The publication of DSM-5 looms, attracting criticism even in advance of field trial results or finalization of criteria. Such criticism may ultimately prove singularly productive in that DSM-5 proposes to become a living document. As soon as convincing evidence supports it, diagnostic modification could be implemented without waiting the traditional 15 to 20 years for the next DSM upheaval. Thus, critics are alerted that alternative proposals should be supported with evidence, not opinions. The DeFife et al study1 is a welcome harbinger of events to come, but is their evidence convincing? In general, what will it take to document validity of a proposed new diagnosis?
Figure. The variation of a diagnosis in a population with 3 nonoverlapping sources: the signal (the disorder of interest), interference (characteristics of patients unrelated to the disorder), and noise (random error).
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