Are we mislabeling mental‑health “comorbidities” and over‑medicating patients?

In this live‑stream episode, host Nasiragami sits down with psychiatry resident Daniel Herringer to challenge the way DSM defines comorbid disorders. They trace the origin of the term from the 1960s, show how overlapping criteria create artificial pairings like GAD + MDD, and argue that nature rarely hands out multiple independent illnesses at once.

The solution they propose is a diagnostic hierarchy—essentially a differential‑diagnosis approach that rules out the most symptom‑rich conditions first. By treating the underlying mood or psychotic illness, secondary symptoms such as anxiety, executive dysfunction or “ADD” often resolve, cutting down poly‑diagnosis and poly‑pharmacy.

For the data behind these claims see the outcome study on borderline personality (https://pmc.ncbi.nlm.nih.gov/articles/PMC3289285/), the bipolar‑OCD review (https://onlinelibrary.wiley.com/doi/full/10.1111/acps.12250), the original hierarchy paper (https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/hierarchy-model-of-psychiatric-symptomatology-an-investigation-based-on-present-state-examination-ratings/61EDD658A63262C07579671481D3B4F9), and classic critiques by Hermann van Praag (https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/comorbidity-psycho-analysed/F1AFDC245EF1CBB4790D6400BADC6389) and his “nosologomania” paper (https://www.tandfonline.com/doi/abs/10.3109/15622970009150584).

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