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Ronald C Kessler - One of the best experts on this subject based on the ideXlab platform.
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the epidemiology of generalized anxiety disorder
Psychiatric Clinics of North America, 2001Co-Authors: Ronald C Kessler, Martin B. Keller, Hans-ulrich WittchenAbstract:The American Psychiatric Association first introduced the diagnosis of generalized anxiety disorder (GAD) 2 decades ago in the DSM-III. 4 Before that time, GAD was conceptualized as one of the two core components of anxiety neurosis, the other being panic. 3 A recognition that GAD and panic, although often occurring together, are sufficiently distinct to be considered independent disorders led to their separation in the DSM-III. The DSM-III definition of GAD required uncontrollable and diffuse (i.e., not focused on a single major life problem) anxiety or worry that is excessive or unrealistic in relation to objective life circumstances and that persists for 1 month or longer. Several related psychophysiologic symptoms also were required to occur with the anxiety or worry for a diagnosis of GAD. Early clinical studies evaluating DSM-III according to this definition in clinical samples found that the disorder seldom occurred in the absence of some other comorbid anxiety or mood disorder. Comorbidity of GAD and major depression was especially strong 16,17 and led some commentators to suggest that GAD might better be conceptualized as a prodrome, residual, or severity marker than as an independent disorder. 19,22,46 The rate of comorbidity of GAD with other disorders decreases as the duration of GAD increases. 18 Based on this finding, the DSM-III-R committee on GAD recommended that the duration requirement for the disorder be increased to 6 months. This change was implemented in the final version of the DSM-III-R. 5 Additional changes in the definition of excessive worry and the required number of associated psychophysiologic symptoms were made in the DSM-IV. 6 These changes in diagnostic criteria led to delays in cumulating data on the epidemiology of GAD. Nonetheless, such data became available over the past decade. As described in more detail later, these new data challenge the view that GAD should be conceptualized as a prodrome, residual, or severity marker of other disorders. Instead, the data suggest that GAD is a common disorder that, although often comorbid with other mental disorders, does not have a rate of comorbidity that is higher than those found in most other anxiety or mood disorders. The new data also challenge the validity of the threshold decisions embodied in the DSM-IV. 6 This article begins by reviewing results from these studies on the prevalence, course, and symptom specificity of GAD. The authors then consider the important issues of comorbidity and impairment. The final section of the article discusses epidemiologic evidence on patterns of help seeking for GAD.
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one year prevalence of subthreshold and threshold dsm iv generalized anxiety disorder in a nationally representative sample
Depression and Anxiety, 2001Co-Authors: Robin M Carter, H Pfister, Hans-ulrich Wittchen, Ronald C KesslerAbstract:Several studies of representative populations have reported prevalence rates of DSM-III and DSM-III-R generalized anxiety disorder (GAD); however, no community study has examined the effect of the stricter DSM-IV criteria on prevalence estimates and patterns of comorbidity. Furthermore, past studies based on “lifetime” symptom assessments might have led to upper-bound 1-year and point prevalence estimates. Data is presented from a national representative sample study of 4,181 adults in Germany, 18–65 years old, who were interviewed for DSM-IV disorders with the 12-month version of the Munich-Composite International Diagnostic Interview. The prevalence rate of strictly defined, 12-month threshold DSM-IV GAD was estimated to be 1.5%; however, 3.6% of respondents presented with at least subthreshold syndromes of GAD during the past 12 months. Higher rates of worrying and GAD were found in women (worrying 10%, GAD 2.7%) and in older respondents (worrying 9.3%, TAD 2.2%). Taking into account a wider scope of diagnoses than previous studies, a high degree of comorbidity in GAD cases was confirmed: 59.1% of all 12-month GAD cases fulfilled criteria for major depression, and 55.9% fulfilled criteria for any other anxiety disorder. In conclusion, prevalence and comorbidity rates found for DSM-IV GAD are not substantially different from rates reported for DSM-III-R GAD. The minor differences in our findings compared to previous reports are more likely attributable to differences in study methodology rather than changes in diagnostic criteria for DSM-IV. Depression and Anxiety 13:78–88, 2001. © 2001 Wiley-Liss, Inc.
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one year prevalence of subthreshold and threshold dsm iv generalized anxiety disorder in a nationally representative sample
Depression and Anxiety, 2001Co-Authors: Robin M Carter, H Pfister, Hans-ulrich Wittchen, Ronald C KesslerAbstract:Several studies of representative populations have reported prevalence rates of DSM-III and DSM-III-R generalized anxiety disorder (GAD); however, no community study has examined the effect of the stricter DSM-IV criteria on prevalence estimates and patterns of comorbidity. Furthermore, past studies based on "lifetime" symptom assessments might have led to upper-bound 1-year and point prevalence estimates. Data is presented from a national representative sample study of 4,181 adults in Germany, 18-65 years old, who were interviewed for DSM-IV disorders with the 12-month version of the Munich-Composite International Diagnostic Interview. The prevalence rate of strictly defined, 12-month threshold DSM-IV GAD was estimated to be 1.5%; however, 3.6% of respondents presented with at least subthreshold syndromes of GAD during the past 12 months. Higher rates of worrying and GAD were found in women (worrying 10%, GAD 2.7%) and in older respondents (worrying 9.3%, TAD 2.2%). Taking into account a wider scope of diagnoses than previous studies, a high degree of comorbidity in GAD cases was confirmed: 59.1% of all 12-month GAD cases fulfilled criteria for major depression, and 55.9% fulfilled criteria for any other anxiety disorder. In conclusion, prevalence and comorbidity rates found for DSM-IV GAD are not substantially different from rates reported for DSM-III-R GAD. The minor differences in our findings compared to previous reports are more likely attributable to differences in study methodology rather than changes in diagnostic criteria for DSM-IV.
