Flipping a Coin Gives Best Odds for a DSM Diagnosis

The results of a recent study published in Frontiers in Psychiatry shows that you have a better chance of getting a reliable mental health diagnosis from flipping a coin than from asking a psychiatrist. The study was done by the University Hospital of Copenhagen in Denmark and it presented over a thousand doctors working in adult psychiatry with clinical cases and then asked them to make a diagnosis based on the symptoms they were given. The participants had to select from thirty standard DSM diagnoses, and these had been named, apparently, because each of the cases would fit one of them. 

     Most of the participating doctors were male psychiatrists and there was pretty good agreement between them with diagnosing cases of bipolar disorder and depression. However, a little less than three quarters of them agreed on diagnosing anxiety and personality disorders.

     With the schizophrenia-type cases they were presented, about two thirds of these doctors disagreed not only with each other, but with the expert panel of psychiatrists who had made their diagnosis of each clinical case before giving them to the study’s participants.

     Schizophrenia was the original catch-all phrase for almost any kind of mental disorder. When the study authors tabulated an overall reliability score for all of the diagnoses they reviewed, that ratio was only a fifty percent agreement between doctors — exactly equal to tossing a coin — about the “right” DSM diagnosis.

     So much for the reliability factor of a psychiatric diagnosis. Then comes the validity factor. None of the mental disorders listed in the DSM are based on any objective criteria. They are the conclusions of a small number of psychiatrists sitting around a table agreeing – to some degree – on the symptoms they have observed. That’s a pretty subjective method of arriving at a diagnostic category.

     At best the DSM mental disorder label is a description, and only a description by consensus. It suggests nothing about underlying causes for or objective aspects of the symptoms being displayed.

     The participating psychiatrists in this Copenhagen study not only disagreed with each other fifty percent of the time, they also only disagreed with the study’s own panel of expert psychiatrists fifty percent of the time, as well.

     So, if you go to a psychiatrist, you have only a fifty percent chance of being given a reliable diagnosis, and that diagnosis itself may not have any validity in the first place.

     (Thanks to Richard Sears for making this study known in his recent Mad in America article).