Therapy Speak and the Terms Clinicians Say Are Misused
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- “Therapy speak” is the use of clinical psychology vocabulary in everyday conversation, and psychologists describe it as both a sign of falling stigma and a source of confusion.
- Clinicians surveyed by the American Psychological Association named triggering, trauma, obsessive-compulsive disorder, self-care, imposter phenomenon, bipolar, and gaslighting as the terms most often misused.
- A 2026 study found that about a quarter of participants defined narcissistic personality disorder in a way that included ordinary, non-pathological behavior.
- A narcissistic personality disorder diagnosis requires at least five of nine criteria, a pattern lasting years, and significant impairment in work or relationships.
- No laboratory or imaging test diagnoses a personality disorder, so assessment rests on clinical interview and history.
Table of Contents
- What Therapy Speak Means
- The Terms Clinicians Say Are Misused Most
- The Case That Wider Vocabulary Helps
- Where the Definitions Drift
- What a Clinical Threshold Requires
- What an Assessment Involves
- Closing Thoughts
What Therapy Speak Means
“Therapy speak” is the use of clinical psychology vocabulary in ordinary conversation. Psychological terms now surface in reality television, popular music and short-form video, used accurately or otherwise [9].
Quick Take & Core Data:
- 414 participants were asked to define narcissistic personality disorder in a 2026 study, and about 25% endorsed definitions that included ordinary behavior.
- 376 mental health professionals mapped the diagnostic criteria in a 2025 network analysis.
- 5 of 9 criteria must be present for a categorical diagnosis.
- 52% of the 100 most popular ADHD videos on TikTok were rated misleading by clinician coders.
- 28 experiments pooled in a meta-analysis found biological explanations cut blame (g = -0.324) and raised pessimism (g = 0.263).
Researchers have a name for the wider pattern. Concept creep describes the gradual expansion of harm-related terms such as trauma, bullying and prejudice, so that they take in milder cases than they once did [6].
Jessi Gold, a psychiatrist and chief wellness officer for the University of Tennessee System, told the American Psychological Association that the pattern is old but accelerating [9]. People once said “schizophrenic” to mean changing your mind, she noted, and “OCD” to mean attentive to detail.
The Terms Clinicians Say Are Misused Most
The APA asked practicing clinicians which terms they see mangled most often. The seven they named were triggering, trauma, obsessive-compulsive disorder, self-care, imposter phenomenon, bipolar and gaslighting [10].
Sarah Bishop, a clinical psychologist in Birmingham, England, drew the line at intent. Gaslighting describes deliberate deception meant to cause harm, and stretching it to cover an ordinary disagreement, she said, “dilutes their meaning and hinders our understanding of the issue [10].”
The drift runs in more than one direction. Erin Parks, a clinical psychologist in Carlsbad, California, told the APA that popular usage treats a trigger as something another person should remove, while eating disorder treatment teaches patients to recognize one and work through it [10].
Misuse also changes what a conversation can do. Parks described a disagreement between friends that ends the moment one of them relabels the other’s viewpoint as gaslighting, because there is no longer anything to discuss [9].
The Case That Wider Vocabulary Helps
Most psychologists treat the spread as a net gain [9]. A 2022 survey of 601 adults found that people with stronger health literacy reported lower mental health stigma and less reluctance to seek care, though the study was cross-sectional and shows association rather than cause [7].
Naming an experience changes what a person does about it. Parks pointed the APA to abuse as the clearest case, since people who lacked the word were likelier to blame themselves and slower to look for help [9].
The benefit carries a measured cost. A meta-analysis of 28 experiments found that biological explanations of mental illness reduced blame toward the person, at a pooled effect of g = -0.324, while raising pessimism about recovery at g = 0.263 [8].
Where the Definitions Drift
A 2026 study asked 414 participants what narcissistic personality disorder covers. About a quarter endorsed definitions that took in ordinary, non-pathological behavior, and the broader a person’s definition, the more often they reported encountering narcissists in daily life [4].
That sample was drawn mostly from students at a single Swiss university and the design was vignette-based. The finding describes a pattern rather than measuring its size in any general population.
Social media rewards the looser version. Clinicians who coded the 100 most popular ADHD videos on TikTok rated 52% of them misleading, and most of those came from people who were not health care providers [11].
One finding cuts against the obvious story, and it comes from the same research group that defined concept creep. A corpus study of academic and general-language text from 1970 to 2018 predicted that “anxiety” and “depression” would soften as they spread, then found the reverse: both words grew more clinically framed over time, not less [12].
What a Clinical Threshold Requires
Narcissistic personality disorder makes a useful test case, because it is a term the APA’s clinicians raised without prompting. The diagnosis calls for a pervasive pattern of grandiosity, a need for admiration and a lack of empathy, and a clinician must find at least five of nine criteria [3].
