Generally cruel people will find the word that maximizes cruelty. Since it is more insulting to claim that someone has 'clinical and official' whatever than to use the time worn insult version of the same word, cruel people will constantly chase whatever the most official version is.

To be clear, the goal of an insult is not to use some bad word, but to claim something that will hurt the person being insulted. Even when I was in school I remember 'retarded' being used almost always a replacement for 'absurd', and people being insulted with words like 'special ed' or 'special eddy'.

Not that I condone those things, but the point is that the insult was to say 'you are like that group of people' where 'that group of people' can be any group that is outside of the in-group. You can see this on message boards today where people are accused of being 'normies', etc.