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October 1984

Exclusion Criteria of DSM-III: A Study of Co-occurrence of Hierarchy-Free Syndromes

Author Affiliations

From the Division of Biometry and Epidemiology, National Institute of Mental Health (NIMH), Rockville, Md (Drs Boyd and Burke and Mr Rae); the Eastern Baltimore Health Survey, School of Hygiene and Public Health and the Department of Psychiatry, The Johns Hopkins University Medical School, Baltimore (Drs Gruenberg and Nestadt); the Yale Greater New Haven (Conn) Health Survey, Department of Psychiatry, Yale University Medical School and Department of Sociology, Yale University (Dr Holzer); the Piedmont Health Survey, Department of Psychiatry, Duke University Medical Center, Durham, NC (Dr George); the Los Angeles ECA Survey, UCLA (Dr Karno); and the St Louis Health Study, Department of Psychiatry, Washington University Medical School (Dr Stoltzman and Mr McEvoy).

Arch Gen Psychiatry. 1984;41(10):983-989. doi:10.1001/archpsyc.1984.01790210065008

• The diagnostic criteria of the third edition of the DSM-III often state that one diagnosis cannot be made If It is "due to" another disorder. Using data from the National Institute of Mental Health Diagnostic Interview Schedule, with a sample of 11,519 subjects from a community population, we found that if two disorders were related to each other according to the DSM-III exclusion criteria, then the presence of a dominant disorder greatly increased the odds of having the excluded disorder. We also found that disorders, which DSM-III says are related to each other, were more strongly associated than disorders, which DSM-III says are unrelated. However, we also found there was a general tendency toward co-occurrence, so that the presence of any disorder increased the odds of having almost any other disorder, even if DSM-III does not list it as a related disorder. We concluded that empirical studies are needed to study the assumptions underlying the use of a diagnostic hierarchy.

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