CRUfAD, School of Psychiatry, UNSW at St Vincent's Hospital, 299 Forbes Street, Darlinghurst, NSW 2010, Australia.
Aust N Z J Psychiatry. 2010 Apr;44(4):309-13. doi: 10.3109/00048670903487241.
DSM-IV diagnostic criteria define thresholds on a continuum of symptoms above which the diagnosis is said to be established. Data from the 1997 Australian Survey of Mental Health and Wellbeing were used for six internalizing disorders, and the levels of distress and disability associated with each diagnosis were investigated.
Mean distress (measured by the K-10) and disability (measured by the SF12-MCS) scores were identified for people in the Survey who reported no physical or mental disorders. The distribution of distress and disability showed by people who met criteria for major depressive disorder, dysthymia, generalized anxiety disorder, social phobia, post-traumatic stress disorder and obsessive-compulsive disorder was plotted against the mean for well people, expecting that > or = 90% of people with these mental disorders would score as more distressed or disabled than this mean.
More than 90% of people with dysthymia, major depressive disorder, generalized anxiety disorder or with post-traumatic stress disorder scored as more distressed or disabled than the mean for well people. A majority were severely distressed or disabled (> 2SD above the mean). This remained the case when the clinical significance criteria were removed. In social phobia and in obsessive-compulsive disorders between 9% and 26% scored below the means for well people, that is, as neither distressed nor disabled, a figure that rose to 16-40% when the clinical significance criteria were removed. In neither case did a majority of cases score in the severe range.
The diagnostic thresholds for social phobia and for obsessive-compulsive disorder are less stringent than that for the other disorders and require revision in DSM-V.
DSM-IV 诊断标准在症状连续体上定义了阈值，超过该阈值就可以做出诊断。本研究使用了 1997 年澳大利亚精神健康与幸福感调查的数据，对六种内在障碍进行了研究，并调查了每种诊断相关的痛苦和残疾程度。
对调查中报告无身体或精神障碍的人群进行了 K-10 量表测量的痛苦均值和 SF12-MCS 量表测量的残疾均值的识别。绘制符合重度抑郁障碍、心境恶劣障碍、广泛性焦虑障碍、社交恐惧症、创伤后应激障碍和强迫症诊断标准的人群的痛苦和残疾分布，并与健康人群的均值进行比较，预期这些精神障碍患者中>或=90%的人会比这个均值更痛苦或残疾。
心境恶劣障碍、重度抑郁障碍、广泛性焦虑障碍或创伤后应激障碍患者中，>90%的人比健康人群更痛苦或残疾。大多数人处于严重痛苦或残疾状态（高于均值>2SD）。当去除临床意义标准后，这种情况仍然存在。在社交恐惧症和强迫症中，有 9%-26%的人得分低于健康人群的均值，即既不痛苦也不残疾，当去除临床意义标准后，这一比例上升到 16%-40%。在这两种情况下，都没有多数病例处于严重程度范围内。
社交恐惧症和强迫症的诊断阈值比其他障碍更严格，需要在 DSM-V 中进行修订。
