False positives in psychiatric diagnosis: implications for human freedom.
Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose a sick role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria.
Silver School of Social Work and Department of Psychiatry, New York University, 1 Washington Square North, New York, NY, 10003, USA. jerome.wakefield@nyu.edu
Jerome C
JC
Wakefield
D003951:Diagnostic Errors / Q000941:ethics; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005189:False Positive Reactions; D005610:Freedom; D006801:Humans; D007348:Insurance, Health; D038801:International Classification of Diseases; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology*; D028681:Moral Obligations; D010686:Philosophy, Medical; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000941:ethics* / Q000379:methods; D011594:Psychometrics; D012016:Reference Values; D015203:Reproducibility of Results; D012803:Sick Role; D012922:Social Change; D012927:Social Control, Informal; D012935:Social Justice; D013315:Stress, Psychological / Q000209:etiology*