“Sticky Labels” and Overlooking Physical Illness—Researchers Highlight Risks of Psychiatric Diagnosis

This week, Mad in America explores four articles around problems with psychiatric diagnoses. The first study finds that childhood diagnoses of autism and ADHD can stick to service users even after they no longer meet diagnostic criteria or require support. The second article argues that DSM-5 diagnostic criteria for ADHD are vague, arbitrary, and fail to make a meaningful distinction between normal and “pathological” behaviors. The third and fourth studies highlight how psychiatric diagnosis can lead treatment teams to interpret physical symptoms as primarily related to poor mental health, delaying treatment of underlying physical ailments.

Childhood Autism and ADHD Diagnoses May Become “Sticky” Labels With Lasting Consequences

A new Swedish study published in Social Science & Medicine finds that childhood autism and ADHD diagnoses can persist into adulthood despite service users no longer meeting diagnostic criteria or requiring support. This research, led by Rose-Marie Lindkvist from Lund University in Sweden, reports that “sticky” diagnoses can negatively affect service users’ careers, healthcare, and self-identity. Most participants seeking to overturn their autism or ADHD diagnosis through a new pilot project were successful.

The goals of this research were to examine service user motivations in having their diagnosis reassessed and their experience of receiving, living with, and attempting to undo these diagnostic labels. The authors recruited 14 people that requested a reassessment of their autism or ADHD diagnosis to participate in semi-structured interviews around their experience of diagnosis and reassessment. The participants were diagnosed between the ages of four and 18. Of the 14 participants, 12 were successful in having their diagnosis formally removed.

Participants described their original diagnosis as a process largely driven by their parents, teachers, and other school personnel. They reported feeling confused, unheard, and coerced. One participant reported that they felt like the adults were “fishing for faults” rather than attempting to understand their individual situation. Many participants believed their symptoms were related to difficult circumstances such as abuse and bullying rather than signs of a neurodevelopmental disorder.

Participants described both benefits and drawbacks of their diagnoses. Benefits included access to supportive teachers, specialized schools, smaller class sizes, and financial aid. One participant said “finally, I was one of the top students the year I graduated. I never would have done that without my ADHD boarding school.” Drawbacks of diagnosis included the negative effects of prescribed drugs, segregation from peers, and a focus on their behavior rather than the underlying social and family issues. One participant reported:

The authors identified four themes around participants’ motivation for seeking to undo their diagnostic labels. (1) “Having capacity” involved participants feeling that they had grown into independent adults capable of managing their own lives and had outgrown their childhood diagnosis. (2) “Being no different” was related to participants realizing they were similar to their peers and no longer needed the support, resources, or treatment that accompanied their diagnosis. Under the theme (3) “demanding fairness,” some participants believed their initial diagnosis was improper and that their behaviors were related to difficult circumstances rather than an underlying disease. (4) “Removing barriers” involved participants seeking to shed their diagnostic label in order to pursue their careers, avoid restrictions such as having to get special medical clearance to get a driver’s license, and avoid physicians attributing physical ailments to their psychiatric diagnosis.

This study had three main limitations. The participants actively sought reassessment of their diagnosis. This means their experiences may not be representative of the larger population with autism and ADHD diagnoses. The participants were all recruited from the Skåne region of Sweden, limiting generalizability. As participants were, in some cases, recalling experiences from their distant past, the data could have been biased due to misremembering.

Researchers Question the Validity of Current ADHD Diagnostic Criteria

A new article published in Acta Neuropsychiatrica argues that DSM-5 criteria for ADHD diagnosis are arbitrary, vague, often overlap with other diagnoses, and are dependent on context. Lead author Kinga Szymaniak from the University of Sydney in Australia contends that these issues significantly undermine the reliability and validity of ADHD diagnosis, make ADHD research less precise, and calls treatment decisions into question.

According to the authors, ADHD diagnosis as outlined in the DSM-5 has arbitrary thresholds. A child needs to demonstrate six symptoms of inattention or hyperactivity to receive a diagnosis, while people 17 years old and older need to have five. However, these thresholds are not tied to any meaningful biological or clinical boundary. There is sometimes little difference between people that fall below this threshold and those above it. It is also possible for two people diagnosed with ADHD to have very different symptoms and struggles.

The criteria used to assess ADHD behaviors are vague. Terms such as “often,” “difficulty,” and “careless mistakes” rely on subjective assessment and can be interpreted differently from one clinician to another. Some of these symptoms also have significant overlaps with other diagnoses such as depression, bipolar disorder, and anxiety disorders. The authors note that people diagnosed with ADHD very often have other mental health diagnoses. The current cutoff requiring symptoms to have started before age 12 is also arbitrary according to the authors.

