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PubMed1996

The DSM-IV panic disorder field trial: panic attack frequency and functional disability.

The goal of the DSM-IV panic disorder field trial was to provide an empirical basis for choosing between alternate proposals (DSM-III-R and proposed DSM-IV) for the diagnostic threshold for panic disorder, in particular the number and frequency of panic attacks required for diagnosis. The two criteria sets were compared with respect to their ability to identify individuals whose panic attacks were associated with distress, impairment, or help-seeking. Subjects were a convenience sample screened in three geographically diverse primary care clinics for presence (past 6 months) or absence (lifetime) of panic attacks. Each underwent a clinician-administered semistructured interview which included assessment of panic frequency, panic-related impairment, psychiatric diagnosis, health services utilization, and medical illness. Self-perceived health-related quality of life was assessed using the Medical Outcome Study SF-36 Health Survey Questionnaire. Although both proposals diagnosed the same proportion of panic-impaired individuals, they were not completely overlapping. Twenty percent of subjects diagnosed by each criteria set were excluded by the other. Subjects who had been excluded by the DSM-III-R but included by the DSM-IV proposal were those with fewer than 4 attacks in 4 weeks who also denied worry about the "next" attack. Broadening the worry criterion to include concerns about the health implications of attacks enabled diagnosis of this group. Subjects who met DSM-III-R, but not the proposed DSM-IV criteria, had 4 attacks in 4 weeks but denied any panic related worry. Modification of the DSM-IV proposal to include a month of worry or "a significant change in behavior related to the attacks" allowed inclusion of this group in the diagnostic category. These data suggest that the finalized DSM-IV panic disorder criteria will diagnose a greater proportion of individuals whose panic attacks are associated with impairment without inflating the diagnostic category or significantly reducing specificity.

Adult↗

PubMedDate not supplied

Factor structure of recalled DSM-IV hypomanic symptoms of bipolar II disorder.

The DSM-IV-TR definition of hypomania in bipolar II disorder (BP-II) has yet to show its validity. The aim of the current study was to find the factor structure of hypomania by using DSM-IV-TR symptoms, and to assess the DSM-IV-TR definition of hypomania. One hundred ninety-seven consecutive BP-II remitted outpatients were interviewed by the Structured Clinical Interview for DSM-IV (SCID-CV) as modified by Benazzi and Akiskal (2003) and by Benazzi (2003), in a private practice, assessing the symptoms that were more common during past hypomanic episodes. The factor structure of hypomania was studied by principal component factor analysis. Almost all patients reported overactivity (increased goal-directed activity) during hypomania, and less commonly elevated mood. Overactivity plus three or more symptoms identified 89.3% of DSM-IV-TR BP-II. Factor analysis found three factors: factor 1, including racing thoughts ("mental activation"); factor 2, including elevated mood ("high mood"); and factor 3, including overactivity ("behavioral activation"). Elevated mood was correlated only with two of the nine DSM-IV-TR hypomanic symptoms. The three-domains structure of hypomania by Kraepelin (i.e., increased mood, thought, and activity) was found in the DSM-IV-TR definition of hypomania, partly supporting its list of symptoms. However, DSM-IV-TR priority given to mood change for the diagnosis of hypomania was not supported. An upgrading of overactivity to at least a priority level similar to mood change was supported by (1) its high frequency, (2) its utility to diagnose BP-II, and (3) by factor analysis showing that elevated mood (the "prototypical" symptom of hypomania in DSM-IV-TR) correlated with few symptoms, and that three factors (of which only one included elevated mood) were present.

Adult↗

PubMedDate not supplied

Clinical utility of DSM-IV pain disorder.

The utility of DSM-IV criteria for pain disorder was investigated within a consecutive sample of 90 chronic pain patients aged between 18 and 65 years. In this sample, 65.6% (n = 59) fulfilled diagnostic criteria for DSM-IV pain disorder. Of the patients with DSM-IV pain disorder, 22% fulfilled additional criteria for depressive disorder, 6.8% for hypochondriasis, and 23.7% for any other DSM-IV diagnosis. Only 54.2% of the patients with DSM-IV pain disorder had no comorbid psychiatric disorder. When assessing somatoform symptoms without hierarchical guidelines, there is a great overlap between the symptomatology of pain disorder and other somatoform disorders. Of 59 patients with DSM-IV pain disorder, 93.2% also met criteria for DSM-IV undifferentiated somatoform disorder and 10.2% for DSM-IV somatization disorder. The mean number of somatoform symptoms was 17 in the total sample. Despite the presence or absence of a general medical condition, there was no significant difference between pain disorder associated with both psychological factors and a general medical condition (code 307.89) and pain disorder associated with psychological factors (code 307.80) with regard to the pain duration, intensity, and type and the level of disability and educational level. The formulation of a distinct psychiatric entity for pain conditions may improve the consideration of psychosocial factors in the pathogenesis and clinical cause of pain. However, with regard to our data, the distinctive validity of different subtypes of pain disorder as provided by DSM-IV awaits further clarification.

