Psychiatric diagnosis on the edge: is there evidence of benefit?

Psychiatric diagnoses are clinical constructs based on interpretation of symptoms and associated dysfunction within the specific socio-cultural context. They are meant to serve as useful tools for therapeutic purposes. Diagnoses, however, can also have unintended consequences, like stigmatization and exposure to unnecessary treatment. We here bring attention to the need to assess the potential benefits and harms of psychiatric diagnoses in children and adolescents in situations of uncertainty about the presence of underlying psychopathology on the edge between normalcy and psychopathology. In particular, considerations are being made regarding ADHD, clinical high risk for psychosis, and suicidal behavior. The risk of stigmatization from psychiatric diagnoses and the possible negative unintended consequences of increasing public mental health awareness and self-diagnosis are discussed. Given that formulating a diagnosis can be considered in itself a therapeutic intervention, the potential benefits and harms of formulating psychiatric diagnoses warrant systematic assessment.