There are converging pressures on psychiatrists, primary care physicians, and other mental health workers to overdiagnose and overtreat mental illness. First, there is a systematic methodological bias that causes all epide-miological studies consistently to report exaggerated rates of mental disorder in the general population [1]. For reasons of cost, such large studies must be conducted using lay interviewers who are unable to judge whether the symptoms they elicit are severe enough to cause clinically significant distress or impairment. The resulting diagnostic inflation gives the false (but widely publicized) impression that psychiatric disorders are frequently missed and are undertreated [2,3]. This encourages practitioners to make false-positive diagnoses and to recommend unnecessarily aggressive treatment.
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