Mild Disorders Should Not Be Eliminated From the DSM-V

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Abstract
TWO MAJOR psychiatric epidemiological surveys have been carried out in the United States since 1980—the Epidemiologic Catchment Area Study1 and the National Comorbidity Survey (NCS).2 Both surveys estimated that about 30% of the respondents in the 18- to 54-year age range met criteria for 1 or more of the 12-month DSM-III (Epidemiologic Catchment Area) or DSM-III-R (NCS) psychiatric disorders assessed in the surveys.3,4 These are lower-bound estimates, as neither of the surveys included the full range of DSM disorders in their assessments and even this range of disorders is likely to be noninclusive.5,6 Nevertheless, these rates seemed high, leading to the suggestion that the lay administered diagnostic interviews in these surveys might be upwardly biased.7,8 However, clinical calibration studies showed that the prevalence estimates in these surveys were not upwardly biased,9,10 leading critics to conclude that the DSM system itself is overly inclusive.3,11,12 This conclusion was instrumental in causing an American Psychiatric Association Task Force to add a clinical significance criterion to many disorders in the DSM-IV to remind readers of the basic definition of a mental disorder in the "Introduction" of the manual. However, even when this additional requirement was applied post hoc to the Epidemiologic Catchment Area and NCS data, the 12-month prevalence of a DSM disorder, equivalent to about 37 million adults in the United States, continued to exceed substantially the number who could be helped with current treatment resources.13