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Letters to the Editor
October 2004

For DSM-V, It’s the “DisorderThreshold,” Stupid—Reply

Arch Gen Psychiatry. 2004;61(10):1051-1052. doi:10.1001/archpsyc.61.10.1051-b

In reply

Regier et al are correct in saying that diagnostic concepts in psychiatryrequire further evaluation and that one important aspect of this enterpriseis to distinguish “homogenous diagnostic groups with greater predictivevalidity with respect to both prevention and treatment response.” Wetook a step in this direction in our article by examining the predictive validityof milder forms of mental disorders in a 10-year prospective follow-up studyof respondents who participated in the National Comorbidity Survey.1 Specifically, we found that a substantial proportionof individuals with mild mental disorders in 1990 subsequently went on tohave mental disability, suicide attempts, or hospitalization for mental illnessin 2000. Narrow et al 2 propose to exclude thesemild cases from the DSM system. Our results suggestthat failure to classify mild cases would be a mistake.