Issues for DSM-V: the limitations of field trials: a lesson from DSM-IV.

摘要

Alesson from DSM-IV is that field testing cannot always predict the rates of mental disorders once a diagnostic system enters general use. The most difficult but also most consequential purpose of field trials is to determine how new criteria sets will affect definitions of caseness and rates of diagnosis. Ironically, clearer wording may make diagnoses easier to use but also make them susceptible to overuse-especially in primary care and by patients, families, and teachers. This potential can be amplified by drug company marketing-not just to psychiatrists, but especially to pediatricians, primary care physicians, and now the general public. The risk of an artifactual increase in diagnoses is particularly high for disorders at the boundary of normality, such as mood and anxiety disorders. "Not otherwise specified" categories and dimensional ratings, in which there is no threshold for diagnosis,but rather a continuous scale, are at particularly high risk for increased identification of symptoms in otherwise normal people.