Applying DSM criteria in a simple checklist fashion can result in significant clinical mistakes and overmedication, Giovanni A. Fava warns in his latest book, Clinical Judgment in Psychiatry: The Foundation of Optimal Treatment.

Because the DSM model is psychometric, disparate symptoms can receive equal weighting. When severity is determined by the number of symptoms, not their intensity or quality, those that are mild are easily conflated with those that are severe and incapacitating.

A second factor is no less critical in avoiding misdiagnosis and overtreatment: the DSM presumes that most symptoms are not iatrogenic in origin—in other words, not an adverse effect of medications taken. After witnessing decades of polypharmacy led by DSM overdiagnoses, Fava finds that premise implausible.

Although psychiatrists and clinical psychologists rely heavily on careful observation, description, and formulation, the literature advising them how best to reach such decisions is thin and oversimplifying. Due to overscheduling and patients’ limited insurance for reimbursements, psychiatrists may be “reluctant to postpone their actions and are often eager to rush to prescription.”

Because DSM criteria also decontextualize suffering and distress, patients and physicians frequently end up with one-sided explanations. The biomedical reductionism that pairs seamlessly with medicine’s commercial interests results not in precision medicine, but rather unneeded hospitalization, overuse of prescription drugs, excessive surgery, and........

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