The diagnostic significance of the functional impairment and subjective distress criterion: An illustration with the DSM-III-R anxiety disorders

The assessment of subjective distress and functional impairment and its influence on DSM-III-R and DSM-IV mood and anxiety disorders are considered. Patients (n=267) were diagnosed at an anxiety disorders clinic using a semistructured interview (Anxiety Disorders Interview Schedule-Revised). DSM-III-R diagnoses that met the DSM-III-R distress/impairment criterion and subclinical diagnoses (those meeting all criteria except clinically significant distress or impairment) were compared. Of the DSM-III-R anxiety disorders, simple phobia and, to a lesser extent, social phobia frequently were diagnosed as subclinicals: Of 210 subclinical diagnoses assigned, 46% were simple phobia and 23% were social phobia. Also, test-retest reliability figures were significantly lower for diagnoses of social phobia when assigned at the subclinical rather than the clinical level. The difference approached significance for simple phobia. Overall, the findings support the DSM-IV Task Force's decision to explicitly include a distress/impairment criterion in the diagnostic criteria of most diagnoses in DSM-IV, despite the possible redundancy of doing so. In addition, the need to develop operational definitions for the distress and impairment criterion is noted.