Author(s) :

Samarth Dhingra.

Volume/Issue :

Abstract :

Over recent decades, diagnostic rates for conditions including depression, attention-deficit/ hyperactivity disorder (ADHD), and autism have risen sharply across high-income countries, prompting debate over whether the increase represents overdiagnosis (the pathologizing of normal distress) or the overdue recognition of suffering that earlier systems failed to detect. This narrative review synthesizes epidemiological, clinical, and public-health literature across three thematic axes to weigh the competing explanations. Because rising diagnoses have been indexed by heterogeneous measures, the review defines its primary outcome as the change in diagnostic rates and distinguishes it from related constructs (symptom prevalence, treatment access, severity, and population burden), specifying how each evidence type bears on the question. First, it examines evidence that diagnostic instruments historically calibrated on narrow demographics rendered large populations (women with autism, racial and ethnic minorities, and the stigma-deterred) invisible to clinicians, producing decades of underrecognition now being corrected. Second, it considers data indicating that the psychological environment has measurably deteriorated, drawing on rising suicide mortality, converging adolescent indicators after 2010, the erosion of protective social infrastructure, and the pandemic-associated surge in depression and anxiety. Third, it identifies the specific domains in which overdiagnosis is genuine, most notably the relative-age effect in ADHD and pharmaceutical demand effects, while weighing meta-analytic evidence that diagnostic criteria have not, on average, broadened across editions of the Diagnostic and Statistical Manual. Taken together, the reviewed evidence indicates that although overdiagnosis is real in identifiable corners of the system, corrected underrecognition and genuine environmental deterioration appear to account for a larger share of the observed increase. Rising rates are thus more consistent with a system beginning to detect previously unmet need than with widespread diagnostic excess, although the two processes are not mutually exclusive.