David A. Katerndahl Anne C. Larme Raymond F. Palmer Nancy Amodei
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Background: This case series was
conducted to demonstrate the limitations of the DSM system in
primary care patients.
Method: Sixty family health center
patients free of mental disorders according to DSM-IV criteria
completed monthly quantitative interviews, using multiple rating
instruments, concerning the levels of psychiatric symptoms,
presence of distress and/or a mental disorder, functional status,
support, and stressors. In addition, a purposive sample of 16
subjects completed an in-depth qualitative interview concerning
their situation at the time they crossed a DSM threshold. Data
were collected from April 2000 to March 2001.
Results: Overall, there were 14 subjects
with distress alone, 6 subjects with subthreshold disorders, and
3 subjects with known transient ( < 2 months' duration)
threshold disorders. Thus, even with the incomplete longitudinal
data in this study, the clinical needs of 23 (38%) of the
original 60 subjects were inadequately met by the DSM criteria.
From the 10 subjects who crossed a DSM threshold and completed a
qualitative interview, we selected 5 case studies with the
most complete and complementary quantitative and qualitative data
to illustrate several findings regarding the utility of the DSM
classification in primary care. First, these cases show that
psychological symptoms and DSM disorders vary considerably.
Second, distress and subthreshold disorders are often seen in
primary care patients. Third, the crossing of a DSM threshold
corresponds to extreme levels of psychological symptoms and may
therefore represent symptom severity. Fourth, psychological
symptoms are often linked to physical illness. Finally, the
context in which these symptoms and disorders develop often
produces complex dynamic patterns.
Conclusions: The current DSM system
failed to adequately reflect the spectrum and context of mental
illness in patients from a predominantly low-income, Hispanic
primary care population.
Prim Care Companion J Clin Psychiatry 2005;7(3):91-99
https://doi.org/10.4088/PCC.v07n0303
© Copyright 2005 Physicians Postgraduate Press, Inc.