Symptoms of ADHD, such as “gets distracted,” “procrastinates,” and “loses things” significantly overlap with normal behavior. The DSM-5 does not make a meaningful distinction for when these ordinary behaviors become “pathological.” These symptoms often overlap with one another. For example “blurting out an answer” and “difficulty waiting one’s turn” could describe the same behaviors. These symptoms can also be heavily context dependent. The DSM criteria do not capture how factors such as motivation, interest, and environment can affect behaviors.

The authors conclude that the DSM-5 criteria for ADHD diagnosis are far too imprecise and that these problems cannot be addressed by simply reworking the current checklist.

Psychiatric Diagnoses May Delay Recognition of Underlying Physical Illness

A pair on new case studies published in Frontiers in Psychiatry highlights how a psychiatric diagnosis can delay treatment of physical ailments. The first study, led by Yuexi Liang from the Shanghai Jiao Tong University School of Medicine in China, reports on a patient that was initially diagnosed with depression. This patient’s increasing physical symptoms were attributed to his depression diagnosis, but a biopsy would later confirm a diagnosis of systemic amyloidosis and heart failure.

The second study, led by Yirui Dai from the Guangzhou University of Chinese Medicine, reports on a patient that was diagnosed with somatic symptom disorder and treated with multiple psychiatric drugs as his condition deteriorated. Later, it is was discovered that his symptoms were the result of a vitamin B12 deficiency.

Both studies aimed to illustrate diagnostic overshadowing, a situation in which clinicians misinterpret physical complaints as manifestations of a psychiatric diagnosis. The authors also wanted to highlight clinical features that should prompt a reevaluation of purely psychiatric explanations for physical symptoms. Both studies were observational reports of one patient’s clinical course using psychiatric and medical evaluations, lab reports, imaging reports, biopsy results, and other medical records.

The first study followed a 57-year-old male patient that was initially diagnosed with depression after reporting insomnia, generalized pain, low mood, anhedonia, appetite loss, and 20kg weight loss. He was prescribed an antidepressant and an atypical antipsychotic. His condition worsened over the next few months with low blood pressure, fainting, pain when swallowing, abnormal lab results, and heart failure. The low blood pressure was initially thought to be an effect of the antipsychotic, but taking him off the drug did not improve his condition and he later developed fainting episodes.

The authors note that even after persistent low blood pressure and fainting episodes, the treatment team did not do formal orthostatic blood pressure measurements which would have revealed that the low blood pressure was not linked to the antipsychotic. After several abnormal lab results, his doctors performed a biopsy of his kidney, which resulted in a diagnosis of amyloidosis. After receiving treatment for the amyloidosis and heart failure, the patient’s mood symptoms improved substantially.

The second study follows a 39-year-old male patient that was initially diagnosed with anxiety and somatic symptom disorder after complaining of gradually worsening numbness, dizziness, fatigue, anxiety, insomnia, and low mood. He was prescribed two antidepressants and two antipsychotics. His symptoms worsened and new symptoms appeared. Eventually a lab test showed that his vitamin B12 levels were critically low. After starting treatment with B12 supplements, his physical symptoms improved and his depression and anxiety scores fell.

These studies had several limitations. As they were case studies of a single patient, these results are meant to highlight issues with diagnostic overshadowing and are not generalizable to all people with these psychiatric diagnoses. Follow-up was limited. The retrospective design of these studies may make it seem like the initial symptoms were clearly related to an underlying physical ailment. This connection may not have been apparent.

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Dai, Y., Wang, Y., Chen, Y., Li, J., Jia, X., Cai, D., Zhang, G., Guo, H., Wei, S., Wang, J., & Qin, X. (2026). Case report: Subacute combined degeneration misdiagnosed as a primary affective disorder: Diagnostic pitfalls and clinical red flags. Frontiers in Psychiatry, 17. (Link)

Liang, Y., Li, W., & Liu, L. (2026). Case report: Diagnostic overshadowing in a patient with major depressive symptoms later diagnosed with systemic amyloidosis. Frontiers in Psychiatry, 17. (Link)

Lindkvist, R.-M., Niklasson, K., Lidström, A., Nilsson, M., Eberhard, S., Gustafsson, P., Lundström, S., Råstam, M., & Eriksson, L. (2026). Diagnostic stickiness and shifting relevance: Reassessing autism spectrum disorder (ASD) and/or attention-deficit hyperactivity disorder (ADHD) diagnoses. A qualitative interview study. Social Science & Medicine, 405, 119549. (Link)

Szymaniak, K., Bell, E., Shivakumar, G., & Malhi, G. S. (2026). Breaking down the attention-deficit/hyperactivity disorder construct to build a valid diagnosis. Acta Neuropsychiatrica, 38. (Link)