On the threshold of disorder: a study of the impact of the DSM-IV clinical significance criterion on diagnosing depressive and anxiety disorders in clinical practice.

Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 11/2004; 65(10):1400-5.
Source: PubMed

ABSTRACT Two recent reanalyses of epidemiologic studies found that adding a clinical significance criterion reduced disorder prevalence. Patients presenting for clinical care are usually distressed or impaired by their symptoms; thus, the DSM-IV clinical significance criterion might have little impact on diagnosis in clinical practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examine the impact of the DSM-IV clinical significance criterion on diagnostic frequencies of depressive and anxiety disorders in psychiatric outpatients.
1500 psychiatric outpatients were evaluated with the Structured Clinical Interview for DSM-IV. We determined the percentage of patients who met symptom criteria but did not meet the DSM-IV clinical significance criterion for major depressive disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social phobia, specific phobia, panic disorder, and obsessive-compulsive disorder.
No patient who met the symptom criteria for current major depressive disorder or PTSD failed to meet the clinical significance criterion. Less than 2% of patients meeting the symptom criteria for current GAD did not meet the clinical significance criterion. There was variability among the remaining anxiety disorders in the percentage of symptomatic patients who met the clinical significance criterion.
In psychiatric patients, the clinical significance criterion had little impact on diagnosing major depressive disorder, GAD, and PTSD, disorders that are defined, in part, by disruptions of daily regulatory domains such as sleep, appetite, energy, and concentration. In contrast, the clinical significance criterion had a greater impact in determining whether phobic fears, obsessive thoughts, and panic attacks were sufficiently distressing or impairing to qualify for disorder status.

  • Source
    • "Frost and Steketee, 1997; OCCWG, 1997; Rheaume et al., 1995, 2000). Sex differences in social anxiety showing a preponderance of females over males are consistent with findings reported before (Lee et al., 1990; Magee et al., 1996; Essau et al., 1999; Weinstock, 1999; Wittchen et al., 1999; Zimmermann et al., 2004). Few studies have asserted that sex does not affect and is not related to social anxiety (e.g. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Physical attractiveness has been of concern in different cultures and at different times. Physical attractiveness can influence one's thoughts and actions, and concerns regarding body image can be destructive, giving rise to psychological problems. The purpose of the present study was to determine the prevalence of body dysmorphic concerns, related sex differences and comorbidity with social anxiety and obsessive beliefs. Using a stratified and cluster sampling procedure, 1,200 males and females were randomly selected. Self-report measures on body image, social anxiety and obsessive beliefs were distributed of which 843 completed questionnaires (54.9% males and 45.1% females) were returned (return rate of 70.25%). Therefore, data pertaining to 463 males and 380 females ranging in age from 17 to 20 years with a mean age of 18.12 years (SD = 1.06) were analyzed. Findings suggest a prevalence rate of 19.1% for body dysmorphic disorder, 23.6% for social anxiety and 8.8% for obsessive beliefs. Both social anxiety and obsessive beliefs were found to be comorbid with body dysmorphic concerns. The percentage of individuals reporting comorbid social anxiety (12.9%) was greater than that of those reporting comorbid obsessive beliefs (6.4%). Males with body dysmorphic concerns reported more obsessive beliefs (8.2% versus 4.1%), while their female counterparts reported more social anxiety (23.4% versus 4.2%). In males, body image concerns appear to be more cognitive in quality, while in females, body image concerns seem more emotional in tone. As the measures used do not yield formal diagnoses, findings should be viewed with caution.
    Asia-Pacific Psychiatry 06/2013; 7(1). DOI:10.1111/appy.12085 · 0.42 Impact Factor
  • Source
    01/2005; 27(1-2).
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article reviews the problem of 'boundaries' in psychopathology and its conceptualization in the diagnostic classification of psychiatric disorders. A modest number of publications in 2004-2005 contribute concepts, methods and data relevant to several aspects of the problem: scientific 'facts' versus value attribution in the definition of mental disorders; the problem of comorbidity between diagnostic entities; the spurious dichotomy between categorical versus dimensional approaches to diagnosis and classification; and the distinction between validity and pragmatic utility. The relative paucity of research explicitly addressing these issues should be a reason for concern in the debate leading up to the next revisions of the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders.
    Current Opinion in Psychiatry 12/2005; 18(6):653-8. DOI:10.1097/01.yco.0000184412.98587.a4 · 3.55 Impact Factor
Show more