Overdiagnosis Problems in the DSM-IV and the New DSM-5: Can They Be Resolved by the Distress—Impairment Criterion?
Bibliographic record
Abstract
Criticisms of psychiatry for overdiagnosing, for pathologizing normality, are not new, dating at least from the antipsychiatry critiques in the 1960s. Inevitably, revisions of the diagnostic manuals, the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders (DSM), provide an occasion for renewed criticism, and the revision process of the DSM-IV became a focus for further debates on overdiagnosis. The debates are typically not about the presence or absence of a decisive marker of specific illnesses or of illness in general-a complex matter on which there is hardly a consensus-but rather about the relative medical, psychosocial, and financial harms and benefits that may accrue from overdiagnosis on the one side and underdiagnosis on the other. It is proposed in this In Review paper that a useful and valid principle for use in these debates is the tight conceptual linkage between illness and distress and impairment of day-to-day functioning. This linkage is fundamental to the conceptualization of mental disorder in the DSM-IV and can still serve to reduce overdiagnosis by excluding cases where distress and impairment are absent or minimal. The same conceptual linkage provides a way of understanding how conditions may warrant a diagnosis even though they are not associated with current distress or impairment, namely, if they carry risk for such in the future. For these conditions, assessments of costs and benefits of overdiagnosis and underdiagnosis depend crucially on high-quality, replicated data on the sensitivity and specificity of the early diagnostic test.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".