Where diagnoses come from
There is no blood test for depression, ADHD or anxiety. A psychiatric diagnosis is an agreed description of symptoms, and the field's own leadership says so.
We have not finished checking this source. No judgement either way. how we score evidence
Caveat on this rating: The NIMH passages quoted here are from the Director's Blog of April 2013. That URL now returns 404 and the text is quoted from an Internet Archive capture dated 27 June 2021 - the second primary US government document in this series that has to be read from a private archive. The often-quoted figure for how many diagnoses each DSM edition contains is deliberately omitted: no citable primary source states it, and the number varies with whether subtypes, residual categories and provisional conditions are counted. It is the most quotable statistic in this subject and the easiest to refute.
Psychiatric diagnoses are agreements about which symptoms cluster together, revised by committee and published in a book. We treat what we can describe, not what we understand.
That is not an anti-psychiatry claim. It is what the field's own leadership says.
Significant findings
Weeks before DSM-5 arrived in 2013, the director of the National Institute of Mental Health wrote that "the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."
The line almost never quoted beside it sits in the same post: "we cannot design a system based on biomarkers or cognitive performance because we lack the data."
Description was not laziness. The explanation is not available yet.
Two words separate the issue. Reliability is agreement - different clinicians reaching the same label, which DSM-III's 1980 checklists largely achieved. Validity is whether the label names a distinct thing that really exists.
You can have the first without the second.
Worth asking
Your diagnosis is a careful description that predicts useful things about treatment. It is not a statement that something was found inside you.
Ask what specifically led to it, and whether treatment failing would make your clinician reconsider.
Source
The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders — Shorter E (2015)
Read the source: https://doi.org/10.31887/DCNS.2015.17.1/eshorter
DOI: 10.31887/DCNS.2015.17.1/eshorter
How this was scored
- Study design
- not recorded
- Funding
- not recorded
- Published in
- not recorded
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
We have not finished checking this source, so there is no scoring to show yet. “We have not checked this yet” and “this is disputed” are different statements, so no scored band is shown rather than a low one.
Read the full scoring rubric, including what it can't tell you.
Published August 31, 2026.
Questions
How strong is the evidence behind this?
Resolv rates this source "not yet assessed". We have not finished checking this source. No judgement either way. One caveat travels with that badge: The NIMH passages quoted here are from the Director's Blog of April 2013. That URL now returns 404 and the text is quoted from an Internet Archive capture dated 27 June 2021 - the second primary US government document in this series that has to be read from a private archive. The often-quoted figure for how many diagnoses each DSM edition contains is deliberately omitted: no citable primary source states it, and the number varies with whether subtypes, residual categories and provisional conditions are counted. It is the most quotable statistic in this subject and the easiest to refute. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders — Shorter E (2015). DOI: 10.31887/DCNS.2015.17.1/eshorter. The full source is linked on this page so you can read it yourself.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.