Adolescent↗

PubMed2001

Is DSM widely accepted by Japanese clinicians?

The Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), a new standardized diagnostic system with multiaxial diagnosis, operational criteria and renewed definitions of mental disorders, was introduced in 1980 and prompted movements to reform conventions in Japanese psychiatry. This review overviews the initial response of Japanese clinicians to accept DSM-III, and its effects on the development of systematic research of psychiatric diagnosis. These new research activities include those on reliability of psychiatric diagnosis, application of various evaluation tools, discussion on the concept of mental disorders, relation of personality disorders with depressive disorders, and Taijin-kyofusho, or culturally distinctive phobia in Japan. A reference database search to survey the latest trend on psychiatric research indicated that the number of papers published by Japanese workers increased sharply after 1987, and DSM apparently greatly influenced their internationalization. Twenty years after the publication of DSM-III, a questionnaire on the use of DSM-IV was set out in 2000 to survey how widely DSM is utilized in clinical practice in Japan. Two hundred and twelve psychiatrists answered the questionnaire, and the results show that DSM has been accepted positively by the younger generation, while the older generation (over 40s) has still less interest in DSM, and DSM is used mainly for research purposes rather than in daily practice.

Adult↗

PubMed1997

DSM-III-R disorders in preschool children from low-income families.

OBJECTIVE: To generate rates of DSM-III-R disorders in a sample of preschool children from low-income families, examine impairment ratings for preschool children meeting criteria for DSM-III-R disorders, and compare rates of psychopathology using DSM-III-R criteria with rates generated by the Child Behavior Checklist (CBCL). METHOD: As part of an ongoing longitudinal study of 104 mother-child dyads from low-income families, data were gathered when children were 5 years of age. DSM-III-R disorders were diagnosed through the administration of the Schedule for Affective Disorders and Schizophrenia for School-Age Children to the mothers, and mothers competed the CBCL. RESULTS: Rates of DSM-III-R disorders among preschool children from low-income families were higher than those reported in community samples, but comparable with rates for low-income school-age children and adolescents. Children meeting criteria for DSM-III-R disorders were rated as significantly impaired. The prevalence of behavioral and emotional problems was similar by both DSM-III-R criteria and the CBCL. There was some evidence, however, that the two systems identified different children. CONCLUSIONS: DSM-III-R criteria appear to adequately identify preschool children with serious behavioral and emotional problems. Longitudinal studies are needed to explore further the relative utility of the DSM and CBCL in the identification of psychopathology in preschool children.

Chi-Square Distribution↗

PubMed1986

Five years of experience with the DSM-III system in clinical work and research: some concluding remarks.

The reliability of the DSM-III is superior to other classification systems available in psychiatry. However, reliability depends on proper knowledge of the system. Some pitfalls reducing reliability of axis 1 diagnosis which commonly are overlooked are discussed. Secondly, some problems of validity of axis 1 and 2 are considered. This is done by discussing the differential diagnosis of organic mental disorders and other psychiatric disorders with concomittant physical dysfunction, and the diagnoses of post-traumatic stress disorders and adjustment disorders among others. The emphasis on health care seeking behaviour as a diagnostic criteria in the DSM-III system, may cause a social, racial and sexual bias in DSM-III diagnoses. The present discussion of the DSM-III system from a clinical point of view indicates the need for validation studies based on clinical experience with the DSM-III. These studies should include more out-patients and patients with psychopathology who do not seek psychiatric treatment. Such studies must also apply alternative diagnostic standards like the ICD-9 and not only rely on structured psychiatric interviews constructed for DSM-III diagnoses. The discussion of axis 4 points to the problem of wanting to combine reliable rating with clinically meaningful information. It is concluded that the most important issue to be settled regarding axis 4 in the future revisions is the aim of including this axis. The discussion of axis 5 concludes that axis 5 is biased toward poor functioning and thus may be less usefull when applied on patients seen outside hospitals. Despite these problems of the DSM-III, our experiences indicate that the use of the DSM-III is fruitful both for the patient, the clinician and the researcher. Thus, the cost of time and effort needed to learn to use the DSM-III properly are small compared to the benefits achieved by using the system.

