Has excess psychological research resulted in too many inappropriate diagnoses of mental health disorders?

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This blog has stemmed from an article I came across online from ‘The psychologist’ which critically analyses the film ‘The Woman In Black’.  For anyone who hasn’t seen this film the basic plot can be found hereGreen (2012) has analysed the behaviour of Arthur Kipps and tried relating this to the context of the film and Kipp’s situation, and has come to the conclusion that he has a case of psychosis.  However, is this really a correct diagnosis? It could be suggested that the figure Kipps sees is just a delusion, one of the criteria set by the DSM to diagnose psychosis (p. 332), however as Kipps sees the woman before he hears the horror stories from the villagers is it more likely to actually be reality?  When this is combined with the deaths of the children in the village, and previous encounters by others with the figure then how can it all be in his head? To me there appears to be too many linked variables for it just to be coincidence and for him to be diagnosed with psychosis. Also, does this superstition regarding the woman in black mean that all of the villagers should be diagnosed aswell, and that any form of belief about an unexplained event or being can be described as a case of psychosis?

So is too much psychological research regarding mental health disorders resulting in over diagnosis, and how does publicly available information impact on diagnosis?

According to the World Health Organisation (2003) mental health disorders make up for 12-15% of disabilities in the world, which is twice as many as cancer.  But is it really possible to distinguish between over diagnosis and the potential reality of prevalence of disorders within society?  Zimmerman et al. (2008) used 700 patients with psychological disorders and compared their previous diagnoses of BiPolar disorder with diagnosis using the current criteria.  He found that less than half of the patients who had been diagnosed in the past would be diagnosed using the latest version of the DSM, suggesting that diagnoses are very inconsistent.

It has also been suggested that there are too many conditions that people could be diagnosed with, therefore the amount of ‘normal’ people is rapidly decreasing (Mayo Clinic, 2011).  For example, there has recently been a disorder identified as the premenstrual dysmorphic disorder, where the symptoms are pretty much the same as what most woman have when approaching menstruation, such as tension and mood swings, so is this really a disorder or is it just a natural state?

Over diagnosis also results in overtreatment, which can have damaging side effects on people.  Enhanced technology increases the likelihood that an abnormality will be identified when someone is examined (Hall, 2011), however the majority of these abnormalities will have no impact on the individual’s health so is it worth the diagnosis?  It has been found that many forms of cancer and similar disorders actually reduce in size without treatment, therefore a diagnosis does not help the situation.  It has also been suggested that the anxiety and increased amount of tests needed on an individual can impact on their health and may result in more damaging consequences than not knowing.  On many occasions a certain diagnosis can be found in so many people that it could be considered normal, so where is the distinction between over diagnosis and reality?

So do the public benefit from information that is made available to them? The NHS have created self-help guides for certain disorders that an individual can use to modify their own behaviour, see here.  These leaflets include information regarding the effects of the behaviour, criteria for diagnosis, ways to measure your own behaviour and identify a problem and ways to then modify this behaviour.  Reports suggest that these help people understand their feelings more and realise that often something that may appear abnormal is actually normal.  These guides have also been recommended by GPs to their patients.  Publicly available information can also help reduce the stigma associated with certain mental health issues so that people who really do require help are not scared to get some, as only 9% of individuals who require counselling or therapy for common mental health issues actually receive any (Royal College of Psychiatrists).

As you can see from the information presented above over diagnosis is a big issue within the field of psychology and can have negative impacts on individuals.  Making research about mental health issues available to the public may help reduce the amount of misdiagnoses and may encourage people to tackle their own problems without needing an official diagnosis.

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11 responses »

  1. This was a very interesting blog, and as I have never considered this question before it has given me something to think about.

    It is possible that psychological research may have resulted in inacurrate diagnoses of mental health. As you pointed out, research has shown that differences in the DSM (presumably from revising the edition) has resulted in patients with the same or similar symptoms and different diagnoses.

    However, I do not believe psychological research can be blamed entirely for inappropriate diagnoses of mental health, and that there are or could be many other factors involved in an inaccurate diagnoses. For example, people with one mental illness are at higher risk of developing others… this could mean they have symptoms from more than one mental illness, the combination of symptoms may result in the doctor concluding it’s a different illness from what it actually is. Patients may also withhold or exaggerate information about their symptoms, for fear of embarrassment or to seem more socially desirable etc. this could also result in a wrong diagnoses. And finally, individual differences may causes some symptoms to be more or less pronounced and possibly overlooked which could again potentially cause problems with diagnoses.

  2. I would argue that diagnosis more often has a positive impact on an individual. People with an undiagnosed mental illness can often feel misunderstood, isolated, unsupported, and may blame themselves. In the event of a diagnosis, patients may feel a relief from their self-blame (knowing their condition is not their fault), and recognition by others may increase social support. Ormel (1991) found that recognition was associated with shorter episode duration among patients with an anxiety disorder. Treatments themselves also have a positive affect, whether the treatment is actively helping the problem, or the patient may simply feel better that something is being done (placebo effect). Therefore, whether we percieve an individual’s problem to be a clinical ‘disorder’ or not, I do not think over diagnosis is too much of a problem to society.

