Overdiagnosis, misdiagnosis, diagnostic inflation and overmedicalisation: why the differences matter
- Levi Pay
- 2 days ago
- 3 min read
In higher education, conversations about student mental health are increasingly featuring, and potentially being shaped by, terms such as overdiagnosis, misdiagnosis, diagnostic inflation and overmedicalisation.
They are sometimes used as if they mean the same thing – but this misses important differences. And when we treat these related but different terms as interchangeable, or when we use these terms without thinking through their meaning, we can easily end up having the wrong conversation.
For example, when people hear the word overdiagnosis, they may assume others believe they have been given a diagnosis for a condition they do not actually have. But that is not what overdiagnosis means.
Overdiagnosis refers to situations where a diagnosis may be correct according to the diagnostic criteria, but still prove unnecessary, unhelpful, or even harmful – particularly over the longer term.
That distinction changes the conversation completely.
Instead of getting stuck in a debate about whether someone “really has” a condition, we can ask more useful questions:
Does this diagnosis help the student make sense of their experience and enable them to access appropriate support?
Is the support they access as a result helping to empower them or is it, in some ways, having a disempowering effect?
Could the diagnosis also shape their expectations, their sense of self, or their sense of what is possible in ways that are not wholly helpful?
Is the diagnosis helping to move the person closer towards positive life outcomes – whether relating to their studies, career, relationships, or broader life outcomes? Or is it fixing very defined ideas in them about the nature of, and about appropriate responses to, the difficulties they face? In what ways is it helpful or not helpful?
Similarly, misdiagnosis, diagnostic inflation and overmedicalisation are related but distinct ideas. Each raises different questions about student support, mental health services, disability provision, institutional culture and the boundaries we draw as a society.
So, how can we best understand these terms?
Understanding these differences helps us move beyond simplistic arguments. It allows us to engage more thoughtfully with the complexity of what students are experiencing – without denying that many students are struggling, and without assuming that every form of struggle is best understood through a clinical lens.
Because these debates are rarely about whether distress is real.
They are about how we understand that distress, how we respond to it, and where we draw the boundaries between illness, distress, difference and the ordinary challenges of being human.
A student may be having a normal stress response to a genuinely stressful situation: exams, academic pressure, uncertainty about the future, bereavement, loneliness, family difficulties, or any of the experiences that can challenge us at different points in life. In some situations, a clinical framework may help a student to recover or to feel more in control. In other cases, seeing things through the same clinical lens may narrow the conversation too quickly, or leave some students seeing their challenges as fixed and hard-wired into them. Believing that our difficulties are a product of the biology of our brains can be surprisingly disempowering if we start to discount the idea that what we do - our choices and our actions - can really shape how we respond to life's challenges.
For those of us supporting students in higher education, these reflections matter. They can help us respond with more nuance, more confidence and more care for what really works.
More fundamentally, as conversations in higher education and beyond increasingly turn to concepts such as overdiagnosis, overmedicalisation and diagnostic inflation, we need to ensure that we are at least working from a shared understanding of what these terms mean. Our view is that these are serious and growing issues for students and for the wider population, although we recognise that others will take a different view. However, whatever our perspectives on the extent to which these trends are occurring, without clear and shared definitions, our conversations are unlikely to be especially fruitful.
We always seek to make sure these distinctions underpin all of the training and resources we deliver to help the HE sector feel confident in managing more complex student presentations and interactions.
Our two courses on Managing distressed students and Balancing compassion with boundaries when working with students are focused on how we can best navigate a range of challenging interactions and support students in ways that are boundaried and effective.
