There have been a striking diagnostic inflation and a corresponding increase in the use of psychotropic drugs during the past 30 years. DSM-5, scheduled to appear in May 2013, proposes another grand expansion of mental illness. In this article, we will review the causes of diagnostic exuberance and associated medical treatment. We will then suggest a method of stepped care combined with stepped diagnosis, which may reduce overdiagnosis without risking undertreatment of those who really need help. The goal is to control diagnostic inflation, to reduce the harms and costs of unnecessary treatment, and to save psychiatry from overdiagnosis and ridicule.
*Department of Special Needs Education and Child Care, University of Groningen, Groningen, the Netherlands; and †Department of Psychiatry, Duke University Medical Center, Durham, NC.
Editor’s note: Proposed DSM-5 criteria sets do not represent the final DSM-5 criteria for the disorders.
Send reprint requests to Laura Batstra, PhD, Department of Special Needs Education and Child Care, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Rozenstraat 38, 9712 TJ Groningen, the Netherlands. E-mail: firstname.lastname@example.org.