In another study published in the April American Journal of Psychiatry, a group of researchers looked at the accuracy of patients’ clinical diagnoses in terms of how well they met the diagnostic criteria for a DSM-IV Axis I diagnosis.

The study, by lead clinical investigator M. Katherine Shear, M.D., a professor of psychiatry at the University of Pittsburgh, noted that clinicians are increasingly expected to use practice guidelines in treating patients. However, the appropriate use of these guidelines depends upon accurate diagnosis. The researchers found that among 164 nonpsychotic patients seen at community mental heath treatment facilities, the vast majority (88 percent) met the criteria for at least one DSM-IV Axis I diagnosis. The Axis I diagnosis was made by trained raters using the Structured Clinical Interview for DSM-IV (SCID.) Surprisingly, the agreement between the SCID-derived diagnosis and the clinical diagnosis was remarkably low. Agreement occurred in less than 25 percent of the patients. In addition, the study found that many patients were diagnosed clinically with a disorder even though they did not meet the diagnostic criteria for that disorder using the SCID.

The study concludes that inaccurate diagnosis is frequent and may be an important barrier to the implementation of diagnosis-specific, efficacious treatments.