The Initial Field Trials of DSM-5: New Blooms and Old Thorns
by Robert Freedman, David A. Lewis, Robert Michels, Daniel S. Pine, Susan K. Schultz, Carol A. Tamminga, Glen O. Gabbard, Susan Shur-Fen Gau, Daniel C. Javitt, Maria A. Oquendo, Patrick E. Shrout, Eduard Vieta, and Joel Yager
American Journal of Psychiatry 2013 170:1-5.
The questionable reliability of major depressive disorder, unchanged from DSM-IV, is obviously a problem. Major depressive disorder has always been problematic because its criteria encompass a wide range of illness, from gravely disabled melancholic patients to many individuals in the general population who do not seek treatment. Although symptom severity on the Hamilton Depression Rating Scale distinguishes those patients who respond more specifically to pharmacotherapy, the DSM-IV criteria do not capture that distinction. A second problem not resolved by the DSM-IV criteria is the common co-occurrence of anxiety, which markedly diminishes the effects of antidepressant treatment. The DSM-5 work group decided not to change the criteria for major depressive disorder from DSM-IV and instead created other diagnoses for the mixture between anxiety and depression. However, these efforts did not improve the poor reliability of DSM-IV depression; “mixed anxiety and depression” has a kappa of 0…
DSM-5: How Reliable Is Reliable Enough?
by Helena Chmura Kraemer, David J. Kupfer, Diana E. Clarke, William E. Narrow, and Darrel A. Regier
American Journal of Psychiatry 2012 169:13-15.
… to see a κI for a DSM-5 diagnosis above 0.8 would be almost miraculous; to see κI between 0.6 and 0.8 would be cause for celebration. A realistic goal is κI between 0.4 and 0.6, while κI between 0.2 and 0.4 would be acceptable.