Overdiagnosis In Mental Health: What Are Its Consequences?
When sick, human beings are immersed in a certain uncertainty about what is happening to them and how to solve it as soon as possible, doubts that, by our very essence, we seek to clarify through different sources of information (experts, people around us, the media…). . In the end, When the subject finds that label that includes the main characteristics of their illness, the patient feels calmer since the diagnosis favors the understanding of the discomfort, the cause of its symptoms and the search for possible treatment alternatives.
For the medical professional or psychologist, nosological classifications such as those contained in the DSM-5 manage to more easily establish treatment guidelines agreed upon between different organizations for the wide catalog of mental disorders and illnesses, so that once one of them has been diagnosed In them, the doctor or psychologist limits himself to following the fundamental recommendations given for each classification, adapted according to the characteristics and circumstances surrounding each patient.
Notwithstanding the above, over the years, the diagnosis of disorders and diseases has turned into the feared overdiagnosis for example in relation to supposed depressive disorders such as major depressive disorder in primary care (Adán and Ayuso, 2009), anxiety disorders (Baile, 2011) or disorders related to childhood and adolescence (Pérez, 2014), among others notable.
In my opinion and as García (2012) emphasizes, overdiagnosis is given by the biomedical model that has accompanied the health field for so many years, including mental health. A model based, among other things, on biological or organic reductionism, focusing on the disease and its possible treatments.
According to Cova, Rincón, Grandón, Saldivia and Vicente (2017), the pharmacological industry, from this perspective, plays a fundamental role in encouraging this health model given its economic interests (the more diagnoses, the greater the probability of treatments that include psychopharmacology). and, therefore, greater income for the industry in the sector). Baile (2011) already pointed out in his book the added problem of overdiagnosis, by favoring the overmedicalization of supposed disorders.
Despite the above, we should not detract from the biomedical model, given that it has caused many diseases (especially of an infectious nature) to be properly treated and even eradicated thanks to professionals assigned to it (Amigo, 2012). But we must not forget that this model, unlike the famous biopsychosocial model, in addition to forgetting such important aspects as prevention and health promotion, puts the patient in a passive position as a mere follower of the instructions of the corresponding professional, who will be responsible for your diagnosis and subsequent treatment.
Overdiagnosis in everyday life
The responsibility of the professional, together with the incentives of the psychopharmacological industry as a convenient and quick means of relieving the patient’s symptoms, causes a clear overdiagnosis of situations in our daily lives that, as stated by García (2012), correspond to discomfort. that do not necessarily have to be tied to a label or nosological classification. The truth is that patients seek information about what is happening to them and how to solve it, wanting to find a panacea for their uncertainty and suffering through options with short-term improvement, little effort and low cost. And psychotropic drugs and overdiagnosis act by favoring this problem.
In my opinion we should think in terms of positive and negative reinforcement. García (2012) states that the overdiagnosed patient obtains advantages from the new acquired role (the role of ‘sick’ or ‘patient with mental disorder’ is adopted, the subject receives love and attention from the social environment, new people are met, he escapes from routine…) but negative reinforcements are also received, such as relief from negative feelings, such as failure or loneliness.
On the other hand, the short-term factor of action of most psychotropic drugs is known, which generate rapid consequences in patients, although this does not necessarily imply complete improvement in discomfort, since the drugs are usually designed for the treatment of the associated symptomatology, not the cause of said symptoms. Additionally, overdiagnosis can be applied to patients who do not have any mental disorder and who are immersed in psychopharmacological or psychological treatments that they do not need, with the consequent negative impact on time, health, money and associated stigmas, as we have mentioned
As indicated by Cova et al. (2017), overdiagnosis is not harmless and affects both the patient and the people around them, but also the field of mental health itself, by affecting the credibility of our profession by diagnosing patients who do not really suffer from the disorder. identified mental disorder or illness. Additionally, we must not forget that the health system is also affected by a significant socioeconomic impact, seeing high health spending and reduced healthcare capacity (Adán and Ayuso, 2010).
In professional terms, Overdiagnosis entails a transfer of responsibility to doctors and psychologists, who will have the power and responsibility to guide the patient in their subsequent treatment, according to the biomedical model mentioned above. Overdiagnosis also leads to an increase in the demand for care services in mental health and primary care centers (García, 2012), given that this type of diagnosis involves long-term treatments or the intake of psychotropic drugs that, although they manage to improve symptoms, They need continuous supervision and monitoring by medical professionals.
Some concrete examples
Even the DSM-5 is immersed in criticism about its overdiagnostic nature, by including a lowering of the thresholds for the diagnosis of disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or Bipolar Disorder Type II (Cova et al. , 2017). The most characteristic example is, precisely, that of children diagnosed with ADHD, who, unlike adults (with a tendency to underdiagnose), have been overdiagnosed and put on treatment with psychostimulants, even though studies confirm that they tend to label children and adolescents in this pathology when they simply show inappropriate behaviors for their age (López, 2018).
To solve the aforementioned problem, authors such as Ortiz and Murcia (2009) have recommended ‘no treatment’ as an alternative measure, very popular in the context of clinical intervention and which allows patients to be discharged in the first interview. As is evident, this type of psychotherapeutic intervention involves, from the professional’s point of view, elaborating or redefining the patient’s demand, so that the patient modifies his personal beliefs where he qualifies himself as a patient.
Most of the problems or discomforts of patients who come to consultation are typical of everyday life and do not involve special complications, except in exceptional cases in which the characteristics of the patient as well as the surrounding circumstances facilitate the appearance of disorders. and mental illnesses.
The psychology professional must be versed in the identification of both patients’ erroneous beliefs and expectations, considering themselves as patients who need treatment (Ortiz and Murcia, 2009), as well as in demands that need to be resignified (granting another meaning). other than that granted by patients). This process must be carried out with the maximum guarantee that the patient feels understood, which is why active listening and empathy play a fundamental role during the clinical interview.
Once this is done, it is necessary to make the patient understand the nature of their problem (the reason for the consultation), which may imply a redefinition of the request, as indicated. Discharge, referral to another professional and pointing out to the patient the need to return for consultation if the symptoms do not disappear or the situation becomes more complicated, will be viable options that will have to be taken into account by the professional on a case-by-case basis.
Author profile
Álex Melic Montañés, general health psychologist specialized in attention deficit hyperactivity disorder and high abilities (both in the adult population), as well as the treatment of body dysmorphic disorder and social anxiety disorder.