Adjustment Disorders↗

PubMed2003

Generalized anxiety disorder in patients with major depression: is DSM-IV's hierarchy correct?

OBJECTIVE: DSM-III imposed a hierarchical relationship in the diagnosis of anxiety disorders in depressed patients, stipulating that anxiety disorders could not be diagnosed if their occurrence was limited to the course of a mood disorder. In the subsequent versions of the DSM this hierarchy was eliminated for all anxiety disorders except generalized anxiety disorder. The authors examined the validity of this remaining hierarchical relationship between mood and anxiety disorders. METHOD: Psychiatric outpatients with major depressive disorder (N=332) were evaluated with a semistructured diagnostic interview and completed paper-and-pencil questionnaires on presentation for treatment. To study the validity of the DSM-IV hierarchical relationship between generalized anxiety disorder and mood disorders, the authors made a diagnosis of modified generalized anxiety disorder for patients with major depressive disorder who met all the criteria for generalized anxiety disorder except for the exclusion criterion. The analyses compared the characteristics of three nonoverlapping groups of patients with DSM-IV major depressive disorder: 1) those with coexisting DSM-IV generalized anxiety disorder, 2) those with coexisting modified generalized anxiety disorder, and 3) those with neither DSM-IV nor modified generalized anxiety disorder. RESULTS: Compared to the depressed patients without generalized anxiety disorder, the depressed patients with DSM-IV and modified generalized anxiety disorder had higher levels of suicidal ideation; poorer social functioning; a greater frequency of other anxiety disorders, eating disorders, and somatoform disorders; higher scores on most subscales of a multidimensional self-report measure of DSM-IV axis I disorders; a greater level of pathological worry; and a higher morbid risk for generalized anxiety disorder in first-degree family members. The two generalized anxiety disorder groups did not differ from each other. CONCLUSIONS: The findings question the validity of the DSM-IV hierarchical relationship between major depressive disorder and generalized anxiety disorder and suggest that the exclusion criterion should be eliminated.

Adolescent↗

PubMed1997

A psychometric evaluation of the DSM-IV personality disorder criteria.

In this study, we examined the psychometric quality of the recently revised DSM-IV Personality Disorders (PD). A nationally drawn sample of mental health professionals rated 280 patients known to them, using a symptom checklist containing all the DSM-IV PD criteria. From this symptom level data we determined internal consistency, convergent validity, and discriminant validity for each DSM-IV PD criteria. Overall, the findings were encouraging. The internal consistency--a measure of reliability--of the PD criteria sets appears to be substantially improved. The median coefficient alpha for the DSM-IV PDs was .73. Convergent validity was generally adequate for the DSM-IV PD criteria sets. However, discriminant validity, a measure of the specificity of a criterion's relationship to its parent scale, continues to be a problem of the PDs. The findings suggest that the DSM-IV PDs may have better reliability than did their DSM-III-R predecessors. However, the weak discriminant validity found for the DSM-IV PD criteria sets indicates that the Axis II system will continue to show high levels of comorbidity. The usefulness of psychometric procedures in the development and refinement of the DSM PDs is also highlighted.

Adult↗

PubMed1998

Confirmation of the diagnosis of schizophrenia after death using DSM-IV: a Victorian experience.

