To the Editor.
—I enjoyed the recent JAMA article entitled "Denial in the Medical Interview."1 Although recognizing the potential impact of denial, the authors did not discuss how the process of denial has been incorporated into psychiatric and medical nosology. Denial was included as a critical component of the definition and criteria for the diagnosis of alcoholism formulated by the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine.2The American Psychiatric Association, however, did not rely on the concept of denial in developing diagnostic criteria for alcohol dependence. Rounsaville et al3 recognized that individuals who denied alcohol use would fail to meet criteria from the Diagnostic and Statistical Manual (DSM),4 but proposed that the criteria were intended to define the minimum symptoms necessary for diagnosis rather than to guide patient assessment. Thus, paradoxically, nonpsychiatrists assigned more
Wiseman EJ, McClellan JL. Denial in the Medical Interview. JAMA. 1995;273(22):1735. doi:10.1001/jama.1995.03520460016011