Impaired but undiagnosed.

OBJECTIVE: To investigate the prevalence and outcomes of individuals with psychosocial impairment not meeting DSM-III-R criteria for any of 29 well-defined disorders and to suggest operational definitions for not otherwise specified (NOS) diagnoses and V codes. METHODS: Two-stage general population sampling resulted in 1,015 youths aged 9, 11, and 13 years being interviewed in the first wave of the Great Smoky Mountains Study. They were reinterviewed 1 year later using the Child and Adolescent Psychiatric Assessment. RESULTS: The weighted prevalence of sibling relational problems was found to be 1.4%. That of parent-child relational problems was 3.6% and that of relational problems NOS was 0.6%. The overall rate of symptomatic impairment was 9.4%. Across a variety of "caseness measures," those with symptomatic impairment proved to be more disturbed than those without either a diagnosis or impairment, and as disturbed as those with a diagnosis but without impairment. CONCLUSION: Children and adolescents who do not meet DSM-III-R criteria for any well-defined disorder but who have symptoms associated with psychosocial impairment should be regarded as suffering from a psychiatric disorder. It is suggested that researchers adopt this definition for the many NOS diagnoses included in the DSM nosology and implement it in their research diagnostic algorithms.

Duke Scholars

Author Adrian Christopher Angold Psychiatry, Child & Family Mental Health & Community Psychia ...

Author Elizabeth Jane Costello Psychiatry, Child & Family Mental Health & Community Psychia ...

Author Alaattin Erkanli Biostatistics & Bioinformatics, Division of Biostatistics