A new study, published in BMJ Open, investigates varying approaches to understanding the phenomenon of overdiagnosis across different medical fields. Jenniskens and colleagues from the University Medical Center Utrecht in the Netherlands found that, although consequences of overdiagnosis can be detrimental to patient health, there is no universal definition. The lack of consensus on the issues hinders communication between healthcare workers, patients, and policy-makers.
“Overdiagnosis is discussed across virtually all clinical fields and in different contexts. The variability in characteristics between studies and lack of consensus on overdiagnosis definition indicate the need for a uniform typology to improve coherence and comparability of studies on overdiagnosis,” write the researchers.
The authors categorize overdiagnosis as a subcategory of “over-medicalization,” meaning “too much medicine.” It can be understood as diagnosing an individual with a condition for which they will never experience symptoms or as diagnosing in a way that would not yield a net benefit. For instance, large-scale screening for depression in adults and an ADHD-focused school culture have been linked to overdiagnosis of mental health disorders.
Jenniskens’ team aggregated the list of drivers of overdiagnosis identified across medical disciplines. They found that screening, technological developments that detect smaller abnormalities, inappropriate application of diagnostic criteria, legal incentives, cultural beliefs, and commercial or professional interests are all contributors to the issue.
They also review potential adverse consequences. The effects identified across the different specialties include:
- “negative effects on patient health and additional costs within the healthcare system,”
- “impaired quality of life and early loss of life due to side effects or complications of unnecessary subsequent testing or treatment,”
- psychological repercussions of “incorrectly labeling” a patient,
- indirect “social effects through eligibility for health benefits,” and
- the monetary impact resulting from “unwarranted usage of (follow-up) tests, treatment and healthcare facilities, and services.”
While the harmful impact of overdiagnosis is evident and there are increasing numbers of publications on the subject, Jenniskens and colleagues are the first to perform an analysis distinguishing between “studies focusing on how overdiagnosis should be studied” versus those reviewing the “impact of overdiagnosis in a certain field.” They searched PubMed in August 2017 and then assessed articles based on predetermined criteria, yielding 1,851 studies. Clinical fields were categorized using the ICD-10 classification.
The researchers found papers in all clinical fields, with most published on oncology (50%, mainly breast, prostate, and lung cancer), then mental health disorders (9%, mainly bipolar disorder), infectious diseases (8%, mainly malaria), and cardiovascular disease (6%, mainly pulmonary embolism).
The types of diagnostic tests used in the studies were mostly comprised of imaging, biomarkers, histology, and medical examination. While imaging, i.e., cancer screening, was predominant in oncology, medical examination characterized as an application tool of the DSM was most prevalent within the field of mental health. Notably, only the field of mental health discussed “disease definition” more than “overdiagnosis estimation,” indicating a potential lag in conceptualizing overdiagnosis.
In this study, significant differences lie in different definitions of overdiagnosis based on diverse methodologies and dissimilar typologies. The researchers call for a systematic method, such as comprehensive typology, to improve communication and provide clarity across disciplines. They conclude:
“Future methodological studies should focus on establishing a framework to aid clinicians and researchers in understanding the different subtypes of overdiagnosis, their consequences, and provide guidance for selecting appropriate study designs and methods that match the research question on interest.”
Jenniskens, K, de Groot, J. A. H., Reitsma, J. B., Moons, K. G. M., Hooft, L., & Naaktgeboren, C. A. (2017). Overdiagnosis across medical disciplines: a scoping review. BMJ Open. doi: 10.1136/bmjopen-2017-018448 (Link)
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We could start by dropping the term “overdiagnosis” and replacing it with “malpractice.” If someone “overdiagnoses” my car with problems it doesn’t actually have, it’s called fraud. Why doesn’t this apply to medicine, or specifically to psychiatry?
Bingo. A diagnosis can only pertain to an actual disease. Psychiatry does not diagnose. It labels. It invents fake “diagnoses” to apply to fake “diseases.” This works perfectly in a system in which fake “doctors” apply fake “remedies” to fake “patients.” It’s all a fraud. Even “malpractice” is putting it lightly, because the term “malpractice” assumes that there would be such a thing as good practice of psychiatry, which is simply not the case. Psychiatry is a pseudo-scientific system of slavery. It is a purely fraudulent endeavor that harms millions of innocent people. Slay the Dragon of Psychiatry.
Consider the diagnosis of Bipolar Disorder or Borderline Personality Disorder. One of the key symptoms is the extreme mood swings but yet it is very difficult to tell the difference between a mood swing of Borderline PD or Bipolar Disorder. The treatment is very different. Bipolar is mainly treated with medication for the purposes of mood stabilisation (I think the main class of drugs is anti-psychotics). Borderline Personality Disorder is mainly considered untreatable or it is treated with psychotherapy.
Borderline Personality Disorder is the most hated disorder amongst Mental Health professionals to the extent that many will avoid persons with the diagnosis like the plague. So they are less likely to be medicated and they are likely to have less interactions with the mental health profession. It is also known that at least partial remission is available for BPD sufferers regardless of treatment and with counsellling many will go into full remission and no longer qualify for the diagnosis. Bipolar disorder on the other hand is a highly disabling and many will not be able to enter the workplace or have any occupational success.
Could it be that the diagnosis of Borderline Personality Disorder is a blessing in disguise, that is an insurance policy against harmful interactions with the mental health profession and psychiatric drugs? as I understand most Bipolar sufferers I know are on disbaility, and yet the BPD sufferers with similar set of symptoms go out and work and for the most part achieve some success. Does BPD (despite the chronic suicidality) mitigate sufferers from the risk of harm from the mental health system due to the fact the mental health system refuses to listen to them
Oh my goodness Bron, if the people dx’ed with BPD at Drop the Disorder and on Twitter at In the Bin etc, read what you wrote here…suffice it to say, they see the plight of their dx very differently than you positioned it for them.
Over the last 10 years I have been involved in this movement, only groups of people who believe they are suffering from “depression and anxiety” (as if they were bona fide “diseases” v a set of symptoms the causes of which are at least 100) are more active and vocal than those dx’ed with BPD.
They are adamant in their belief that they are the most harmed, hated, abused and the most likely to say their lives have been destroyed by the system. If you challenge the validity of that, be prepared to hear differently – or more likely, be banned.
Per the litter-ature, most persons labeled with/as “BPD were victims of Child Sexual Abuse, mis dx’ed as “BPD”, drugged and trapped in the system to be belittled by uncaring professionals for most of their lives.
From what I have read and witnessed, CSA is likely to be ground zero of the 3 ring circus that makes up the DSM dx fiasco’s… followed by ADDH, “s” and then “BP”.
I follow “medical” trends and see several newly emerging problems developing across the board of sick care, which is in and of itself an incalculable, unsustainable disaster, more likely to bankrupt the country than any other mass scam being perpetrated against humanity on the planet today.
As such, timely and important article Hannah. God’s speed to addressing any measure of the mess.
I think the suffering from Depression and BPD can be quite real. However, the medical model can do nothing much for these conditions and often changes in their own behaviour and education will be helpful. I would assume this is why such therapies such as DBT can be effective because for the most part it is teaching people how to relate to each other and how to manage overwhelming emotions