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the epidemiology of dsm iii r bipolar i disorder in a general population survey
Psychological Medicine, 1997Co-Authors: Ronald C Kessler, Jamie M Abelson, David R Rubinow, C Holmes, Shanyang ZhaoAbstract:BACKGROUND: Data are presented on the general population epidemiology of DSM-III-R bipolar I disorder in the United States. METHODS: Data come from the US National Comorbidity Survey (NCS), a general population survey of DSM-III-R disorders. A modified version of the Composite International Diagnostic Interview was used to make diagnoses. RESULTS: A small (N = 59) clinical reappraisal study showed that the only manic symptom profile that could validly be assessed with the CIDI is characterized by euphoria, grandiosity and the ability to maintain energy without sleep, which described approximately half of all clinically validated bipolar I cases in the NCS. Further analysis focused on this symptom profile, which involved N = 29 cases in the total sample. Lifetime prevalence was estimated to be 0.4% and 12-month prevalence only slightly lower. Caseness was negatively related to income, education and age, positively related to urbanicity, and elevated among the previously married, never married and non-whites. All cases reported at least one other NCS/DSM-III-R disorder and 59.3% reported that their episode of bipolar disorder (either mania or depression) occurred at a later age than at least one other NCS/DSM-III-R disorder. Although 93.2% of lifetime cases reported some lifetime treatment, only 44.7% of recent cases were in treatment. CONCLUSIONS: The type of bipolar disorder examined here is highly chronic, co-morbid and impairing. Increased efforts are required to attract current cases into appropriate treatment. Methodological research is needed to develop more accurate measures of other bipolar symptom profiles for use in general population epidemiological studies. Language: en
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lifetime co occurrence of dsm iii r alcohol abuse and dependence with other psychiatric disorders in the national comorbidity survey
Archives of General Psychiatry, 1997Co-Authors: Ronald C Kessler, Christopher B Nelson, Lynn A Warner, Rosa M Crum, John E Schulenberg, James C AnthonyAbstract:Objective: To study patterns of co-occurrence of lifetimeDSM-III-Ralcohol disorders in a household sample. Methods: Data came from the National Comorbidity Survey (NCS), a nationally representative household survey. Diagnoses were based on a modified version of the Composite International Diagnostic Interview. Results: Respondents with lifetimeNCS/DSM-III-Ralcohol abuse or dependence had a high probability of carrying at least 1 other lifetimeNCS/DSM-III-Rdiagnosis. Retrospective reports have suggested that most lifetime co-occurring alcohol disorders begin at a later age than at least 1 other NCS/DSM-III-Rdisorder. Earlier disorders are generally stronger predictors of alcohol dependence than alcohol abuse and stronger among women than men. Lifetime co-occurrence is positively, but weakly, associated with the persistence of alcohol abuse among men and of alcohol dependence among both men and women. Conclusions: Caution is needed in interpreting the results due to the fact that diagnoses were made by nonclinicians and results are based on retrospective reports of the age at onset. Within the context of these limitations, though, these results show that alcohol abuse and dependence are often associated with other lifetimeDSM-III-Rdisorders and suggest that, at least in recent cohorts, the alcohol use disorders are usually temporally secondary. Prospective data and data based on clinically confirmed diagnoses are needed to verify these findings.
Bridget F Grant - One of the best experts on this subject based on the ideXlab platform.
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Withdrawal and tolerance: prognostic significance in DSM-IV alcohol dependence.
Journal of Studies on Alcohol, 2000Co-Authors: Deborah S. Hasin, Andrea Paykin, J Meydan, Bridget F GrantAbstract:Objective: The clinical and research importance of tolerance and/or withdrawal in the diagnosis of substance dependence has been identified as a key area needing clarification. Earlier longitudinal studies did not identify whether diagnoses of alcohol dependence were current or lifetime. In this study, the prognostic significance of the DSM-IV physiological specifier was investigated among cases of alcohol dependence current at the baseline interview. The role of tremors, required in DSM-III and DSM-III-R, was investigated as well. Method: Household residents (N = 130; 57% men) meeting full criteria for current DSM-IV alcohol dependence in a baseline interview were re-interviewed a year later and DSM-IV alcohol dependence was again evaluated. Reliable structured interviews were used to make the diagnoses. The DSM-IV physiologic specifier and its components were tested as predictors of outcome of DSM-IV alcohol dependence, and included an additional definition of alcohol withdrawal that required tremors. C...