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  4. Really interesting blog you caught my eye when you began your blog about the woman in Black which i recently saw at the cinema and i wondered where you was going to take it. It acted as a great example of how people can definately over diagnose people! After all it was only a film and in the film you knew that everyone else knew about the woman in black so he was not psychotic. I have to agree with you that i believe that people can be over diagnosed. For example, if you have a flu and type your symptoms in on google it nearly always comes back that you must seek medical attention as you may have a brain tumor or something really extreme when really all you have is a cold! A study was also carried out that suggested that the DSM is not always accurate at diagnosing patients. The study basically found that white british people would diagnose people from a different culture a lot differently to what doctors from a different culture would. For example in certain cultures hearing voices is seen as a blessing and not a negative thing whereas according to the DSM hearing voices would be classified as a symptom of schizophrenia.
    Although it is also important that people who do need a diagnosis of what ever disorder they may have understand what the possible symptoms are i believe that particularly online diagnose websites often misdiagnose. Also i think there should be more strict guidelines when it comes to diagnosing disorders to avoid anyone with minor symptoms being misdiagnosed. But overall really good blog 🙂

  5. Attitudes towards mental illness certainly seem to have changed for the better over the years, compared to when people deemed as ‘mentally ill’ were locked in asylums and treated like animals. Due to the progression of psychology as a field there is a much better understanding of the originations and eventual treatments for the vast range of disorders, but this didn’t come without a price.
    It appears that with the increased knowledge of mental disorders, people are starting to take disadvantage of the research that psychologists and also medical researchers have offered to the field. This doesn’t only have consequences on the health of people, but I believe it can also affect economy, government and of course society. One example of this is qualifying for special educational needs, where there is often not only personal but financial assistance available to parents, children and schools. http://www.telegraph.co.uk/education/educationnews/7904999/Sharp-rise-in-number-of-special-needs-pupils.html This article suggested that parents are finding it hard to distinguish between bad behaviour and SEN, and that the term is used ‘overzealously’ by experts there have been suggestions that diagnoses may be occurring for more ulterior reasons, as schools and even parents seek to take advantage of the extra help given to children with special needs. The way to diagnose SEN is via behaviour analysis, which isn’t particularly objective as experts can only study what behaviours appear on the surface, for example behaviour-rating scales are commonly used in assessing for ADHD http://www.springerlink.com/content/gl11218518506044/. Therefore, the ease and readiness of diagnosing SEN has started to become inappropriate as it is being used for alternative means when the focus should be providing the child in question with a better chance of an education etc.
    However, I believe the impact of increasing amounts of research into mental disorders isn’t all detrimental. Unfortunately there is still, like you have afore mentioned a lot of stigma still attached to mental illness. Another side of the coin might be that in the face of increased awareness people with genuine mental illness might deny the fact they are ill and refuse to seek help. They are aware of the stereotypes of mental illness and for a while dissociate themselves from these stereotypes, despite showing characteristics of mental illness http://onlinelibrary.wiley.com/doi/10.1111/j.2044-8341.1982.tb01489.x/abstract. Denial however, is a common process for all who are/have been classed as mentally ill, so like you have also mentioned the vast amount of research into the area has led an increase in the availability of treatments and being able to identify with the symptoms as an illness and not seeing it as a part of themselves.

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  7. This was such an interesting blog! I agree with most of the points you raised, particularly about overtreatment doing more harm than good (which is why doctors do not like prescribing antibiotics as repeated exposure only leads to a mutant, stronger strain of the infection). However, to answer your question as to whether or not the public benefit from the information that is made available to them, I believe the answer is no in some situations. For example, information that is readily accessible on the internet generally only documents the worst case scenario, so can just make the worried individual even more paranoid that they’re going to be struck down by something terminal!

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  9. I did thoroughly enjoy this blog, and you really raised some interesting points. In essence, it’s quite similar to the whole argument of the government going far too politically correct with some issues. We’ve all heard the stories of nursery’s banning children’s rhyme’s such as “ba ba black sheep” as it may be considered racist. A rhyme that has been sung by children for hundreds of years with no sort of stigma attached, yet the second we enter the technological phase when people are becoming offended more and more frequently, there is public outcry. Yet with this example and the issue of psychological research, it is only the minority that have a problem. Same as if a child doesn’t get the toy they want during a game with other children, they will scream and cry until they are heard. We as humans thrive for new information everyday, our curiosity will never be stifled. If the information is available to us, then of course we are going to want to find out as much as we can. Whether it’s to do with our general health or not, the more information that is presented to us, the more that curiosity is fed. It is genuinely nothing to be worried about, at the end of the day all we still need is what we have had since the beginning, and that’s common sense. As long as we are still able to think rationally, then regardless the amount of information presented to us, we should still be able to make sense of it. People had the same conditions hundreds of years ago, they simply didn’t have a label. We just have to accept we now live in a society where everything must be organised, categorised, and ordered. Welcome to the joy of the technological age.

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