The Diagnostic and Statistical Manual (DSM), is in its fifth edition. Called the DSM-V, the manual offers new ways of diagnosing certain mental disorders that dramatically changed clinical practices for how patients are diagnosed and treated. This is particularly the case for alcohol use disorder.
The DSM-V relies on a count of certain criteria to define alcohol use disorder. The criteria in the fifth edition specify that one out of four of the criteria qualify for alcohol abuse. Three out of nine criteria constitute alcohol dependence and two out of 11 criteria are necessary for a diagnosis of an alcohol use disorder.
Alcohol use disorder over diagnosed?
A study in Frontiers in Psychiatry addresses a common complaint against the DSM-V’s criteria to diagnose alcohol-related disorders.
Many clinicians and other experts say that the method tends to overestimate the occurrence of alcohol use disorders in the general population. The study attempts to test whether this strategy to identify alcohol use disorder patients may lead to over-diagnosing of the disorder.
The study was based on a plan to develop a theoretically-derived definition of alcohol use disorder to test against data to determine whether it may be a more reliable way to diagnose the disorder.
Alcohol-related disorders and DSM-V research
The researchers used a general population study called the National Comorbidity Survey, which included 7,599 participants 18-54 years old. The participants were administered a full diagnostic interview that examined the occurrence of lifetime and past-year instances of multiple mental health disorders, including alcohol-related disorders.
The researchers used their theoretical criteria of alcohol use disorder, which included evidence of both harm and dysfunction. The researchers assigned harm as manifesting itself in negative consequences, such as neglected responsibilities, relationship problems, risky behaviors and legal, health and emotional problems.
Likewise, dysfunction was measured by an inability to control drinking, evidenced in withdrawal, symptoms, an inability to stop drinking and uncontrollable cravings.
The researchers compared the prevalence rates as measured through the DSM-V criteria against the prevalence rates using the theoretical measure of alcohol use disorder created by the research team. The researchers measured how the different measures of alcohol use disorder were related to service utilization and the duration of the disorder.
The results of the DSM-V study
According to the study results, the prevalence of alcohol use disorder for both lifetime and past-year numbers were significantly lower when using the harm and dysfunction method in place of the DSM count method.
The participants that met criteria for alcohol use disorder according to the theoretical harm and dysfunction criteria were more likely to have a longer duration of the disorder, as well as higher rates of attendance in support groups like Alcoholics Anonymous, as well as seeking treatment, when compared with participants meeting criteria for alcohol use disorder through DSM criteria.
The authors of the study determined, however, that there were several limitations to the study’s findings. For example, the data used in the study relied on self-report, which may be influenced by a participant wanting to appear a certain way to an interviewer.
Potential flaws in the DSM-V study’s results
The study may also be flawed in its perception of the DSM-V diagnostic methods. The criteria in the DSM allow individuals to be scored along a severity continuum, which can help in diagnosing in a nuanced way.
In addition, the use of the theoretical harm and dysfunction model may heighten awareness of more extreme alcohol use disorder cases and ignore milder cases that may still require intervention and treatment. The cases that escaped the harm and dysfunction criteria may be situations in which intervention could prevent a person from becoming more susceptible to negative consequences associated with excessive alcohol use.
The study’s findings support the idea that a nuanced approach to alcohol use disorder may help in accurately diagnosing the condition. Each of these methodologies have weak spots, and combining the premise behind each type of diagnosis could aid in more accurately diagnosing patients who may be battling alcohol use disorder.