The Risks of Diagnostic Labelling in Adolescents and Young People

Consider a teenager who watches a short video about attention difficulties and announces to friends that they are "so ADHD". Now consider a teenager who hears the words "generalised anxiety" in a clinic room and, within weeks, begins introducing herself as "the anxious one". Parents who have watched this happen often feel torn. A name for what a young person is going through can be a genuine relief, and it can also begin to define them.

For some adolescents, a diagnosis explains years of struggle, opens the door to practical support, and ends the sense of being the only person who feels this way. For others, the same label becomes a ceiling, a source of shame, or a script they feel obliged to follow. The difference rarely lies in the label alone. It lies in how the label was reached, how it was explained, and how the people around the young person respond to it.

This article looks at the risks of diagnostic labelling during adolescence and young adulthood, covering formal diagnoses, labels young people apply to themselves, and labels applied by others. It is not an argument against assessment or diagnosis, and it cannot replace an assessment by a qualified clinician. It is psychoeducation, and where a statement reflects clinical judgement rather than a research finding, the article says so.

If you are still deciding whether an assessment is the right step, we explore that decision in more detail in Does Your Child Need a Psychological Assessment? This article concentrates on a different question: what happens to a young person's identity, relationships, and behaviour once a label is in play.

What a Diagnostic Label Is, and What It Is Not

A formal diagnosis is a clinician's judgement that a pattern of experience fits the recognised criteria for a condition. At its best, it works as shorthand: this cluster of difficulties has been seen before, and something is known about what helps. It describes a pattern. It does not explain the whole person, predict their future, or measure their worth.

In everyday life, three kinds of label circulate, and each carries different risks.

• A formal diagnosis given after assessment by a qualified clinician.

• A self-applied label, adopted after recognising oneself in an online description, a friend's experience, or a questionnaire.

• A label applied by others, such as "the anxious one", "the lazy one", or "the problem child", used informally by family, peers, or school.

All three can shape how a young person sees themselves. The informal ones are often the least examined, because no clinician is present to place them in context or to say what they do not mean.

Why Adolescence Makes Labels Especially Powerful

Adolescence is the stage of life when identity is under construction. Young people try out ways of being, watch closely how their peers respond, and form a view of who they are and who they might become. This is general developmental psychology rather than the finding of a single study, but it helps explain why a label offered during these years can be absorbed so quickly. It arrives at the moment a young person is looking for words to describe themselves.

Peers matter in a particular way. A systematic review of 27 studies of young people aged 8 to 19 who were using mental health services concluded that the effects of stigma relate to the need to protect social identity and standing among peers (Ferrie et al., 2020). Some young people in the reviewed studies limited contact with peers who had mental health problems in order to feel more accepted by their social group. A label, in other words, does not simply sit inside a young person. It changes the social landscape they have to navigate.

A limitation is worth stating. That review concerned young people who were already in contact with services, so it speaks most directly to labelled young people rather than to adolescents in general.

How a Label Can Reshape the Sense of Self

From "I Have Anxiety" to "I Am an Anxious Person"

The difference between having a difficulty and being that difficulty is small in grammar and large in effect. A young person who thinks "I am experiencing anxiety" can still picture a self that exists alongside it. A young person who concludes "I am an anxious person" has made the difficulty part of their identity, and identity is far harder to shift than a pattern of experience.

Foulkes and Andrews (2023) proposed what they call the prevalence inflation hypothesis to describe one way this might occur across a population. Their argument is that awareness efforts help people recognise symptoms that were previously overlooked, which is a real benefit. They also suggest that awareness may lead some people to label mild distress as a mental health problem, and that the label can then shape self-concept and behaviour in ways that worsen symptoms. Their example is mild anxiety being treated as a disorder, leading to avoidance, which in turn strengthens the anxiety.

The authors presented this as a hypothesis to be tested, not as an established finding, and it should be read in that spirit. It is a useful lens rather than a conclusion.

Avoidance, Reduced Confidence, and Lowered Expectations

In counselling work with young people, a recurring concern is that a label becomes both an explanation for everything and permission to avoid anything difficult: "I cannot do the presentation, I have anxiety." This is a matter of clinical judgement rather than a settled research finding. Understanding a difficulty is helpful. Being limited by it is a different experience, and the two are easy to confuse.

Adults can lower expectations in the same way. When parents, teachers, or coaches begin to read every behaviour through the label, a young person may receive fewer opportunities to try, struggle, and recover, which are the experiences through which confidence is built. This is general psychoeducation, and it applies to well-meaning adults as much as to anyone else.

Diagnoses Are Not Always Stable

Adolescents change quickly, and so do their patterns of difficulty. In a review of overdiagnosis among children and adolescents in developed countries, Merten et al. (2017) noted that studies re-evaluating earlier diagnoses found many changes, although those designs cannot show whether the original diagnosis was too generous or too cautious. They also pointed to overlapping symptoms between some conditions, such as ADHD and bipolar disorder, which can make diagnosis harder.

