What is overdiagnosis and is it actually happening?

Modern healthcare is drastically overdiagnosing people, says a leading neurologist, and this might be doing more harm than good.

In a book described as a "searing critique" by The Sunday Times, Suzanne O'Sullivan says that overdiagnosis – the diagnosis of a condition that would not have caused symptoms or issues – is not helping people and could be making us sicker.

What is happening?

In "The Age of Diagnosis", O'Sullivan backs up her claim with some eye-catching facts. ADHD diagnoses doubled for boys and trebled for girls between 2000 and 2018. Between 1998 and 2018, autism diagnoses soared by 787% in the UK. Lyme disease has an estimated 85% rate of overdiagnosis, including in countries where it’s impossible to contract the disease.

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When "The Diagnostic and Statistical Manual of Mental Disorders", an encyclopaedia of psychiatric and psychological conditions, was first published in 1952, it listed 106 diagnoses across 132 pages, said The New Statesman. But the 2013 edition contains nearly 300 diagnoses across 947 pages, which a psychiatrist described as "thick enough to stop a bullet".

Why is it happening?

O'Sullivan believes that many dubious diagnoses come from patients pushing doctors for a label and doctors wanting to keep them happy. "It's a collusion between people desperate for answers and people desperate to provide answers and to satisfy people."

She admits that we're "correcting a mistake which definitely needed to be corrected", because in the 1980s "there must have been people with special educational needs that were never acknowledged". But we have now "meandered into overdiagnosis", which can be "just as harmful – or more so".

Is it a problem?

Fears of overdiagnosis of ADHD are "unfounded" and a "moral panic", said Women's Health. There is "less stigma" and "more awareness" about how the condition shows up in "traditionally under diagnosed groups such as women and people of colour". This means some "communities" are "getting to grips" with the idea they may have ADHD.

A greater understanding of autism is "something to be celebrated", said Dr Conor Davidson in a blog for the Royal College of Psychiatrists, because most people diagnosed with autism report "positive benefits" in terms of "self-acceptance, self-understanding" and greater connection to help.

But while the "increased representation" of ADHD and autism in the media and among celebrities is "invaluable" by making neurodiverse people "feel seen", some psychiatrists argue that it may be contributing to ADHD and autism being the diagnoses "du jour", said London's The Standard.

Professor Simon Wessely, the former president of the Royal College of Psychiatrists, has argued that the increase in ADHD diagnoses is unlikely to be "simply due to better recognition or help-seeking".

There is "no clear consensus" on whether ADHD is overdiagnosed or not, said Healthline, but "misdiagnoses" of the condition "do occur among children, teens and adults".