OVERDIAGNOSIS OF NEW DISORDERS:
“There is also the serious, subtle, and ubiquitous problem of unintended consequences. As a rule of thumb, it is wise to assume that unintended consequences will come often and in very varied and surprising flavors. For instance, a seemingly small change can sometimes result in a different definition of caseness that may have a dramatic and totally unexpected impact on the reported rates of a disorder.20 Thus are false “epidemics” created. For example, although many other factors were certainly involved, the sudden increase in the diagnosis of autistic, attention-deficit/hyperactivity, and bipolar disorders may in part reflect changes made in the DSM-IV definitions. …
“This issue becomes particularly relevant when one considers the skillful pressure likely to be applied by the pharmaceutical industry after the publication of DSM-V. It has to be assumed that they will attempt to identify every change that could conceivably lead to a marketing advantage—often in ways that will not have occurred to the DSM-V Task Force. To promote sales, the companies may sponsor “education” campaigns focusing on the diagnostic changes that most enhance the rate of diagnosis for those disorders that will lead to the increased writing of prescriptions. As I will discuss, there is a great risk of many new “epidemics” based on changes suggested for DSM-V.”
NON-GENERALIZABILITY OF RESEARCH FINDINGS:
“A further problem is that almost everyone responsible for revising the DSM-V has spent a career working in the atypical setting of university psychiatry. This type of clinical experience is restricted to highly select patients who are often treated in a research context. It is a basic tenet of clinical epidemiology that research results and clinical experience derived from tertiary-care settings often do not generalize well when the diagnostic system has to be applied routinely in a more population-based manner.23,24”
 
INCREASING FALSE POSITIVES:
“Undoubtedly, the most reckless suggestion for DSM-V is that it include many new categories to capture the subthreshhold (eg, minor depression, mild cognitive disorder) or premorbid (eg, prepsychotic) versions of the existing official disorders. The beneficial intended purpose is to improve early case finding and promote preventive treatments. Unfortunately, however, the DSM-V Task Force has failed to adequately consider the potentially disastrous unintended consequence that DSM-V may flood the world with tens of millions of newly labeled false-positive “patients.” The reported rates of DSM-V mental disorders would skyrocket, especially because there are many more people at the boundary than those who present with the more severe and clearly “clinical” disorders. The result would be a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatments—a bonanza for the pharmaceutical industry but at a huge cost to the new false-positive patients caught in the excessively wide DSM-V net. They will pay a high price in adverse effects, dollars, and stigma, not to mention the unpredictable impact on insurability, disability, and forensics.
“In my experience, experts on any given diagnosis always worry a great deal about missed cases but rarely consider the risks of creating a large pool of false positives—especially in primary care settings. The experts’ motives are pure, but their awareness of risks is often naive. Psychiatry should not be in the business of inadvertently manufacturing mental disorders. The clinching argument against including subthreshold and prodromal “disorders” is that they are supported only by thin literatures and will not have extensive field trials to predict the extent of the false-positive risks, particularly in primary care settings. I am convinced that none of the proposed subthreshold or premorbid suggestions should be converted to official diagnoses of mental disorder in DSM-V. Each should instead be included in an appendix of suggested disorders that require more research and testing.”