Rethinking the Boundaries of Psychiatry: A Critical Review of Overmedicalization and the DSM Paradigm

Abstract

Psychiatry is undergoing a period of critical self-examination as concerns grow regarding diagnostic inflation, the medicalization of ordinary human experiences, and the limitations of categorical diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the DSM has provided a shared language for clinicians, critics argue that its expansion has contributed to overmedicalization, pathologizing normative variations in emotion and behavior. This narrative review synthesizes historical, empirical, sociocultural, and philosophical critiques of psychiatric overmedicalization, with particular attention to diagnostic expansion, pharmaceutical influence, and the growing evidence supporting dimensional models of mental distress. We examine the evolution of psychiatric nosology, the drivers and consequences of diagnostic inflation, and the implications for global mental health. The review concludes by proposing a paradigm shift toward contextual, dimensional, and culturally grounded approaches that embrace epistemic humility and resist reductionist tendencies.