What We’ve Said

What we’ve said about Overdiagnosis

8 points from 6 episodes, newest first

Also searched as medicalization

In short

Categories that once meant severe illness have drifted until a little of a trait counts as the full disorder, and turning normal or rational behavior into a diagnosis implies it is out of control. It is not one-directional, though: trauma is over-referenced while PTSD is missed, and for autism over- and underdiagnosis are both true.

How labels go wrong

  1. Medicalizing behavior that falls within the range of normal, even at its extreme, or behavior that is rationally driven, is a mistake. The diagnosis carries an implicit belief that the behavior is out of control.

    “trying to medicalize human behavior that falls within the range of normal even when it's an extreme in the range of normal or human behavior that's rationally driven Turning that into a medical diagnosis is a mistake because then there's this implicit philosophical understanding or belief that it's out of control”
    2:00The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026

  2. Over several decades, and then very quickly after modern mass media and the internet, we started saying that even a little bit of something means the full-on disorder.

    “And then slowly and gradually over several decades and then suddenly very quickly after modern mass media and the internet, we started to say, even if you have a little bit of this, you have the full on disorder”
    22:15The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026

  3. A label can first help people understand themselves by putting words to experience. More and more, the label is allowing less insight and less self-understanding.

    “diagnostic labels initially can kind of help people understand themselves better because it's putting words to experience that before they didn't have words to. And what we've seen more and more is that the The diagnostic label is actually allowing less insight and less self-understanding”
    22:41The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026

  4. Hiding a life problem behind a medical diagnosis, and having someone push through it on what is essentially amphetamine at the cost of their physical and mental health, is a detriment to their overall life.

    “if we hide that behind a diagnosis, a medical diagnosis, and we have you push through it at the cost of your physical and mental health by putting you on essentially amphetamine speed, that's a detriment to your overall life, right”
    50:02ADHD Is Not the Only Diagnosis: Differential and Diagnostic HierarchyNov 2025

By diagnosis

  1. Over- versus underdiagnosis is a false dichotomy. For autism, the more obvious answer is that both are true.

    “there's a false dichotomy that either you think it's overdiagnosed and all these people think they have autism when they don't, or you think it's underdiagnosed and there's people suffering who have a diagnosis that's underdiagnosed. And the much more obvious route is that both are true”
    17:24Autism Diagnosis Explained: DSM-5 Criteria, Autistic Traits & the Difficult DifferentialSep 2026

  2. Trauma is over-referenced: everyone thinks everyone has clinically relevant trauma. Yet not enough people are identifying PTSD and giving treatment recommendations specific to PTSD.

    “i think that it's over referenced everyone thinks everyone's got trauma and that's clinically relevant but i don't think that enough people are identifying ptsd and giving the treatment recommendations specifically for ptsd”
    50:46Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21Apr 2025

  3. The less optimistic view of rising ADHD diagnosis: it rests on subjective report, and even with strict DSM criteria, the requirement that it impacts function is not concrete.

    “The less optimistic view will point out that the diagnosis is really based on subjective reporting. And, you know, yes, we are looking at strict DSM criteria. But the problem is the criteria, it's not concrete. You know, it needs to meet the criteria that it's impacting function”
    9:20ADHD... Diagnosis, What is ADHD? Is ADHD real? Do I have ADHD? Is ADHD biological?Sep 2024

In the room

  1. Ask for a free-form narrative, not labels. "Depression" or "anhedonia" gives you no picture of what is going on with this person.

    “When you say depression or anhedonia, I don't have a picture in my head of what's going on or this person. I like a free-form narrative”
    26:08How to Do a Psychiatric Intake | The Art and Science of the First HourSep 2025

From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.