Are People getting sicker or is medical science expanding the definition of old conditions? Consider ADHD, irritable bowel syndrome, Tourette’s, Ehlers–Danlos syndrome, autism, postural orthostatic tachycardia syndrome, dyslexia and dyspraxia, mast cell activation syndrome and Chiari malformation? What about depression, anxiety, and a whole host of other mental health syndromes? These maladies have various symptoms in common with significant overlap. Many are also found in other diseases and in people with no disease at all. This from WSJ:
What all of these diagnoses have in common is that they all have a severe form with a demonstrable pathology, like a genetic or biochemical abnormality, that’s been recognized for decades, but have expanded in the past 20 to 30 years to include mild cases with no proven pathology. While there has been no real change in the share of people suffering from the severe form of these diseases, sufferers with the milder form have shot up dramatically. For example autism diagnoses in the U.K., where I work, rose by 787% between 1998 and 2018.
Because the line now between normal and abnormal for these diagnoses is often faint, some physicians fear that these labels pathologize healthy bodies, particularly in young people.
The Wall Street Journal writer is questioning whether it is healthy to saddle people with a diagnosis for a milder form of a condition and pathologize it as a medical disease? Probably not.
It’s easy to see how it might be counterproductive. A patient who is told they have an abnormal heart-rate response to standing may grow cautious about sudden movements and spend more time sitting down. This inactivity then makes the body respond more sluggishly to changes in posture, making a fall in blood pressure on standing more likely, increasing the chances of fainting. It’s a vicious cycle.
What is normal, what is borderline normal, and what is abnormal is not always a fine line. Often patients who are told they have various conditions have symptoms so mild as to be hard to quantify. Often there is no pathology for a minor set of symptoms. Some disease names did not even exist until 30 years ago.
Moving the parameters of ‘normal’ not only encourages people to seek medical attention for something they might not have medicalized before, it can also inspire some to unconsciously conform to a diagnosis’s description. Basically, a label can encourage people to register symptoms they might have otherwise dismissed.
Controversial disorders for which there is no proven pathology, including autism, ADHD and anxiety, often cluster together. Yet not enough people are asking how a growing group of young people like Darcie could be so unlucky as to have multiple apparently unrelated diagnoses. These disorders cannot be explained by a shared pathology—otherwise people with severe autism and severe ADHD would have the same high rate of hEDS and PoTS as those with mild autism and mild ADHD. They don’t.
Being labeled as having some obscure, possibly made-up disorder, often leads sufferers to join online support groups, where they learn about other potential problems. This can lead patients to be hyper attentive to symptoms, both real and imagined.
Embracing a group identity that centers around illness can pre-empt an identity that concentrates on recovery.
For those with moderate to severe problems, the benefits of a diagnosis are clear. My concern is with expanding diagnostic labels to include people at the mild end. The milder a medical problem is, the smaller the impact of any intervention and the greater the risk of harm from treatment.
Basically, slapping a medical diagnosis on borderline problems runs the risk of making us feel sicker, even if not actually sick. It goes beyond being a hypochondriac. If you have a set of overlapping mild, occasional symptoms you can easily get an official diagnosis, that legitimizes your sickness. That is not always a good thing if some of the symptoms are psychosomatic. I have known someone like this, and the damage was lifelong.
Read more at WSJ: We Are Turning Too Many People Into Medical Patients