer to the wrong mental health disorder being diagnosed, often leading to incorrect treatment. Overdiagnosis may result from broad diagnostic criteria or more intense medical scrutiny.

The scope of overdiagnosis usually includes various mental health conditions, such as the following:

• Major depressive disorder
• Bipolar disorder
• Attention-deficit/hyperactivity disorder (ADHD)
• Personality disorders
• Conduct disorder
• Autism spectrum disorder
• Anxiety disorders

These disorders often rely on subjective symptom reporting. As a result, the potential for overdiagnosis can increase. Studies have shown that the high rates of diagnosis can sometimes lead to unnecessary prescriptions and treatments.

Are mental health providers overdiagnosing mental illness?

During the late 20th century, awareness of mental health disorders began to rise significantly. People started recognizing conditions like depression, anxiety, and ADHD more frequently. However, the criteria for diagnosis were less stringent, often leading to a broader interpretation of symptoms.

In the 2000s, diagnoses of mental health conditions generally increased, partly due to better diagnostic tools and wider education among healthcare providers. For example, attention to ADHD grew, raising debates about overdiagnosis. As awareness increased, so did the number of people seeking mental health care, leading to more diagnoses.

What does the data show?

Today, the diagnosis rate for mental health conditions has continued to climb. A recent study from the Netherlands, the NEMESIS survey, highlighted that the prevalence of common mental disorders rose between 2007 to 2009 and 2019 to 2022. In the same period, service use also increased, with both general medical and specialized mental health care seeing notable rises.

In 2020, about 20.3% of U.S. adults received mental health treatment. Women were usually more likely to receive treatment than men. Discussions about overdiagnosis often continue, especially for conditions like ADHD, where prevalence rates remain high. Researchers are still debating whether these increases represent actual rises in mental health disorders or reflect better detection and diagnosis efforts.

The problems with overdiagnosis

The overdiagnosis of mental health conditions can lead to serious effects on individuals and society. These effects may include changes in public perception, increased healthcare costs, and altered patient quality of life.

Stigma and public perception

The overdiagnosis of mental health conditions can increase stigma. When more people are labeled with a mental disorder, it can blur the lines between normal behavior and clinical conditions. This might make it harder for the public to understand what constitutes a genuine mental health condition.

People may start to view normal emotional reactions as symptoms of a disorder. This blurred understanding may make people hesitant to seek help for genuine conditions, fearing they may be inaccurately labeled.

Healthcare costs

Overdiagnosis may lead to increased healthcare costs. When individuals are diagnosed with conditions they do not have, they may receive unnecessary treatments, which can lead to wasted resources. These additional medical bills can strain both families and the broader healthcare system.

Medical personnel and facilities may be burdened by the need to address unnecessary diagnoses. Resources like medications, therapy sessions, and follow-up appointments may be allocated to those who might not need them.

Quality of life

Receiving an incorrect diagnosis can greatly affect a person’s quality of life. People diagnosed with mental health conditions they don't have might experience stress, anxiety, and confusion. They may take medications with severe side effects, unnecessarily impacting their mental state or physical health.

Some people might also undergo therapy or other treatments, affecting their daily routines, relationships, and work. These changes may lead to a sense of dependency or a belief that they are "broken," which may affect their self-esteem and overall mental health.

Why might mental health diagnoses be increasing?

Several elements are thought to drive the overdiagnosis of mental health conditions. These include the role of the healthcare system, changes in diagnostic criteria, and the influence of sociocultural factors.

Sociocultural influences

Sociocultural factors can contribute significantly to overdiagnosis. In general, there is a growing awareness and acceptance of mental health challenges, which can encourage people to seek help. Media portrayals and public campaigns often highlight mental health, but they might also lead to self-diagnosis or increased sensitivity to everyday stress.

In addition, increased help-seeking behavior can be seen. People today may be more likely to seek professional help for their mental health challenges compared to previous generations. This rise in help-seeking behavior may contribute to the growing number of diagnoses.

Expanded diagnostic criteria

Another factor may be the expanded criteria in manuals like the DSM-5. The definitions of many mental health conditions have expanded, making it possible to diagnose a wider range of symptoms. Broader criteria usually mean more individuals fit the diagnosis, even if symptoms are mild or borderline. 

As a result, more people may be classified as having mental health conditions. For example, ADHD diagnoses appear to have increased as criteria have loosened, frequently causing concern among experts about potential overdiagnosis. Normal behavioral changes might be seen as problems when they are not.

Health system changes

The healthcare system and its structure may play a role as well. Insurance incentives and the pressure on healthcare providers to make quick diagnoses may contribute to the rise in mental health diagnoses. Clinicians often have limited time per patient, potentially leading to quicker diagnostic decisions.

The system's focus on efficiency sometimes means that quick diagnoses can be prioritized over thorough evaluations. This pressure can lead to overdiagnosis or incorrect diagnoses of mental health conditions.

Public awareness

In general, public awareness of mental health has grown significantly. Campaigns and media coverage seem to have reduced the stigma associated with mental illness, encouraging individuals to seek help. With more people willing to address their mental health, diagnoses have become more common.

The reduction in stigma also means more people tend to be open about their mental health struggles. This openness can lead to more people identifying with mental health conditions and seeking diagnoses.

Screening and diagnostic tools

Advancements in screening and diagnostic tools may also contribute to increased diagnoses. Modern tools and methods may detect mental health conditions earlier and more accurately than older techniques. This improved accuracy may lead to higher diagnosis rates.

However, relying more on these tools can sometimes result in overdiagnosis, especially with broader diagnostic criteria. Increased detection can identify milder or borderline cases.

Cultural shifts

Cultural shifts can influence diagnostic trends. As societal norms evolve, behaviors previously considered "normal" may now be seen as symptoms of a disorder; and vice versa. These shifts can affect how mental health professionals diagnose and treat their patients.

As society changes, what is considered a mental health condition also tends to change. This can lead to more people being diagnosed with conditions that were not previously recognized.

Healthcare provider training

Many individuals seek help for mental health concerns at their primary care office. These providers may more effectively identify and diagnose mental health conditions with improved training. Ongoing education can ensure primary care providers stay updated on the latest diagnostic processes and treatment methods.

Seeking support

If you believe you may be living with a mental health condition, speaking with a licensed therapist can offer clarity. However, it may not always be convenient to attend therapy appointments in person. Online therapy usually allows for increased accessibility, enabling individuals to work with licensed mental health professionals from the convenience of their homes at times that fit their schedules.

A large body of evidence suggests that online therapy is just as effective as in-person therapy. Both options can be valid sources of treatment for a variety of mental health conditions and challenges.

Takeaway

Modern psychiatry often faces claims regarding the overdiagnosis of mental health disorders. Some critics argue that more symptoms are being labeled as disorders now than ever before. However, increased access to mental health care can empower more people to seek help. While increased mental healthcare access can be positive, it may also lead to more diagnoses, especially if practitioners lack experience or work under pressure to diagnose quickly. If you’re concerned about your mental health, don’t hesitate to reach out for professional help. While BetterHelp therapists can not make an official diagnosis, you can connect with a licensed professional in your local area or through our online therapy platform.