Giving people with mental health issues a diagnostic label could do more harm than good

At the end of last year, I was doing some research for this story when I stumbled upon an online quiz inviting me to test for ADHD — attention deficit hyperactivity disorder.

It looked legit, being on the same page as an academic article I was reading, among other things.

But after working through the questions I wasn’t so sure.

I’d never seen my occasional issues with focus, anxiety and self-confidence as a major problem, yet I was told I had a “high level of ADHD symptoms” that could lead to “increased stress, missed opportunities, damaged relationships, and reduced wellbeing”.

I was encouraged to buy a “personalised ADHD management plan” — at a special pre-Christmas price — which promised to fix me by the end of January.

Within a matter of minutes, I had been labelled with a mental disorder, worthy of treatment — all without setting foot inside a professional’s door.

Listen to the full episode of Trauma or a tough time? How our mental health labels are changing over time

Hashtags for a range of conditions are alive and well on TikTok, and self-diagnosis of mental disorders is on the rise, according to experts such as Nick Haslam, a psychologist from the University of Melbourne.

“People have always loved identifying themselves with categories … but I think it’s sort of been turbocharged now.”

ADHD is included in the Diagnostic and Statistical Manual of Mental Disorders, which is the handbook used by psychologists and psychiatrists to diagnose and classify a range of conditions.

While diagnostic labels like this are important for many people, Professor Haslam warns there can be risks from their ever-widening use.

“There is a lot of under-recognised suffering and mental illness out there. So I’m not saying avoid diagnostic concepts. I’m just saying be mindful of it,” he tells ABC Radio National’s All in the Mind.

“Only when these phenomena cause significant harm and dysfunction do they really qualify as mental illnesses.”

Mental health labels changing over time

Professor Haslam examined millions of psychology texts and news articles, and most recently Reddit posts, to study how language around mental health has shifted over the years.

“We track how the meaning of words changes using computational linguistic approaches,” he says.

And Professor Haslam found that, as a society, we have been broadening the definition of what counts as mental illness — something he calls “concept creep”.

PTSD definition in black print.
The term PTSD (post-traumatic stress disorder) first appeared in 1980 and is now a household expression. (Getty Images: Devonyu)

He points to the example of trauma.

“A hundred years ago it referred exclusively to physical wounds. It was then broadened to include psychological wounds,” Professor Haslam says.

Conditions such as post-traumatic stress disorder (PTSD), psychological stress that occurs after a traumatic event, have since been included in the DSM.

And the expert criteria for a “traumatic” event have also been widened to include something that you witnessed happening to others.

Most recently, Professor Haslam found the biggest influence on concept creep was the general public.

“People were more likely to talk about sadness as if it was depression … more likely to describe ordinary worries as anxiety disorders … more likely to start referring to ordinary life adversities — unpleasant as they might be — as traumas,” he says.

He is concerned about “a widespread pathologisation of ordinary emotions and life challenges”.

Professor Haslam doesn’t want to be seen as “the language police”, but he wonders what will happen if psychiatric terms continue to be used in a wider and wider way.

“How much further can these ideas stretch before they become completely meaningless?

“Let’s just think twice before we call a bad hair day a ‘trauma.'”

Pros and cons of diagnostic labels

Professor Haslam says diagnostic labels are helpful because they encourage people to take their problems seriously, and encourage them to get help. 

And having a diagnosis can entitle you to resources, treatments or dispensations you otherwise might not qualify for.

Having a label can also be legitimising and give people a way to make sense of their experiences, Professor Haslam says.

“A lot of people, when they receive a diagnosis, say ‘I finally understand myself’.

“It often allows people to form groups… [and think] ‘here’s my tribe, here are the people I belong to.'”

But as well as such benefits, Professor Haslam says there can also be a downside to labels.

He points to evidence that labels like “depression”, “anxiety” or “schizophrenia” can lead to people feeling a bit helpless, with stereotypes around the conditions reducing expectations they have of themselves, or that others have of them.

