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The Problem With Overdiagnosis in Psychiatry

Human suffering is a widespread issue that is not fully understood by the field of psychiatry. Practitioners don’t always know all of the answers. Practitioners and clinicians may air on the side of caution, feeling that the risk of under-diagnosing a client outweighs the dangers of over-diagnosing. Most clinicians consider ethics and strive to provide the best treatment for their clients. Still, over-diagnosis holds considerable risks for our clients and our infrastructure as a community over-burdened by mental health issues.

Over-diagnosis Is a Common but Dangerous Problem

Over the years, the depth and breadth of criteria described in the Diagnostic and Statistical Manual of Mental Disorders may have contributed to over-diagnosing clients who seek help for relatively common issues. Ian Freckelton, in an article titled “How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life’s Misfortunes,” quotes Joel Paris as saying that diagnosing life’s misfortunes makes psychiatry “a cure for unhappiness.” As mental health treatment providers, we know that unhappiness isn’t always clinical. Yet, the fear of not offering pharmaceutical help to someone experiencing a clinical disruption in their lives may outweigh the hesitance to diagnose. Unfortunately, psychiatry has developed, in many cases, to diagnose rapidly. Less and less time is spent with the person seeking answers to unhappiness that may be overcome with counseling and coping techniques. A lack of time spent analyzing the life circumstances of the suffering, and a lack of objectivity to measure mental illness through biometric markers contribute to over-diagnosis. We can’t change the way we diagnose mental illness overnight, such as with medical advancements to measure physical symptoms. However, we can learn and stress the dangers of over-diagnosis to encourage more caution in practitioners.

The Disadvantages and Dangers of Over-Diagnosing

It’s difficult to discuss the dangers and burdens of over-diagnosis when there are so many whose suffering goes unrecognized and without intervention. However, for the sake of this article, we will not discuss under-diagnosis and will only focus on the harm that can come from its counterpart. There are two major disadvantages of over-diagnosing mental health problems. One of these disadvantages is a global and personal financial cost. According to Agenda Item 6.2 of the Sixty-fifth World Health Assembly titled “Global Burden of Mental Disorders and the Need for a Comprehensive, Coordinated Response From Health and Social Sectors at the Country Level,”  mental illness accounts for around thirteen percent of the global disease burden. In addition, poor mental health can cause poor physical health, both of which are taxing to the economy; it can also disable an individual from working and living a “normal” life. Primary care physicians do much of the diagnosing of mental health disorders; this may lead to clients receiving pharmaceutical intervention without therapeutic help. If clients are receiving pharmaceutical treatment without therapy, their condition may become life-long. Missed opportunities, assessments, and treatments can be significant financial losses for the individual. In addition, some pharmaceuticals, such as atypical antipsychotic medications, are expensive for the client to maintain, which is one reason that an accurate diagnosis is important. While we can’t yet fully understand the burden of mental illness not recognized by under-diagnosis, it’s fair to assume that the prevalence of genuine mental health disorders isn’t being addressed by over-diagnosis. Instead, as a financial and social burden, the prevalence of true mental health disorders is actually being exacerbated by over-diagnosis. Finally, a significant danger of over-diagnosis is to the client’s self-image. Psychiatric diagnoses are already strongly associated with low self-esteem.  It is important to consider the added effect of stigma on persons diagnosed with mental illness.  According to a 2001 Psychiatry Online article called “Stigma as a Barrier to Recovery: The Consequences of Stigma to the Self-Esteem of People With Mental Illness,” clients who anticipate social rejection, devaluation, or discrimination may experience damage to their self-esteem, as well. While the diagnosis of a mental disorder itself doesn’t directly cause low self-esteem, it is present with many mental health problems. Stigma and self-image are intertwined, and the act of diagnosing can put a client at risk of a damaged self-image or social circle. Therefore, clinicians must be more cautious in diagnosing so that the benefits of receiving help for those who actually require diagnosis outweigh the social consequences for those who do not.

How to Avoid Over-Diagnosing Psychiatric Clients

The most effective way to avoid mistakenly over-diagnosing a client is simple: know them well. Psychological conditions should be examined and treated by both physicians and therapists. A unified treatment should be created that helps clients prevent future mental health problems and deal with issues that result from circumstances that can be solved without long-term pharmaceutical help. Clinicians who know the life circumstances of their clients in detail can make educated decisions about diagnosing and treating them. Treatment of this caliber involves:
  • Individualized care and attention to detail
  • Long-term working relationships
  • Collaborative care across health providers
  • Attention to physical and mental health components
  • Preventative care
  • Life skills and coping mechanism education
    At Casa Recovery, collaborative care and individualized treatment are the pillars of our program designed to better your client’s quality of life. Clinicians like you who want an ethical and effective treatment for their clients know that quality of care can prevent life-long mental health problems that develop into financial and emotional burdens. At Casa Recovery, our goal is to include all avenues for positive strides in our clients’ lives, including their primary therapist. We want to collaborate with you in providing life-altering treatment for your client that will give them the skills to succeed outside of treatment. The client is the director of their journey, but we are the stagehands. As clinicians collaborating on your client’s mental health progress, we meet daily to discuss and adjust the best possible treatment. To discuss how we can help you offer the best quality of care for your clients, call Casa Recovery at (888) 928-2272.

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