MentalSeek-Dx: Towards Progressive Hypothetico-Deductive Reasoning for Real-world Psychiatric Diagnosis

Mental health disorders represent a burgeoning global public health challenge. While Large Language Models (LLMs) have demonstrated potential in psychiatric assessment, their clinical utility is severely constrained by benchmarks that lack ecological validity and finegrained diagnostic supervision. To bridge this gap, we introduce MentalDx Bench, the first benchmark dedicated to disorder-level psychiatric diagnosis within real-world clinical settings. Comprising 712 de-identified electronic health records annotated by boardcertified psychiatrists under ICD-11 guidelines, the benchmark covers 76 disorders across 16 diagnostic categories. Evaluation of 18 LLMs reveals a critical paradigm misalignment: strong performance at coarse diagnostic categorization contrasts with systematic failure at disorder-level diagnosis, underscoring a gap between pattern-based modeling and clinical hypothetico-deductive reasoning. In response, we propose MentalSeek-Dx, a medical-specialized LLM trained to internalize this clinical reasoning process through supervised trajectory construction and curriculumbased reinforcement learning. Experiments on MentalDx Bench demonstrate that MentalSeek-Dx achieves state-of-the-art (SOTA) performance with only 14B parameters, establishing a clinically grounded framework for reliable psychiatric diagnosis. The dataset and code are available at MentalSeek-Dx.