The pattern has to persist for years and cause real functional impairment at work or in relationships. A person can be arrogant, self-important or difficult without meeting the definition [3].
A 2025 network analysis asked 376 mental health professionals to map how the criteria relate to one another [1]. The need for admiration emerged as the most central criterion, and antagonism as the central trait domain.
That study mapped clinicians’ judgments rather than patient records, so it describes how professionals understand the diagnosis. The current manual also offers a dimensional model, which rates impairment across identity, self-direction, empathy and intimacy so severity can be recorded instead of a yes or no [2].
What an Assessment Involves
No blood test or scan diagnoses a personality disorder [13]. A psychiatrist or psychologist asks about a patient’s history and their dealings with family and friends, then rules out conditions that produce similar effects [13].
A label supplied in advance is what makes that harder. Taisha Caldwell-Harvey, a clinical psychologist in Martinez, California, described to the APA what happens when a patient opens by calling a boss a narcissist [9].
“I need so much more information about what’s going on, but they feel like they’ve told me the person is a narcissist, so there’s nothing more to know.”
Closing Thoughts
The distance between everyday usage and clinical definition is not a failure of public interest. Wider vocabulary has lowered stigma and helped people ask for care [7].
Two researchers writing in 2025 compressed the trade-off into a single sentence [5]. “People have become better at recognizing the presence of mental illness but may have become worse at recognizing its absence.”
That asymmetry is the practical problem in a consulting room. A patient who arrives with the diagnosis already chosen has narrowed the conversation before it opens, and the work of an assessment is to widen it again.
References
[1]. Gori, A., & Topino, E. (2025). DSM-5-TR criteria and domains for narcissistic personality disorder: Evidence from network analysis based on the mental health professionals’ perspective. Clinical Psychology & Psychotherapy, 32(6), e70179. https://doi.org/10.1002/cpp.70179
[2]. Weinberg, I., & Ronningstam, E. (2022). Narcissistic personality disorder: Progress in understanding and treatment. Focus, 20(4), 368-377. https://doi.org/10.1176/appi.focus.20220052
[3]. Mitra, P., Torrico, T. J., & Fluyau, D. (2026). Narcissistic personality disorder. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/32310461/
[4]. Hengartner, M. P., Eymir, A., & Haslam, N. (2026). Expanded definitions of psychopathology: Exploring concept creep in narcissistic personality disorder. Acta Psychologica, 264, 106604. https://doi.org/10.1016/j.actpsy.2026.106604
[5]. Haslam, N., & Tse, J. S. (2025). Public awareness of mental illness: Mental health literacy or concept creep? Australasian Psychiatry, 33(1), 18-20. https://doi.org/10.1177/10398562241292202
[6]. Haslam, N., Vylomova, E., Zyphur, M., & Kashima, Y. (2021). The cultural dynamics of concept creep. American Psychologist, 76(6), 1013-1026. https://doi.org/10.1037/amp0000847
[7]. Fleary, S. A., Joseph, P. L., Gonçalves, C., Somogie, J., & Angeles, J. (2022). The relationship between health literacy and mental health attitudes and beliefs. Health Literacy Research and Practice, 6(4), e270-e279. https://doi.org/10.3928/24748307-20221018-01
[8]. Kvaale, E. P., Haslam, N., & Gottdiener, W. H. (2013). The “side effects” of medicalization: A meta-analytic review of how biogenetic explanations affect stigma. Clinical Psychology Review, 33(6), 782-794. https://doi.org/10.1016/j.cpr.2013.06.002
[9]. Medaris, A. (2024, September 1). How to harness the power of therapy-speak. Monitor on Psychology, 55(6), 18. https://www.apa.org/monitor/2024/09/therapy-speak
[10]. Medaris, A. (2024, September 1). Seven of the most frequently misused psychological terms. Monitor on Psychology, 55(6), 21. https://www.apa.org/monitor/2024/09/therapy-misspeak
[11]. Yeung, A., Ng, E., & Abi-Jaoude, E. (2022). TikTok and attention-deficit/hyperactivity disorder: A cross-sectional study of social media content quality. The Canadian Journal of Psychiatry, 67(12), 899-906. https://doi.org/10.1177/07067437221082854
[12]. Xiao, Y., Baes, N., Vylomova, E., & Haslam, N. (2023). Have the concepts of “anxiety” and “depression” been normalized or pathologized? A corpus study of historical semantic change. PLOS ONE, 18(6), e0288027. https://doi.org/10.1371/journal.pone.0288027
[13]. Cleveland Clinic. (2023, August 3). Narcissistic personality disorder. https://my.clevelandclinic.org/health/diseases/9742-narcissistic-personality-disorder
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