The Problem of Polydiagnosis

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Patients who have been diagnosed with multiple psychiatric disorders have become the rule, not the exception—with serious consequences for treatment.

Many patients with whom I meet for the first time tell me that they have been diagnosed with a laundry list of." When I occasionally review patients' past records, I find that even formal psychological evaluations conducted by clinical psychologists often list four, five, six psychiatric diagnoses.—is a relatively novel trend in psychiatry.

The notion of a diagnostic hierarchy, which is a fundamental principle across all of medicine, has been largely forgotten by psychiatry for about the past 40 years. In sum, diagnostic hierarchy refers to the idea that not all diagnoses are created equal—that some are more important or more primary than others.

The problem of polydiagnosis is not simply a theoretical one. In practice, it can lead to inadequate treatment or overtreatment. Much has been written in recent years about the problem of polypharmacy—the use of multiple psychiatric drugs across drug classes and sometimes within drug classes—but little attention has been paid to one of its main drivers: polydiagnosis.

 

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