Holding the line against diagnostic inflation in psychiatry.

pet diagnoses and from consumer advocacy groups who worry a great deal about false negatives but tend toward indifference about false positives. The only pushback against all of these pressures causing diagnostic inflation comes from those practice guidelines that suggest a cautious, stepped care approach to treatment [5, 6] . However, these efforts have not been sufficient to hold the diagnostic line in psychiatry and in primary care practice. Rates of diagnosis and use of psychotropic medication continue to escalate [2, 7] . Our purpose here is to suggest an explicitly stepped approach to diagnosis that will increase the acceptance and practicality of stepped care for mental disorders. The goal is to reduce the high rate of false positives without risking undertreatment for those who need it.