Three (or more) alcohol-dependence symptoms but not clustered in the same 12 months: diagnostic orphans from a longitudinal perspective.
OBJECTIVE
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), currently uses a polythetic classification system for defining alcohol use disorders (AUD; alcohol abuse and dependence). This classification results in individuals who are subthreshold for an official AUD diagnosis but still endorse one or two criteria of dependence: so-called "diagnostic orphans." To our knowledge, however, there has been no attention given to diagnostic orphans from a lifetime perspective. The goal of the current article was to compare various diagnostic groups based on lifetime reports of abuse and dependence symptoms on a range of outcomes.


METHODS
Data taken from the National Epidemiological Survey of Alcohol and Related Conditions study were used to form seven mutually exclusive diagnostic groups based on lifetime abuse and dependence symptomatology.


RESULTS
Diagnostic groups that experienced extensive dependence symptoms, regardless of past-12-month clustering (i.e., formal diagnostic criteria), tended to exhibit poorer outcomes compared with participants that met formal lifetime diagnosis for an AUD through abuse alone. It is notable that a significant group of individuals who failed to meet formal lifetime AUD diagnosis, but who endorsed a number of dependence symptoms, consistently demonstrated more problematic outcomes on a range of measures compared with individuals who never reported dependence symptoms but who were formally diagnosed with lifetime AUD through alcohol abuse.


CONCLUSIONS
DSM-IV lifetime diagnostic criteria may exclude individuals with a history of extensive dependence symptomatology. Implications regarding lifetime diagnosis conceptualization are discussed.
Department of Psychological Sciences, University of Missouri-Columbia and the Midwest Alcoholism Research Center, Columbia, Missouri 65211-0001, USA. akl9af@mail.missouri.edu
Andrew K
AK
Littlefield
Alvaro
A
Vergés
Kenneth J
KJ
Sher
D000328:Adult; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D016000:Cluster Analysis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013997:Time Factors