DSM-IV diagnostic criterion for clinical significance: Does it help solve the false positives problem?

Objective: A major change in DSM-IV is the inclusion in almost one-half of the diagnostic criteria sets of a clinical significance criterion, which re quires that symptoms cause "clinically significant distress or impairment i n social, occupational, or other important areas of functioning." In respon se to concerns that the DSM criteria are overly inclusive, the clinical sig nificance criterion attempts to minimize false positive diagnoses in situat ions in which the symptom criteria do not necessarily indicate pathology. T his article examines whether the clinical significance criterion achieves i ts purpose and considers its broader impact on diagnostic validity. Method: The effect of the clinical significance criterion on the diagnostic validi ty of DSM-IV criteria for a wide range of disorders was examined. Results: For many diagnoses to which the clinical significance criterion was added, the symptom criteria are inherently associated with significant impairment, so the clinical significance criterion is redundant and therefore does not affect caseness, For some diagnoses, the clinical significance criterion i s potentially helpful in eliminating false positives by elevating the level of required distress. However, there may be advantages to obtaining the sa me results by modifying some of the symptom criteria. Often the clinical si gnificance criterion has led to the possibility of false negative diagnoses . Conclusions: In the process of revising DSM-IV, the generic use of the cl inical significance criterion should be reconsidered. For each DSM diagnosi s, it should be determined whether there is a need to raise the threshold o f any of the existing symptom criteria or to add a criterion that excludes normal reactions to psychosocial stress.