Clinical Reasoning and the Debate Over Psychiatric Diagnosis

"Applying DSM criteria in a simple checklist fashion can result in significant clinical mistakes and overmedication, Giovanni A. Fava warns in his latest book, Clinical Judgment in Psychiatry: The Foundation of Optimal Treatment. Because the DSM model is psychometric, disparate symptoms can receive equal weighting. When severity is determined by the number of symptoms, not their intensity or quality, those that are mild are easily conflated with those that are severe and incapacitating."

"Because DSM criteria also decontextualize suffering and distress, patients and physicians frequently end up with one-sided explanations. The biomedical reductionism that pairs seamlessly with medicine's commercial interests results not in precision medicine, but rather unneeded hospitalization, overuse of prescription drugs, excessive surgery, and inappropriate use of diagnostic tests. In such widespread scenarios, accurate diagnosis becomes haphazard, and iatrogenic harm a likelihood."

The DSM's psychometric checklist model assigns equal weight to disparate symptoms and defines severity by symptom count rather than intensity or quality, enabling mild symptoms to be conflated with severe, incapacitating ones. The DSM also tends to assume symptoms are not medication-induced, a premise challenged by decades of polypharmacy and resultant adverse effects. Time pressures, limited reimbursement, and thin guidance on clinical formulation push clinicians toward rapid prescribing. Biomedical reductionism combined with commercial incentives leads to unnecessary hospitalization, overuse of medications, excessive surgery, and inappropriate testing, creating structural overdiagnosis and heightened risk of iatrogenic harm.

Read at Psychology Today