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Introduction

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is the 2013 update to the American Psychiatric Association's classification and diagnostic publication.

Purpose

DSM-5 was developed to aid in clinical decision making with the goal to provide the greatest possible assurance that those with a particular disorder will have it correctly identified (sensitivity) and that those without it will not have it mistakenly identified (specificity). (1)

Purpose of the Field Trials

The DSM-5 field trials were designed to evaluate the reliability, utility, (and, where possible, convergent validity) of the proposed criteria. To accomplish this patients were evaluated by two clinicians form various mental health disciplines. This approach permitted the estimate of test-retest reliability. The trials involved evaluating over 4,000 patients at 11 field trial sites (2) The goal was to establish intraclass kappa between 0.4 and 0.6; κ>0.2 were considered acceptable.

Reliability of diagnoses

One of the serious shortcomings of DSM-5 is that the kappa (test-retest reliability) was quite low for many disorders. Multiple other criticisms levied against DSM-5 are less objective.

Adult trials

  • Diagnoses were in the very good (kappa 0.60–0.79) range: PTSD, complex somatic symptom disorder, and major neurocognitive disorder.
  • Diagnoses in the good (kappa 0.40–0.59) range: schizophrenia, schizoaffective disorder, bipolar I disorder, binge eating disorder, alcohol use disorder, mild neurocognitive disorder, and borderline personality disorder.
  • Diagnoses were in the questionable (kappa 0.20–0.39) range: major depressive disorder, generalized anxiety disorder, mild traumatic brain injury, and antisocial personality disorder.
  • Proposed diagnosis, mixed anxiety-depressive disorder, was in the unacceptable (kappa <0.20) range.


References

1. Kraemer HC et.al. DSM-5: How Reliable Is Reliable Enough? American Journal of Psychiatry 2012 169:1, 13-15

2.