Overdiagnosis and underdiagnosis
There's a healthcare conversation we need to be having
I recently read a review of The Age of Diagnosis, praising the book and calling Christians to be more caring, for our leaders to be... more pastoral, frankly. To hold the tension between relying on modern medicine while addressing the spiritual dimensions of health, of how we experience suffering as humans.
I am not saying this is bad advice or that the review’s call to church leadership is unwarranted. I look forward to reading the book. I’ve seen tons of praise for the writing and the content, and it sounds like O’Sullivan raises some valuable points—about how medicine increasingly labels normal human experiences as medical conditions, how diagnoses can shape identity, and how modern culture sometimes encourages people to seek out labels in pursuit of validation, support, or even community.
While I don’t disagree that these are important conversations that require an immense amount of thoughtful nuance, I also can’t shake an urgent feeling that we’re missing something critical.
Because when we talk about overdiagnosis, overdetection, and overmedicalization, we would be remiss not to talk about underdiagnosis, underdetection, and lack of access, too.
I feel viscerally uncomfortable when talking points trend toward the assumption that everyone is over-medicalized, over-diagnosed, and over-treated. Because that’s just not the full picture.
Many people—especially women, people of color, and lower-income individuals—actually struggle to get a diagnosis at all. Conditions like chronic pain, mental health disorders, and autoimmune diseases are consistently underdiagnosed in these groups. So is autism.
And for many, getting a diagnosis isn’t about seeking identity—it’s about survival. It’s about being taken seriously. It’s about accessing care in a system that often refuses to provide treatment unless there’s an official, formal label attached. And beyond that, the label must be attached in the right order, in the right place.
So when we ask why people are seeking out diagnoses at higher rates than ever before, we also have to ask: What’s broken in our healthcare system that forces them to?
Overdiagnosis Is Real—But So Is Underdiagnosis
I often see conversations about this topic pointing at conditions like chronic fatigue syndrome and functional neurological disorders as examples of diagnoses that have expanded over time, sometimes encompassing people whose symptoms may not fit neatly into a clear-cut disease. And I get that concern. There are legitimate questions to be asked about how we define and classify illness.
But at the same time, we have to recognize that certain groups struggle enormously to get diagnosed in the first place.
Chronic pain is under-treated in women and Black patients. There’s more than enough data out there indicating that women’s pain is often dismissed as psychological, while Black patients are systematically undertreated due to racial biases in pain assessment.
Mental health conditions are underdiagnosed in communities of color. Black and Hispanic individuals are less likely to be diagnosed with depression and anxiety, even when they report symptoms at similar rates as white patients.
Autism is underdiagnosed in women and people of color. Because diagnostic criteria were historically developed around young white boys, autistic women and nonwhite and older individuals are frequently overlooked, leading to delayed or missed diagnoses. These rates are increasing in recent years, but there’s no sign we have reached a plateau yet.
Autoimmune diseases are notoriously difficult to diagnose. Many conditions, like lupus and multiple sclerosis, disproportionately affect women and often take years to be correctly identified due to systemic biases in medical research and care.
These aren’t small oversights. These are failures that leave people suffering, untreated, and sometimes even dying due to a lack of medical recognition.
The Role of Healthcare Access
In the U.S., our healthcare system is so deeply tied to insurance and employment that pursuing a diagnosis becomes a necessity for basic care. Insurance companies demand a formal diagnosis before covering treatments, medications, therapy, or even time off work. And when you live in a country where medical debt is one of the leading causes of bankruptcy, getting that diagnosis isn’t just about validation—it’s about survival.
I spent months fighting with insurance to get coverage for services that were required to be covered, only to find out that because our provider had included autism AFTER other diagnoses, the services could be rejected. Our providers’ billing teams and I went through countless claims to appeal and resubmit with autism as a primary diagnosis. But so many individuals don’t have the time, the margin, the space, the ability for any reason to navigate endless calls and emails for months. It was like another full time job.
And now, as I’m grappling with my own ongoing and as yet unidentified health issues, I am struggling not to assume my weight, gender, and late diagnosis of neurodivergence factor into the way I’m being treated (or dismissed). I’m not desperate for a diagnosis because I want to wear the label like a badge—I know I can get attention in other ways. But I want a diagnosis so that I can figure out what wellness and thriving actually looks like for me.
Friends, if people seem overly eager for a label, maybe we should be asking why they have to fight so hard for one in the first place.
Faith, Healing, and the Christian Response
I also want to acknowledge something else that often gets brought up in these discussions: spiritual health. I’ve seen well-meaning Christians argue that we need to focus more on healing through faith rather than relying on medical labels. And while I absolutely believe that spiritual well-being is a vital part of health, I also know that prayer alone doesn’t pay for insulin. It doesn’t cover therapy. It doesn’t eliminate medical debt.
One of the most impactful ministries I’ve ever been a part of was a church initiative that helped families pay off medical debt. Hundreds of thousands of dollars raised that helped abolish millions of dollars of medical debit. (If the math feels weird here, it is. I am trying to learn more about the ways medical bills are itemized and negotiated.) Eliminating medical debt and advocating for more affordable solutions is exactly the kind of work we should be doing as Christians—coming alongside, tending, and supporting the sick, pushing for a system that doesn’t leave people bankrupt over a hospital stay, and advocating for reasonable, dignifying access to healthcare.
Because whether we’re talking about overdiagnosis or underdiagnosis, the real crisis isn’t just the labels—it’s what people have to go through to get the care they need. And if we, as Christians, are called to care for the sick, then we need to start thinking bigger.
Bits & Bobs
General Update | Whew. I have done one of these sections in awhile. I’m ok. Aforementioned health issues are what they are. It’s not totally taking me down, but it is making my life a little more complicated. My family is doing well, and we’re constantly evolving and adjusting. Flexibility and curiosity are critical in this seasons.
Resource Recommendation | I am currently listening to the audiobook of Sincerely, Your Autistic Child. It’s definitely worth a read, but I am able to access the audiobook through the Organization for Autism Research’s online library, which can be accessed for free through the Libby app. This is such a great way to get books and resources for all ages. I especially love middle grade fiction, and there is a growing collection of MG books, as well as tons of nonfiction, from memoir to more academic research.
Key Ministry’s Disability and the Church Conference | I will be leading a breakout session on how churches can come alongside individuals navigating adult autism & ADHD diagnoses. Click here for all the info!
Recent writing and podcasts | I can’t remember the last time I shared something I’ve been a part of, so I am going to very humbly point you to my website: Writing can be found here. Podcasts and speaking here.
Writing Workshop | I am so unbelievably excited to offer Words for the Season You’re In: A Writing Workshop for Parents of Neurodivergent Kids. The initial promo code I offered is sold out, and there are already 16 people signed up. I had initially capped it at 20 people, but I’ve added a few more spots. I also want to add that if you could really use a space like this, but the price point just won’t work for whatever reason, please email me. We can work something out—no questions asked. Just tell me an amount that works for you, and I’ll send you a coupon code.
It’s Official | Finally, I am so proud to announce that I will be joining Amanda Diekman’s team as a Low Demand Certified Coach. I’m excited to support families like mine, especially when navigating cultural dynamics or seeking support and understanding within their faith communities. All the details are here.
Ok. That’s it. See you next time, friends.
Thank you, Sunita, for sharing these words in your community. 💞💞💞