Diagnostic Hierarchy Explained: Why Patients Get 5 Diagnoses

Podcast: Psychofarm Podcast · Psychiatry, Skepticism, and Integration.

Opublikowano: 2026-11-03

Why do so many patients arrive with four, five or six psychiatric diagnoses? Mark Ruffalo, a psychoanalytically trained clinical social worker who teaches psychiatry residents, joins Dr. Malzberg and Dr. Fu to discuss his new paper with psychiatrist Ronald Pies in Psychiatric Services, “The Need for a Validity-Based Diagnostic Hierarchy in DSM-6.” We trace how DSM-III chose reliability over validity, why the Washington University group of Robins and Guze pushed back, and how losing the diagnostic hierarchy opened the door to false comorbidity, polypharmacy and symptom-by-symptom treatment. Mark lays out which conditions sit at the top of a validity-based hier...