None of this means diagnoses are unreliable as a rule. It does suggest that a diagnosis is best treated as the clinician's best current description rather than a final verdict, and that a young person benefits from hearing it explained that way.

Stigma, Shame, and Secrecy

The same review of 27 studies linked stigma among young people to a cluster of outcomes: accepting or rejecting diagnostic labels, poorer mental health, feeling socially rejected or pressured to fit in, avoiding help, shame, and keeping difficulties or medication use secret (Ferrie et al., 2020). Stigma and labelling are not identical, but the two are closely connected, because a diagnosis can make a young person newly aware of how others might judge them.

It is telling that rejecting a label appears alongside accepting it. This fits the authors' wider conclusion that these responses are about protecting social identity. A teenager who refuses to accept a diagnosis may be protecting themselves from the stigma attached to it, even if that means turning away from support that could have helped.

The review also found that family members and healthcare professionals shaped young people's negative views of mental illness. This places a quiet responsibility on adults. The way a parent says the word, the tone a clinician uses to explain a result, and the way a relative reacts at a family gathering all become part of what the label means to the young person.

Secrecy brings its own difficulties, because a young person who is hiding their struggles may find it harder to ask for help when they need it. If medication has been prescribed, any decision about taking or stopping it belongs with the prescribing doctor, not with the young person or the family alone.

Labels, Schools, and the Singapore Context

Singapore is widely described as a high-achieving, examination-focused environment, and this is a general observation rather than a research finding. In a setting where academic performance is closely watched, families may find themselves weighing a label's usefulness, such as access to support or accommodations, against concern about how it will be seen by teachers, peers, and future institutions. Both concerns are reasonable, and neither is a reason to avoid an assessment that is genuinely needed.

How adults evaluate children once a label is attached is discussed further in Does Your Child Need a Psychological Assessment?. The practical lesson is to ask, before an assessment begins, what the resulting report will contain, who will receive it, and how it will be explained to the young person and, if the family chooses, to the school.

Cultural background also shapes how labels are received. Some families avoid mental health language altogether because of how it may be perceived, while others welcome a diagnosis as a way to unlock help. You can learn more about how counselling approaches this in culturally sensitive counselling in Singapore.

Social Media and the Rise of Self-Diagnosis

For many young people, short-form video is now the main place they meet mental health vocabulary. A study by Yeung et al. (2022) analysed the 100 most popular TikTok videos under the #adhd hashtag and classified just over half of them (52 of 100) as misleading. Videos made by healthcare professionals were far more likely to be rated useful, at 7 of 11 (63.6 per cent), than those made by non-professionals, at 14 of 89 (15.7 per cent).

The study has clear limits. It examined one hashtag on one platform at one point in time, and it assessed the quality of the content rather than what young people did with it. It cannot tell us how many teenagers self-diagnose, or whether watching such videos changes their behaviour.

It does illustrate a problem that clinicians recognise. Many online descriptions list experiences that are common, such as difficulty concentrating, low energy, or discomfort in groups, and nearly every teenager recognises these at times. Recognising yourself in a description is not the same as meeting the threshold for a condition. Clinicians consider how long a pattern has lasted, how intense it is, how much it interferes with daily life across settings, and whether a different explanation fits better, such as poor sleep, stress, trauma, or a learning need.

Self-recognition is not always mistaken, and it would be unfair to treat it that way. Merten et al. (2017) noted that rising rates of diagnosis may partly reflect greater awareness, better detection, and changes in diagnostic criteria, not only overdiagnosis. A young person who recognises themselves in an accurate description may be right, and may seek help because of it. The aim is to treat self-recognition as the beginning of a conversation rather than its conclusion.

When a Label Helps, and What the Evidence Can and Cannot Tell Us

A mixed-method systematic review of how young people, carers, and professionals view psychiatric diagnosis in childhood and adolescence organised its findings into three themes (Gill et al., 2024).

• Diagnostic subjectivity, which covers questions about accuracy, usefulness, potential harm, and alternatives such as psychological formulation.

• Utility, meaning whether a diagnosis helps young people obtain support and understand themselves.

• Stigma, including the negative experiences and discrimination a diagnosis can bring.

The authors also concluded that the evidence base is limited and gives little attention to the experience of young people themselves. They noted that differing views among professionals, carers, and young people could affect quality of life, access to healthcare, and identity development. In plain terms, the research cannot yet tell us which young people will benefit from a diagnosis and which will be harmed by it.

The potential benefits are real, and this article does not argue otherwise. A diagnosis can open access to support, give a young person and their family shared language, and relieve the belief that something is simply wrong with them. This is general psychoeducation rather than a specific research finding, but it is a large part of why people seek assessment. Delaying an assessment that is needed can also delay support.