OBJECTIVE: This study examines the reliability of antemortem diagnoses of schizophrenia using DSM-IV criteria. METHOD: The case histories of 83 subjects with a provisional diagnosis of schizophrenia at autopsy were retrospectively reviewed using a semi-structured chart review and application of DSM-IV criteria. Agreement between antemortem and postmortem diagnoses of schizophrenia was examined, as well as the concordance between DSM-IV diagnoses and previously obtained diagnoses using DSM-III-R and ICD-10 criteria for schizophrenia. RESULTS: According to DSM-IV, 30.1% of cases did not have schizophrenia, compared to 36.1% using DSM-III-R criteria and 51.8% of cases using ICD-10 criteria. Concordance between DSM-IV and DSM-III-R diagnoses of schizophrenia was excellent (kappa = 0.81), but only fair between DSM-IV and ICD-10 (kappa = 0.57). Of the cases that did not meet the formal criteria for schizophrenia, the majority were reassigned diagnoses of schizoaffective disorder and affective disorder. CONCLUSIONS: The use of human brain tissue in postmortem studies of schizophrenia must be linked to standardised diagnostic assessment procedures. Diagnoses can be upgraded with the development of new criteria, providing sufficient clinical data is available in case histories.

Adult↗

PubMed2005

Reflections on DSM classification and its utility in primary care: case studies in "mental disorders".

BACKGROUND: This case series was conducted to demonstrate the limitations of the DSM system in primary care patients. METHOD: Sixty family health center patients free of mental disorders according to DSM-IV criteria completed monthly quantitative interviews, using multiple rating instruments, concerning the levels of psychiatric symptoms, presence of distress and/or a mental disorder, functional status, support, and stressors. In addition, a purposive sample of 16 subjects completed an in-depth qualitative interview concerning their situation at the time they crossed a DSM threshold. Data were collected from April 2000 to March 2001. RESULTS: Overall, there were 14 subjects with distress alone, 6 subjects with subthreshold disorders, and 3 subjects with known transient (< 2 months' duration) threshold disorders. Thus, even with the incomplete longitudinal data in this study, the clinical needs of 23 (38%) of the original 60 subjects were inadequately met by the DSM criteria. From the 10 subjects who crossed a DSM threshold and completed a qualitative interview, we selected 5 case studies with the most complete and complementary quantitative and qualitative data to illustrate several findings regarding the utility of the DSM classification in primary care. First, these cases show that psychological symptoms and DSM disorders vary considerably. Second, distress and subthreshold disorders are often seen in primary care patients. Third, the crossing of a DSM threshold corresponds to extreme levels of psychological symptoms and may therefore represent symptom severity. Fourth, psychological symptoms are often linked to physical illness. Finally, the context in which these symptoms and disorders develop often produces complex dynamic patterns. CONCLUSIONS: The current DSM system failed to adequately reflect the spectrum and context of mental illness in patients from a predominantly low-income, Hispanic primary care population.

Journal Article↗

PubMed2000

Do the DSM decision trees improve diagnostic ability?

Experiment 1 examined whether the use of the DSM-III-R decision trees increased the accuracy of DSM-III-R diagnoses. Results indicated that the use of the decision trees interacted with the level of DSM-III-R experience to affect diagnostic accuracy. The use of the decision trees resulted in a modest increase in diagnostic accuracy for participants with less DSM-III-R experience; for participants with more DSM-III-R experience, the use of the decision trees had no significant effect on diagnostic accuracy. Experiment 2 examined whether the use of the DSM-III-R decision trees increased the accuracy and confidence and decreased the time of DSM-IlI-R diagnosis across participants with varying levels of DSM-III-R experience. The primary analyses consisted of a 3 x 2 x 2-multivariate analysis of variance (MANOVA) to determine whether the use of the decision trees increased diagnostic accuracy and diagnostic confidence and decreased diagnostic time. Results indicated (1) the experienced participants made more accurate diagnoses than the less-experienced and no-experience participants: (2) the decision trees, combined with practice, increased class diagnostic accuracy and decreased diagnostic time; and (3) participants were more confident in their diagnosis when they used the decision trees than when they did not use the decision trees. Supplementary analyses consisted of two one-way analysis of variance (ANOVA) procedures and indicated that participants' preference for and knowledge of how to use the decision trees did not significantly affect their diagnostic accuracy.

Adult↗

PubMed2001

One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample.

