Psychiatric diagnosis tends to rise when it can lead to something valuable
The prevalence of any psychiatric diagnosis will rise artificially whenever it is a gatekeeper to something valuable. In a simpler world, psychiatric diagnosis was once based only on perceived clinical need. But now that it has gained powerful (and unwelcome) influence on many administrative and financial decisions, these decisions have also reciprocally obtained a powerful influence on the rates of diagnosis. Diagnostic inflation is promoted whenever a physician provides an “up-diagnosis” to help a patient gain access to something valuable—like disability benefits or school services. If autism, ADHD, or pediatric bipolar disorder is a prerequisite to being admitted to a small class with lots of individual attention, equivocal cases get shoehorned into these categories, and soon an epidemic is born.
In like fashion, “mental disorder” increases whenever there is high unemployment. Some of the people laid off will get a new diagnosis because they have developed symptoms, others because it will make them eligible for disability. Because veterans’ benefits require a diagnosis of PTSD, PTSD gets overdiagnosed. There is a paradox—trying to help by providing a diagnosis may wind up hurting. Many returning vets from Iraq and Afghanistan are having trouble landing jobs because of the stigma associated with their diagnosis of PTSD. And overdiagnosis distorts allocations across the system, reducing resources and benefits for those who most need them.
References
- Frances, Allen. (2013). Saving Normal CHAPTER 3. Diagnostic Inflation (p. ). New York, NY: HarperCollins.
Metadata
Type:🔴 Tags: Psychiatry Status:☀️