Julie Nordgaard | 24 April 2025

The psychiatric diagnostic interview is the foundation of clinical assessment and diagnosis, yet the most valid approach to it remains a subject of ongoing debate. This presentation explores the methodological and phenomenological challenges inherent in psychiatric diagnosis. While structured interviews are widely used to enhance reliability, their ability to capture the depth of subjective experience as well as the whole person remains questionable. Building on findings from a first-admission hospital sample, we examine the limitations of structured diagnostic tools, particularly their tendency to oversimplify complex psychopathological phenomena. A fully structured approach risks reducing patients’ suffering to checked boxes on a symptom checklist, neglecting their lifeworld and contextual reality. Furthermore, the decline in psychopathological expertise over recent decades raises concerns about the over-reliance on standardized schedules at the expense of qualitative understanding. A phenomenologically informed approach is proposed as a way forward—one that prioritizes detailed descriptions of subjective disturbances, integrates open-ended patient-centered inquiry, and acknowledges the inherently interpretative nature of psychiatric assessment. Ultimately, if psychiatric diagnoses are to be both clinically valid and relevant to patients, we must shift toward a model that balances structure and subjectivity, bridging the gap between scientific rigor and the lived experience of mental illness.

Julie Nordgaard, MD, PhD, DMsc Clinical Professor, University of Copenhagen, Denmark Professor Nordgaard’s research focuses on psychopathology and the psychiatric diagnostic interview, utilising a phenomenologically informed approach with an emphasis on subjective experiences. Her work primarily centers on disorders within the schizophrenia spectrum. Professor Nordgaard is the chairman for the Institute of Psychopathology and Director of all EASE (Examination of Anomalous Self-Experiences) related activities. She teaches at an expert level in psychopathology and the psychiatric interview, both internationally and domestically. Professor Nordgaard is the author of more than 80 peer-reviewed journal articles, some newer publications are: Psychiatric comorbidity: a concept in need of a theory (Psychological Medicine 2023) and Self-disorders and psychopathology: a systematic review (Lancet Psychiatry 2021). Other publications include The Psychiatric Interview for Differential Diagnosis (book, Springer) and Phenomenological Psychopathology and Quantitative Research (chapter in Oxford Handbook of Phenomenological Psychopathology)