“The moment you start using these terms a little bit promiscuously, you do run the risk of changing people’s identities and changing their sense that they actually have autonomy and capacity to overcome the problems they’re having.

“That can be quite powerful and hard to escape.”

Professor Haslam studied people who were on the borderline of being diagnosed with major depression, generalised anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder and binge eating disorder.

He found that when people had a label they were given more empathy by others, but it also meant they were perceived to be less likely to recover because they were not seen to be in control of the condition.

“It probably is something that will interfere with your process of recovery — at least it could.”

Child from behind wearing headphones.
Research on children has questioned how much benefit the ASD label provides those with mild symptoms. (Getty Images: Maskot)

Psychologist Rebecca Sims, who completed a recent PhD at Bond University titled “Label with care“, agrees there are positive and negative effects of diagnostic labels.

Her study found that for some, diagnosis brought feelings like anxiety, fear, anger, helplessness and confusion, and for others it brought relief, validation, support or empowerment.

While family and friends rushed in to help some people once they were diagnosed, others found their family pulled away or they were told they could not work with the condition they had.

And while diagnosis brought effective treatments for some, others were left trialling numerous medications or contending with detrimental side effects.

Labelling people in the ‘grey zone’

As part of her PhD, Dr Sims studied a group of children with mild symptoms of autism spectrum disorder, only half of whom had been labelled as having the condition.

She found little difference in the educational and wellbeing outcomes between those who were labelled and those who weren’t, raising questions over the relative benefit of a formal diagnosis of children with mild symptoms.

“The diagnostic label may not be as beneficial to their psychosocial wellbeing as we anticipate it might be,” Dr Sims says.

One of Dr Sims’ PhD supervisors, psychologist Rae Thomas from James Cook University, emphasises there are definitely people who will benefit from being diagnosed.

“But there are people who are in the grey zone, from whom potentially the harms of a diagnosis outweigh the benefits,” says Dr Thomas, who was part of a group arguing this case in the British Medical Journal last year.

Dr Sims found in some cases there was pressure for a person with milder symptoms to get a formal diagnosis to qualify for support.

Other research found similar dynamics at play in the labelling for children with ADHD.

Support independent of diagnosis

Given the potential negative impacts of a diagnosis, researchers such as Dr Thomas and Dr Sims argue it is better to provide children with mild symptoms with support — for example, to help with emotional regulation or sensory issues — without requiring they are formally diagnosed.

This might help ensure children have access to beneficial interventions while limiting the harms that can come from labelling.

Dr Thomas says this will take systemic change, including proper funding for support people in schools and homes.

It is also important to avoid overloading the system which requires expensive and time-consuming assessments for a formal diagnosis, Dr Thomas adds. Such “bottlenecks” make it harder for those who benefit from a formal diagnosis to get the help they need.

If you or anyone you know needs help:

Looking at the broad array of possible diagnostic labels that people apply to their mental health, Professor Haslam agrees there are concerns that providing substantial social benefits for “relatively mild problems” can be costly for society, and possibly bad for people.

He advises if you have diagnosed yourself with a mental disorder, or think you might have a problem, it’s important to seek a professional opinion.

And rather than focus on labels, focus on actual symptoms, whether it’s difficulty concentrating, feeling miserable or not being able to get out of bed.

Even if you don’t meet the criteria for a mental disorder, it is good to reach out for help when it’s needed, he emphasises.

“You can still seek counselling. You can still seek social support. You can still seek online help and apps and things like this.

“No-one’s saying you have to have a ratified diagnosis in order to deserve some sort of intervention.”

1 COMMENT

  1. If you look hard enough you can self diagnose yourself with a multitude of disorders. Let’s leave this to the medical fraternity. But in saying that I do believe that some doctors are diagnosing people with “mental disorders” too easily and without enough investigation. Unfortunately, you are not allowed to have any of characteristics without being labelled as having a disorder. Total BS.

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