Chapter 11 Psychological Disorders 3831
The danger of overdiagnosis. If you give a small
boy a hammer, the old saying goes, it will turn
out that everything he runs into needs pounding.
Likewise, say critics, if you give mental health pro-
fessionals a new diagnostic label, it will turn out
that everyone they run into has the symptoms of
the new disorder.
Consider attention deficit/hyperactivity disor-
der (ADHD), a diagnosis given to children and
adults who are impulsive, messy, restless, and eas-
ily frustrated and who have trouble concentrating.
Since ADHD was added to the third edition of
the DSM, the number of cases has skyrocketed in
America, where it is diagnosed at least 10 times
as often as it is in Europe. Parents, teachers, and
mental health professionals are all overdiagnosing
this condition, especially in boys, who are labeled
ADHD twice as often as girls. The percentage of
children given the label increases every year, with
rates ranging from 6.2 percent in Utah to 15.6
percent in North Carolina (Centers for Disease
Control, 2013). Critics argue that normal boyish
behavior—being rambunctious, refusing to nap,
being playful, not listening to teachers in school—
has been turned into a psychological problem
(Cummings & O’Donohue, 2008; Panksepp, 1998).
A longitudinal study of more than a hundred 4- to
6-year-olds found that the number of children who
met the criteria for ADHD declined as the children
got older (Lahey et al., 2005). Those who truly had
the disorder remained highly impulsive and unable
to concentrate, but others simply matured. Now
ADHD is being overdiagnosed in adults as well.
Have trouble concentrating? Bored? You could get
diagnosed as having ADHD (Frances, 2013).
In children, an alarming example of overdi-
agnosis involves bipolar disorder, which occurs
primarily in adolescents and adults. Childhood
bipolar disorder, a diagnosis that was based on
small, inconclusive studies, was promoted by one
psychiatrist who received multimillion-dollar pay-
ments from a pharmaceutical company that makes
a powerful, risky antipsychotic drug often pre-
scribed for bipolar children (Greenberg, 2013). As
soon as CBD had a name, the number of diagno-
ses rose from 20,000 to 800,000 in just one year
(Moreno et al., 2007; Leibenluft & Rich, 2008).
“The CBD fad is the most shameful episode in
my forty-five years of observing psychiatry,” wrote
Allen Frances (2013), an eminent psychiatrist who
directed revision of the DSM-IV. The DSM-5
removed this diagnosis.2
The power of diagnostic labels. Once a person
has been given a diagnosis, other people begin
to see that person primarily in terms of the label
and overlook other possible explanations of thecategories, so that clinicians and researchers can
agree on which disorders they are talking about
and then can study and treat these disorders. Its
diverse diagnostic categories include, among oth-
ers, attention deficit disorders, disorders caused
by brain damage, eating disorders, problems with
sexual identity or behavior, impulse-control dis-
orders (such as violent rages), personality disor-
ders, psychotic disorders such as schizophrenia, and
sleep-wake disorders.
The DSM has had an extraordinary impact
worldwide. Virtually all textbooks in psychiatry
and psychology base their discussions of mental
disorders on the DSM. With each new edition of
the manual, the number of mental disorders has
grown. The first edition, published in 1952, was
only 86 pages long and contained about 100 dis-
orders. The fourth edition, published in 1994 and
slightly revised in 2000, was 900 pages long and
contained nearly 400 mental disorders. The fifth
edition, DSM-5, which was published in 2013, is
947 pages long and contains about the same num-
ber of disorders.
A primary reason for this explosion of diag-
noses is that insurance companies require clini-
cians to assign their clients an appropriate DSM
code number for whatever the client’s prob-
lem is—from trouble sleeping to trouble giving
up coffee, from upsetting conflicts to crippling
emotional problems. That means that compil-
ers of the manual are motivated to add more
diagnoses so that mental health professionals
will be compensated and patients won’t have
to pay out of pocket (Greenberg, 2013; Zur &
Nordmarken, 2008).
The DSM affects you in ways you prob-
ably can’t imagine. Its influence is reflected in the
casual way that people today talk of someone’s
being “bipolar,” having “a touch of Asperger’s,”
“being a borderline,” suffering from PTSD, or
claiming to have learned they were “ADHD” at
the age of 40. As we will see, some of its diagnos-
tic categories, such
as childhood bipo-
lar disorder (CBD),
became cultural fads
that spread like wild-
fire, causing much
harm before the fires
were extinguished.
Because of the DSM’s powerful influence, there-
fore, we want you to understand its limitations
and some of the problems that are built into the
effort to classify and label mental disorders.
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