The iatrogenic power of labeling medically unexplained symptoms: A critical review and meta-analysis of “diagnosis threat” in mild head injury.

Abstract

Authors have claimed that exposing individuals who report ambiguous symptoms with diagnostic labels may have an iatrogenic (i.e., harmful) effect. Experimental studies on what has been dubbed diagnosis threat have, indeed, documented impairments on cognitive performance tests and symptom self-reports among individuals whose attention has been called to such labels and their connotations. What is the clinical potential of these laboratory observations? To address this issue, we conducted a review and meta-analysis of published diagnosis threat studies. All these studies relied on individuals reporting a mild head injury in their history (k = 6 data sets; N = 309), a diagnosis known to be accompanied by lingering medically unexplainable symptoms in a subset of individuals. The obtained weighted effect size was modest (d = 0.19, 95% confidence interval [−0.04, 0.41]), with a more pronounced effect on cognitive measures (d = 0.25) than on symptom self-reports (d = −0.05). Taken together, our findings indicate that strong claims about the harmful potential of diagnostic labels may need to be reconsidered. We conclude this article with a recommendation for future research on iatrogenic clinical practices surrounding medically unexplained symptoms. Namely, to go beyond the study of diagnostic labels and systematically target additional sources that may encourage and maintain nonadaptive illness behavior in patients, including the use of premature interventions, excessive diagnostic testing, (intentional) symptom exaggeration, and the presence of secondary motives.

COVID-19: Impact of Diagnosis Threat and Suggestibility on Subjective Cognitive Complaints

“…More specifically, highly suggestible recovered COVID-19 patients were found to be particularly prone to the effects of diagnosis threat in their reporting of cognitive dysfunction. Self-reports of everyday cognitive functioning, a key element in the medical interview, may therefore be prone to the effect of diagnosis threat and related non-neurological factors (e.g., clinician driven iatrogenic processes; Niesten et al, 2020 ).…”

Performance Validity and Outcome of Cognitive Behavior Therapy in Patients with Chronic Fatigue Syndrome

“…Besides factitious disorder (i.e., intentionally feigning symptoms for internal motives), various psychological constructs are suggested that might result in invalid performance (Silver, 2015). Empirical studies on this topic, however, are limited and focused, for example, on "diagnosis threat" (for a critical review, see Niesten, Merckelbach, Dandachi-FitzGerald, & Jelicic, 2020), perceived injustice (Iverson, Terry, Karr, Panenka, & Silverberg, 2018), and the health locus of control and self-efficacy (Armistead-Jehle, Lippa, & Grills, 2020). Preferably, these constructs are measured independently (of self-reporting) and at least using a check on the validity of self-reported measures.…”

The biopsychosocial model in paediatric clinical practice—An interdisciplinary approach to somatic symptom disorders

“…10 Connecting processes from the cellular level, via the organs, to the psyche and social environment, the BPS model underlines that healthcare professionals can influence all of these levels through examinations and treatment, both positively and negatively. 11,12 This implies that iatrogenic factors pose a separate risk in the relationship between patients and the healthcare providers. General systems theory forms the basis for juxtaposing and evaluating psychological and social factors in line with biological data.…”