This criterion is unique to the DSM-IV and is not found in the earlier versions of the text. The stated reason for adding it to the DSM was to
"establish the threshold for the diagnosis of a disorder in those situations in which the symptomatic presentation by itself (particularly in its milder forms) is not inherently pathological and may be encountered in individuals for whom a diagnosis of mental disorder would be inappropriate."Since mental health disorders are made by subjective analysis (often referred to as clinical judgment), does the addition of this criterion aid in the diagnostic process?
Not according to Wakefield et. al who published an article in the January 2010 issue of the American Journal of Psychiatry (5). In the article, titled, "Does the DSM-IV Clinical Significance Criterion for Major Depression Reduce False Positives? Evidence From the National Comorbidity Survey Replication," the authors' reason why the criterion is ineffective, is because it is redundant.
Wakefield argues that "distress is common to both normal reactions (e.g., acute grief) and disordered conditions, 'since most of these symptoms are either intrinsically distressing or are almost invariably accompanied by distress about having the symptom."
In other words, it's highly unlikely that an individual will satisfy full diagnostic criteria for a disorder and not be distressed or impaired.
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It's unlikely that any modification of this criterion, other than its deletion, will resolve this issue of redundancy. If the definition is narrowed, there will be more false negatives; if the definition is broadened, there will be more false positives. Actually, the whole idea of false negatives/positives for already highly arbitrary (i.e. not valid) diagnoses is quite humorous, but I digress...
Wakefield, J., Schmitz, M., & Baer, J. (2010). Does the DSM-IV Clinical Significance Criterion for Major Depression Reduce False Positives? Evidence From the National Comorbidity Survey Replication American Journal of Psychiatry DOI: 10.1176/appi.ajp.2009.09040553