Several studies of representative populations have reported prevalence rates of DSM-III and DSM-III-R generalized anxiety disorder (GAD); however, no community study has examined the effect of the stricter DSM-IV criteria on prevalence estimates and patterns of comorbidity. Furthermore, past studies based on "lifetime" symptom assessments might have led to upper-bound 1-year and point prevalence estimates. Data is presented from a national representative sample study of 4,181 adults in Germany, 18-65 years old, who were interviewed for DSM-IV disorders with the 12-month version of the Munich-Composite International Diagnostic Interview. The prevalence rate of strictly defined, 12-month threshold DSM-IV GAD was estimated to be 1.5%; however, 3.6% of respondents presented with at least subthreshold syndromes of GAD during the past 12 months. Higher rates of worrying and GAD were found in women (worrying 10%, GAD 2.7%) and in older respondents (worrying 9.3%, TAD 2.2%). Taking into account a wider scope of diagnoses than previous studies, a high degree of comorbidity in GAD cases was confirmed: 59.1% of all 12-month GAD cases fulfilled criteria for major depression, and 55.9% fulfilled criteria for any other anxiety disorder. In conclusion, prevalence and comorbidity rates found for DSM-IV GAD are not substantially different from rates reported for DSM-III-R GAD. The minor differences in our findings compared to previous reports are more likely attributable to differences in study methodology rather than changes in diagnostic criteria for DSM-IV.

Adolescent↗

PubMed2005

Concurrent validity of the DSM-IV scales Affective Problems and Anxiety Problems of the Youth Self-Report.

This study investigated the concurrent validity of the DSM-IV scales Anxiety Problems and Affective Problems of the Youth Self-Report (YSR) in a community sample of Dutch young adolescents aged 10-12 years. We first examined the extent to which the YSR/DSM-IV scales reflect symptoms of DSM-IV anxiety disorders and DSM-IV Major Depressive Disorder, assessed with the Revised Child Anxiety and Depression Scale (RCADS). Second, we examined whether the association between the YSR/DSM-IV scales and the RCADS scales was stronger than the association between the empirically derived YSR narrow-band scales Anxious/Depressed and Withdrawn and the same RCADS scales. Results showed that the YSR/DSM-IV scale Affective Problems had a stronger association with symptoms of DSM-IV Major Depressive Disorder than the YSR narrow-band scales Withdrawn and Anxious/Depressed. However, the YSR/DSM-IV scale Anxiety Problems had a weaker association with symptoms of DSM-IV anxiety disorders, compared to the YSR narrow-band scale Anxious/Depressed. It was concluded that the construction of the DSM-IV scales improved the correspondence with DSM-IV Major Depressive Disorder, but not with DSM-IV anxiety disorders.

Adolescent↗

PubMedDate not supplied

Classification of sexual dysfunctions: towards DSM-V and ICD-11.

This article reports on the changes in the classification of sexual dysfunctions since DSM-III, and on the results of the efforts to make these disorders compatible in DSM-IV and ICD-10. A comparison is made between the ways in which sexual dysfunctions are conceptualized in DSM-III, DSM-III-R, DSM-IV, and ICD-10. Special attention is given to the extent to which: (1) in the diagnostic criteria due weight is given to the physiological and psychological aspects, and to the different phases of the sexual response cycle; and (2) these disorders apply to people of different sexes and sexual orientations, and to problems arising while using different sexual techniques. After publication of DSM-III, the classification of sexual dysfunctions has evolved considerably. Moreover, there are still important differences between DSM-IV and ICD-10. Suggestions for DSM-V and ICD-11 are (among others): (1) introduction of excessive (hyperactive) sexual desire in addition to diminished (hypoactive) sexual desire; (2) differentiation between genital arousal disorder and sexual excitement disorder; and (3) differentiation between orgasmic disorder, anhedonic orgasm, ejaculation disorder, and premature orgasm.

Female↗

PubMed2001

Comparability of sleep disorders diagnoses using DSM-IV and ICSD classifications with adolescents.

STUDY OBJECTIVES: The use of diagnostic classifications to define sleep disorders is still unusual in epidemiological studies assessing the prevalence of sleep disorders in an adolescent population. DESIGN: Cross-sectional study. Representative samples of general populations in United Kingdom, Germany and Italy were selected and interviewed by telephone about their sleep habits, sleep and mental disorder diagnoses. Overall, 724 adolescents ages 15-18 years and 1447 young adults ages 19 to 24 years were interviewed. ICSD-90 and DSM-IV diagnoses provided by the Sleep-EVAL expert system were used for the comparisons. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: 8% of the adolescents and 12.6% of the young adults had ICSD dyssomnia or sleep disturbances associated with a mental disorder. According to the DSM-IV classification, 5.7% of the adolescents and 8.1% of the young adults had a dyssomnia diagnosis. The comparison between the two classifications show that 73.2% of adolescents and young adults with a DSM-IV dyssomnia diagnosis also had similar ICSD diagnosis. The reverse comparison, ICSD vs. DSM-IV, shows that 39.8% of the subjects with an ICSD diagnosis had a DSM-IV diagnosis. DSM-IV primary insomnia was the most frequent diagnosis. Subjects with such a diagnosis were found in about 10 different ICSD diagnoses, mainly inadequate sleep hygiene, psychophysiological or idiopathic insomnia and insufficient sleep syndrome. CONCLUSIONS: ICSD-90 classification provided higher prevalence of sleep disorder diagnoses than the DSM-IV classification. In adolescents and young adults, DSM-IV primary insomnia is two times more often associated with ICSD inadequate sleep hygiene than with ICSD psychophysiological or idiopathic insomnia.

