Table 1 Seven types of expansion of disease with descriptions, examples and potential challenges. Adapted and expanded from [48]
Type of expansion | Description | Example | Problem/challenge |
|---|---|---|---|
Medicalization (expansion of experienced phenomena) | Including ordinary life experiences [9] | Grief, sexual orientation (homosexuality) | Inefficient or inappropriate handling |
Overdiagnosis (expansion of non-experienced phenomena) | Labelling indolent conditions as disease [5] | Ductal carcinoma in situ (DCIS) | |
Aesthetic expansion | Treating aesthetic characteristics as disease [69] | Protruding ears | Reinforcing or enhancing attitudes and stigma |
Pragmatic expansion | Making something disease because it can be detected and treated [62] | Erectile dysfunction, “alcoholism,” hypertension | Making healthy persons patients, overtreatment, side-effects |
Conceptual expansion | Expanding definitions or indications of disease [43] | Pre-diabetes, pre-Alzheimer, (making menopause or aging a disease) | Making healthy persons patients, overtreatment, side-effects |
Ethical expansion | Making something disease because that will provide attention and access to care | Obesity [60], Attention Deficit Hyperactivity Disorder (ADHD), gender incongruencen [55] | Pathologization, stigmatization, opportunity costs |
Disease mongering | Making biological or social conditions disease in order to sell diagnostic tests or therapies | Low testosterone (Low T) [63, 64], “restless legs syndrome” [70] | Making people patients for the purpose of profit |