Diagnostic assignment of criteria: Clinicians and DSM-IV

The study examined clinician matching of diagnostic criteria to selected DSM-IV Axis I and II disorders. A national sample of clinical psychologists and psychiatrists assigned symptom criteria, presented in scrambled order by axis, to DSM-IV diagnoses with which they believed the criteria belonged, without using the DSM. On average, clinicians assigned 69% of Axis I criteria and 75% of Axis II criteria to the designated DSM-IV diagnosis. The Axis II data represent increased agreement over the 66% found for DSM-III-R. Reasons for the increase are discussed, focusing on modifications made in DSM-IV and increased familiarity with personality disorders. The significantly higher rate of agreement for Axis II over Axis I contrasts with typical reliability data which suggests that Axis I disorders are better defined. Specific points of disagreement between clinician criteria assignments and the DSM-IV are discussed.