Adolescent↗

PubMed1991

Child psychiatrists' views of DSM-III-R: a survey of usage and opinions.

The DSM-IV Child Psychiatry Work Group surveyed 460 child psychiatrists about their use of DSM-III-R and their reactions to specific proposed nosological revisions for DSM-IV. This paper presents the responses of the sample as a whole and of respondent subgroups with different theoretical, practice, and training characteristics. The survey indicates that DSM-III and DSM-III-R are widely used and generally accepted by child psychiatrists. Ninety-eight percent of respondents believe a criterion-based diagnostic system is useful, and 65% consider DSM-III-R to be an improvement over DSM-III. Depending on the diagnosis 47% to 66% of the respondents reported that they generally assess all applicable criteria and 28% to 49% often refer to the manual before assigning a diagnosis. A majority of respondents supported proposals for several new diagnostic subtypes. Ninety-three percent of respondents indicated that "adequacy of family support" was very valuable for treatment planning or estimating prognosis. Fifty-five percent of respondents admitted to diagnosing adjustment disorders in order to avoid the stigma associated with other disorders. Child psychiatrists who are psychodynamically oriented or practicing in an office-based setting or out of training for more than 10 years tend to use the DSM-III-R less rigorously.

Adolescent↗

PubMed1999

Experimental cross-validation of DSM-IV types of attention-deficit/hyperactivity disorder.

OBJECTIVE: To examine the discriminant validity of DSM-IV attention-deficit/hyperactivity disorder (ADHD) types by testing the hypothesis that types are associated with specific kinds of functional impairment and to compare overlap of DSM-IV and DSM-III-R ADHD. METHOD: Consecutive referrals (n = 692) to a pediatric subspecialty clinic for ADHD were classified into 1 of each of the 3 DSM-IV types of ADHD using parent and teacher checklist ratings of ADHD symptoms. The resulting types were compared on clinical correlates and on whether the children also met criteria for DSM-III-R ADHD. RESULTS: The validity of DSM-IV types was supported by dimension-specific impairment and other distinct correlates. Academic problems aggregated in the 2 types defined by extreme inattention, and externalizing problems aggregated in the 2 types defined by extreme hyperactivity. CONCLUSION: DSM-IV appeared superior to DSM-III-R in subcategorical homogeneity and in exhaustiveness (ability to classify all apparent cases).

Adolescent↗

PubMed1987

The value of DSM-III for psychotherapy. A feasibility study.

Establishing the usefulness of DSM-III for psychotherapy will probably require numerous studies. This paper reports a feasibility study for one kind of investigation: the use of clinical records to survey the DSM-III diagnoses and therapy outcome of 30 patients who had outpatient psychotherapy. We were interested in what range of DSM-III diagnoses was represented by patients in outpatient therapy; whether judgments of diagnosis and outcome could be made reliably from clinical records; how well patients in the therapy fit DSM-III diagnoses; if patients did not fit well, why not? We found that an exploration of the relationship between DSM-III diagnosis and outcome from clinical records is feasible; a relatively wide range (13) of DSM-III diagnoses was represented by the 30 patients; 80% of the patients fit well or moderately well into a DSM-III diagnosis; most of the 20% who did not fit well represent the class of problems of living, which does not mean, however, that their problems were minor or unimportant; in some cases the diagnosis--even when it fit the patient well--did not express the essence of the problem for which he or she was to be treated; there was a small correlation (.19) between the patient's rating on axis V and therapy outcome. The findings are discussed in terms of the pro and con arguments that have been made about DSM-III.

Adolescent↗