December 12, 1998

Questions Over the Large Scale Accuracy of Psychiatric Diagnosis

Limitations of Diagnostic Criteria and Assessment Instruments for Mental Disorders, DA Regier, et al, Archives of General Psychiatry, vol. 55 (1998), pp. 109 - 115 (+ commentary which follows pp. 119-120).

This article critically reviews the results of two large psychiatric epidemiological studies and finds major discrepancies between them. The reviewers conclude that assessment and DSM-IV diagnoses remain quite problematic especially for lower grade disorders (like dysthmia or Attention Deficit). Very high rate prevalent rates call into question whether these diagnostic cases represent true disease or aspects of normal coping behavior. Furthermore, Robert Spitzer, the acknowledged father of the modern DSM in his commentary states "our current diagnostic criteria are limited" as guides to the need for treatment. To confuse making a mental disorder diagnosis with demonstrating treatment need, however, would be a serious mistake. Yet this is precisely how researchers justify current rates of national stimulant medication use by invoking prevalence rates of 3 to 20% (depending on what study is cited).

Reviewed 12/12/98

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