Misdiagnosing normality: Psychiatry's failure to address the problem of false positive diagnoses of mental disorder in a changing professional environment.
BACKGROUND
In psychiatry's transformation from primarily an asylum-based profession to a community-oriented profession, false positive diagnoses that mistakenly classify normal intense reactions to stress as mental disorders became a major challenge to the validity of psychiatric diagnosis. The shift to symptom-based operationalized diagnostic criteria in DSM-III further exacerbated this difficulty because of the contextually based nature of the distinction between normal distress and mental disorder, which often display similar symptoms. The problem has particular urgency because the DSM's symptom-based criteria are often applied in studies and screening instruments outside of the clinical context and by non-mental-health professionals.


OBJECTIVE
To consider, through selected examples, the degree of concern, systematicity and thoroughness - and the degree of success - with which recent revisions of the DSM have attended to the challenge of avoiding false positive diagnoses.


METHODS
Conceptual analysis of selected criteria sets, with a focus on possible counterexamples to the claim that DSM criteria imply disorder.


RESULTS
Psychiatry has so far failed to systematically adjust its diagnostic practices to confront the problem of false positives. Flaws in criteria, which can be recognized immediately by lay people, remain unaddressed or are addressed on a hit-or-miss random basis years after the flaw has been introduced, even though the issue is purely conceptual and is not sensitive to any new research information.
Wakefield
Jerome C
JC
Silver School of Social Work and Department of Psychiatry, New York University, New York, NY 10025, USA. jerome.wakefield@nyu.edu
D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D004644:Emotions; D005189:False Positive Reactions; D006262:Health; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D009155:Mutism / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D010698:Phobic Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D011570:Psychiatry / Q000639:trends*; D011594:Psychometrics; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000145:classification / Q000175:diagnosis; D012565:Schizophrenic Psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D012931:Social Environment