Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes

209 Pages·2015·5.48 MB·English

by  Joel Paris

Advance Praise for Overdiagnosis in Psychiatry
“Dr. Paris is a psychiatrist who knows his onions and so can make you weep. He
weeps at the failure to recognize strengths in people rather than weaknesses, and
after reading his book we should all gain from one of its key sentences ‘it would
probably be better to define mental health, not as happiness, but as resilience in the
face of adversity’.”
—Peter Tyrer, Professor of Community Psychiatry, Centre for Mental Health,
Imperial College, London
“Most discussions of diagnosis focus on problems with missed diagnoses or mis-
diagnosis. Dr. Paris does the field a great favor by focusing on the problem of
overdiagnosis, and showing how it is as great a problem as underdiagnosis.”
—Mark Zimmerman, Professor of Psychiatry and Human Behavior, Brown
Medical School, Providence, RI
“Too much medicine can be bad for your health—overdiagnosis and over-treatment
are now serious public health problems. Dr Paris has provided an important pebble
in the David vs Goliath battle to contain the medical-industrial complex.”
—Allen Frances, Professor Emeritus and former Chair, Duke University and
author of Saving Normal, Coronado, CA
“Dr. Joel Paris has written a wonderfully provocative book that will irritate some
readers and delight others. With opinions based on his many years working in the
trenches, Dr. Paris points out the problems of overdiagnosis, misdiagnose, and diag-
nostic epidemics that have been fueled in part by overenthusiasm for the DSM.
Written in an accessible style, this book is bound to become a classic in the field.”
—Donald W. Black, MD, Professor, Department of Psychiatry, University of
Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA

✦
OVERDIAGNOSIS IN
PSYCHIATRY
How Modern Psychiatry Lost Its
Way While Creating a Diagnosis for
Almost All of Life’s Misfortunes
JOEL PARIS, MD
Professor of Psychiatry, McGill University
1
1
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Library of Congress Cataloging-in-Publication Data
Paris, Joel, 1940–, author.
Overdiagnosis in psychiatry: how modern psychiatry lost its way while
creating a diagnosis for almost all of life’s misfortunes/Joel Paris.
p. ; cm.
ISBN 978–0–19–935064–3 (alk. paper)
I. Title.
[DNLM: 1. Mental Disorders—diagnosis. 2. Diagnostic Errors.
3. Diagnostic Techniques and Procedures—utilization. WM 141]
RC473.D54
616.89′075—dc23
2014039665
This material is not intended to be, and should not be considered, a substitute for medical or
other professional advice. Treatment for the conditions described in this material is highly
dependent on the individual circumstances. And, while this material is designed to offer
accurate information with respect to the subject matter covered and to be current as of the
time it was written, research and knowledge about medical and health issues is constantly
evolving and dose schedules for medications are being revised continually, with new side
effects recognized and accounted for regularly. Readers must therefore always check the
product information and clinical procedures with the most up-to-date published product
information and data sheets provided by the manufacturers and the most recent codes of
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Without limiting the foregoing, the publisher and the authors make no representations or
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application of any of the contents of this material.
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
This book is dedicated to my fellow researchers in
psychiatry, who have taught me the importance of
caution in clinical practice.

CONTENTS
Acknowledgments  ix
Introduction  xi
PART I. BACKGROUND
1. Diagnosis in Psychiatry  3
2. The DSM and Its Discontents  25
3. Overdiagnosis and Over-Treatment  41
4. Science, Philosophy, and Diagnosis  55
PART II. CATEGORIES MOST LIKELY
TO BE OVERDIAGNOSED
5. How Major Is Major Depression?  67
6. Bipolar Disorders  81
7. Post-traumatic Stress Disorder  95
viii | CONTENTS
8. Attention Deficit Hyperactivity Disorder  105
9. Personality and Personality Disorder  117
10. Other Disorders in Which Overdiagnosis
Is a Risk  129
PART III. DIAGNOSIS AND NORMALITY
11. How Do We Know What Is Normal?  137
12. Where Do We Go From Here?  149
References  153
Index  173
ACKNOWLEDGMENTS
Don Black and Mark Zimmerman read earlier versions
of this book and made many helpful suggestions for its
improvement.