[Limitations of the DSM IV as a Diagnostic Tool]

By

ABSTRACT

Alcohol abuse and dependence are among the most common psychiatric conditions identified in epidemiological surveys of the general population. The aim of this article is to examine the psychometric properties of Diagnostic and Statistical Manual of Mental Disorders, (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for alcohol abuse and dependence using latent class analysis (LCA). Six thousand two hundred and sixty-five young Australian twins (median age 30 years) were interviewed by telephone between 1996 and 2000 using a modified version of the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). DSM-IV symptoms of alcohol abuse and dependence were collected by structured diagnostic interview and analyzed using methods of LCA. LCA revealed a 4-class solution for women that classified individuals according to the severity of their alcoholrelated problems: no/few problems (66.5%), heavy drinking (23.9%), moderate dependence (7.6%) and severe dependence (2.0%). Among men the preferred solution included 5 classes corresponding to no/few problems (46.4%), heavy drinking (34.3%), moderate dependence (12.2%), severe dependence (3.0%) and abuse (4.0%). Evidence of a male-specific class of alcohol-related problems corresponding to abuse partially supports the DSM conceptualization of alcohol use disorders but suggests that this conceptualization — and measurement — may need to be refined for women. Identification of a malespecific abuse class also has important implications for interventions and treatment as these individuals experienced significant alcohol-related problems and comprised approximately 21% of all men classified with an alcohol use disorder.

TABLE OF CONTENTS

ABSTRACT2

1. INTRODUCTION4

Broad overview of the problem4

Statement of problem4

Objective of the Study5

Rationale of the study5

Clinical Implications6

II. REVIEW OF LITERATURE8

III. THEORETICAL FRAMEWORK12

The Theoretical Basis of the DSM-IV14

IV. METHODOLOGY19

Sample19

Assessment19

Alcohol Dependence20

Alcohol Abuse21

V. CONCLUSION22

REFERENCES26

1. INTRODUCTION

Broad overview of the problem

The use of the DSM-IV is limited and has also a number of disadvantages. The first one concerns to the system itself, which produces an excessive fragmentation of the clinical states of mental disorders. This is the reason why many patients are given many different diagnoses simultaneously, once the symptoms overpass the rigid borders the manual proposes. Co-morbidity within an axis (or many of them) is almost a rule and not an exception. Eighty percent of individuals with social phobia are given other correlate diagnosis. The panic disorder is associated to depression in more than 50% of cases, and many times it is associated with generalized anxiety, social phobia, obsessive-compulsive disorder and other personality disorder as well, from Axis II. The recommendation of recording all diagnosis obviously poses a disadvantage. Besides, the list of symptoms does not comprise all patients' complaints. For example, headache, dry mouth, blurred sight and cry outbursts are not described as symptoms of panic attack, although they are frequently present in those episodes.

Statement of problem

The second problem concerns the professional that will use the manual. The DSM-IV must not be used as an infallible list that automatically provides psychiatric diagnoses after it is filled. The results may be a disaster in non-experienced hands. Many symptoms overlap different clinical conditions, and deciding their origin, or the state they belong ...