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In these first analyses of data from the field trials, 14 of the 23 adult or child psychiatric diagnoses had “very good” or “good” reliability. Among these were autism spectrum disorder and ADHD in children and posttraumatic stress disorder and binge-eating disorder in adults. The papers also report on tests of a number of “cross-cutting symptoms” that appear across many psychiatric disorders, and these were also generally found to have good to excellent reliability. The cross-cutting symptom measures are proposed to appear as supplemental material to the DSM to help clinicians conduct a more comprehensive assessment.
Six of the diagnoses had relatively low reliability scores, which the report characterized as “questionable” but acceptable; among these diagnoses were major depressive disorder and generalized anxiety disorder, two of the most common psychiatric diagnoses. Task Force Chair David Kupfer, M.D., said, “We believe at least some of the reason why the scores were not at the level of previous field trials is the attention we devoted to new diagnoses and criteria sets that are often comorbid with depression and anxiety. Moreover, depression and anxiety represent symptom clusters that can fluctuate during several weeks, and the rigorous trial design of the field trials—employing a test-retest design requiring two separate clinicians to evaluate the same patient on different days—may have contributed to a lower reliability score than was found in previous field trials.”
Just three diagnoses had “unacceptable” rates of reliability, and these have been substantially revised or are no longer proposed for inclusion in the manual.
The proposed DSM-5 criteria are still under review and will not be final until they are approved by the APA Board of Trustees. The criteria were tested October 2010 through February 2012 by 279 clinicians at 11 academic centers in the in the United States and Canada. A second set of data from small group practices and private practices will be reported early next year.
Kupfer said that the field trials provide critical new data for the ongoing review of proposed diagnostic criteria for DSM-5. “We accomplished what we set out to do—which was to look at a limited group of diagnoses in which either a new disorder was being proposed or there were significant changes to existing criteria and to test both reliability and clinical acceptance,” he said. “The good to very good reliability of most diagnoses underscores that clinicians are comfortable using these new criteria.”
To read the studies in AJP in Advance, click on their titles: DSM-5 Field Trials in the United States and Canada, Part I: Study Design, Sampling Strategy, Implementation; DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses and Analytic Approaches; DSM-5 Field Trials in the United States and Canada, Part III: Development and Reliability Testing of a Cross-Cutting Symptom Assessment for DSM-5.
(Image: Shutterstock/Marcin Balcerzak)