The evidence on overdiagnosis is similarly limited. Merten et al. (2017) found the evidence too weak to draw firm conclusions about how widespread it is. They identified only one study with a design capable of demonstrating overdiagnosis, which concerned ADHD, and in which clinicians were more likely to diagnose the condition when criteria were not met than to withhold it when they were. The study used case vignettes with German child and adolescent psychotherapists, which limits how far its findings can be generalised.

The same review also described relative age effects, where children born just after a school cut-off date are more likely to receive an ADHD diagnosis. It is a useful reminder that diagnosis is a human judgement made in context, which is exactly why the quality of the assessment matters as much as the decision to seek one.

Signs That a Label Is Becoming Limiting

The following signs come from clinical experience rather than from a single research study. A single sign does not prove that a label is causing harm, but a pattern is worth discussing with the clinician or a counsellor.

• The label is used to explain every difficulty, including ordinary ones such as a poor night of sleep, a difficult week, or an argument with a friend.

• Avoidance is widening, with more tasks and situations being declined "because of" the label.

• Other people use the label to predict, excuse, or dismiss the young person's behaviour.

• Mentioning the diagnosis brings shame, secrecy, or visible distress.

• The young person has withdrawn from friends or activities since receiving the label.

• The label has become the main way the young person describes themselves, and they feel unable to change it.

If withdrawal from school, friends, and daily life has become prolonged, our article on youth withdrawal in Singapore explains what clinicians look for and when to seek a proper clinical conversation.

How Parents and Carers Can Talk About a Diagnosis

Involve the Young Person

Gill et al. (2024) observed that research gives little attention to young people's own experience, and the same gap can appear at home. Ask what the label means to your teenager, what they think it explains, and what worries them about it. Their answers will often differ from what adults assume.

Present It as a Description, Not a Verdict

A diagnosis can be explained as a description of a pattern that helps people choose support, and one that may change as the young person develops. It helps to say plainly what the label explains and what it does not. A young person who hears "this describes part of your experience" is likely to take it differently from one who hears "this is what you are".

Respect the Language the Young Person Prefers

Preferences about wording vary. Some people prefer to say that they have a condition, while others, including some autistic people, prefer identity-first language such as "I am autistic". Asking your teenager which wording feels right to them is a simple way to show respect and to keep the label from being imposed.

Respond to Self-Diagnosis With Curiosity

When a teenager announces a self-diagnosis, an argument rarely helps. A question such as "What about that description felt like you?" keeps the conversation open and gives you information about what they are actually experiencing. If the difficulties persist across settings and affect daily life, an assessment by a qualified clinician is a reasonable next step, and the self-recognition can be treated as a useful starting point.

Keep Expectations and Warmth in Place

A label explains a need. It is not a reason to withdraw belief in the young person's capacity to grow. Keeping the same warmth and the same reasonable expectations helps the young person see the diagnosis as something they can work with, not something that limits them.

Questions Worth Asking the Clinician

• What does this label describe, and what does it not describe?

• How confident are you in this conclusion, and what else was considered?

• Could this description change as my teenager develops?

• Who will see the report, and how will the school be told, if at all?

• What support follows, and does it depend on the label?

• Can the findings be explained to my teenager in plain language that includes their strengths?

For wider guidance on supporting a young person through a difficult period, see how to support someone struggling with mental health in Singapore.

What Counselling Can Offer Without a Label

Counselling does not require a diagnosis. For many young people, being able to talk through a stressor, a transition, or a persistent pattern of feeling with an adult who is not defined by the label is valuable in itself. Our guide to youth counselling in Singapore for parents explains what to expect.

A counsellor can help a young person build a formulation, which is an understanding of how their difficulties developed and what keeps them going within the context of their own life, family, school, and relationships. Several approaches can be used to build one. Person-centred therapy places the young person's own experience at the centre. For a deeper explanation of an approach that separates the person from the problem, see narrative therapy. Neither requires a label in order to begin.

Young people who are working out who they are, and who find that a label has complicated that process, may also find it helpful to explore identity confusion in a safe and unhurried setting.

Counselling can also help identify when a formal assessment would add something useful, and the counsellor can say so honestly rather than reaching for the same tool every time. If you would like to talk through whether counselling or assessment is the right starting point for your teenager, you can read about adolescent and youth counselling, review what happens at an initial counselling visit, book a session, or contact The Bridge Counselling with questions.

When Urgent Support Is Needed

This article is general psychoeducation and is not suitable for a situation in which a young person is in crisis or at risk of harm. In that situation, please use the emergency resources page or contact emergency services immediately. Urgent counselling sessions are also available when a family needs support quickly.

Holding a Label Lightly

A diagnostic label is most useful when it opens doors, such as support, understanding, and shared language, and least useful when it closes them. The research on this question is still developing, and the honest summary is that outcomes depend on how accurately a label is reached, how thoughtfully it is explained, and how the people around the young person respond. Holding a label lightly means taking it seriously enough to act on it and lightly enough to let the young person remain larger than it.

Frequently Asked Questions