Misdiagnosing normality: Psychiatry's failure to address the problem of false positive diagnoses of mental disorder in a changing professional environment

Jerome C. Wakefield

    Research output: Contribution to journalReview article

    Abstract

    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. Aims: 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. Method: 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.

    Original languageEnglish (US)
    Pages (from-to)337-351
    Number of pages15
    JournalJournal of Mental Health
    Volume19
    Issue number4
    DOIs
    StatePublished - Aug 1 2010

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    Diagnostic Errors
    Mental Disorders
    Psychiatry
    Diagnostic and Statistical Manual of Mental Disorders
    Health
    Research

    Keywords

    • circadian rhythm disorder-shift work subtype
    • clinical significance
    • Diagnosis
    • false positives
    • harmful dysfunction
    • history of psychiatry
    • philosophy of psychiatry
    • primary insomnia
    • selective mutism
    • social phobia
    • subsyndromal depression
    • validity of diagnostic criteria

    ASJC Scopus subject areas

    • Psychiatry and Mental health

    Cite this

    Misdiagnosing normality : Psychiatry's failure to address the problem of false positive diagnoses of mental disorder in a changing professional environment. / Wakefield, Jerome C.

    In: Journal of Mental Health, Vol. 19, No. 4, 01.08.2010, p. 337-351.

    Research output: Contribution to journalReview article

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