Desert Island Diagnoses
The Carlat Psychiatry Report, Volume 19, Number 9, September 2021
Chris Aiken, MD.
Editor-in-Chief, The Carlat Psychiatry Report
In 1974, Drs. Donald Goodwin and Samuel Guze put forth a radical idea. They wanted to pare down the unwieldy list of psychiatric diagnoses to only the most valid:
- Bipolar disorder
- Panic disorder and specific phobias
- PTSD (provisional)
- Anorexia and bulimia
- Somatization and conversion disorder
- Antisocial personality disorder
- Borderline personality disorder (provisional)
- Alcohol & substance use disorders
- Dementia and delirium
That list was published in their 1974 classic Psychiatric Diagnosis. The book is now in its seventh edition, but five decades of research have only elevated two diagnoses to the list: PTSD and borderline personality disorder (reluctant additions, as the editors believed their features overlapped too much with those of other disorders).
The editors of the DSM-III were inspired by this stoicism, but by the time of its release in 1980, the book had grown to include 265 disorders. The DSM editors got around this by adding a warning to many diagnoses, advising that we should not diagnose them if they are better explained by a more strongly validated disorder like one on Goodwin and Guze’s list. This warning is easy to miss, but it’s one of the most important parts of the book. Without it, the DSM is just a symptom checklist—one that inevitably leads to the kind of diagnostic creep Dr. Joel Paris warns about in this issue.