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dsm iv dsm iii r and icd 10 alcohol and drug abuse harmful use and dependence united states 1992 a nosological comparison
Alcoholism: Clinical and Experimental Research, 1996Co-Authors: Bridget F GrantAbstract:This study assessed agreement between DSM-IV, DSM-III-R, and ICD-10 diagnoses of alcohol and drug use disorders using data from a large representative sample of the United States population. Agreement between the three diagnostic systems for dependence was good to excellent for past year, prior to the past year, and lifetime diagnoses, for both genders, each ethnic group, and younger and older respondents. Cross-system comparisons between DSM-IV and DSM-III-R abuse were good to excellent, but concordance was consistently poor when ICD-10 harmful use diagnoses were compared with DSM-IV and DSM-III-R abuse diagnoses. Implications of these results are discussed in terms of the degree to which future research findings could be integrated with one another and the results from earlier studies using older versions of the DSM, to advance scientific knowledge in the drug and alcohol fields.
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nosological comparisons of dsm iii r and dsm iv alcohol abuse and dependence in a clinical facility comparison with the 1988 national health interview survey results
Alcoholism: Clinical and Experimental Research, 1994Co-Authors: Deborah S. Hasin, Bridget F GrantAbstract:The purpose of this study was to compare DSM-III-R and proposed formulations of DSM-IV diagnoses of alcohol use disorders in a clinical sample with the same assessment methods used in a large national survey previously reported. Issues included the number of symptoms required for abuse and dependence diagnoses, the effects of requiring evidence of physiological dependence to make the dependence diagnosis (Option 1 vs. Option 2), whether to require a duration criterion, and the concept of alcohol abuse. The diagnostic criteria proposed in the 1991 DSM-IV options book were the criteria investigated in this study. Concordance between DSM-III-R and DSM-IV was closest when the form of DSM-IV used was most similar to DSM-III-R. The duration criterion had much less effect on a dependence diagnosis in this clinical sample than in the general population. DSM-IV Option 2 for alcohol dependence excluded a number of cases from the dependence diagnosis who received such a diagnosis under DSM-III-R and DSM-IV Option 1. Abuse continued to function as a residual category, especially noticeable under increasingly restrictive definitions of dependence, and was rare in both the clinical and general population sample. Implications of the findings for research and other purposes are discussed.
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the dimensionality of alcohol abuse and dependence factor analysis of dsm iii r and proposed dsm iv criteria in the 1988 national health interview survey
Addiction, 1993Co-Authors: Bengt O Muthen, Bridget F Grant, Deborah S. HasinAbstract:Decisions on the final version of the DSM-IV alcohol abuse and dependence criteria will be determined largely by the APA's substance abuse field trials, conducted primarily in treated, clinical samples. Among the major objectives of the field trials are to study the boundaries between abuse and dependence, and to identify specific criteria that define the abuse category. The decisions on revisions of the abuse and dependence criteria in DSM-IV should, however, be informed by data from non-treated or general population samples as well. The present study addresses the field trial objectives using recent data from a large general population survey, the 1988 National Health Interview Survey (NHIS88). The paper reports on factor analyses to assess the dimensions underlying the DSM-III-R and DSM-IV dependence and abuse criteria as operationalized in the NHIS88. The focus of the analyses is on whether models with more than one dimension are needed and if so, the correspondence of the dimensions to criteria sets defined in the DSM-III-R and DSM-IV. The analyses show that a two-dimensional model is required. The dimensions are interpreted as abuse and dependence, but the sets of criteria that define each of the dimensions show important deviations from the criteria sets used in the DSM definitions.
Larry J Siever - One of the best experts on this subject based on the ideXlab platform.
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the trh stimulation test in dsm iii personality disorder
Biological Psychiatry, 1993Co-Authors: Richard J Kavoussi, Juliet Lesser, Emil F. Coccaro, Howard Klar, Larry J SieverAbstract:Abstract The authors examined thyrotropin-releasing hormone (TRH) stimulation testing in the neuroendocrine evaluation of DSM-III major depressive disorder in 26 consecutive medication-free, medically healthy patients meeting a primary DSM-III diagnosis of axis II personality disorder. Thyroid-stimulating hormone (TSH) responses to TRH challenge were not significantly different between patients with or without major depression at time of study, or between patients with or without a life history of major affective disorder. Further, TSH responses to TRH among 11 healthy male nonpsychiatric controls were not significantly different from those in patients with personality disorders. Comparison of those patients with blunted TSH responses (
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schizoid personality disorder a review of current status and implications for dsm iv
Journal of Personality Disorders, 1993Co-Authors: Oren Kalus, David P Bernstein, Larry J SieverAbstract:Schizoid personality disorder (SZD) is one of three Diagnostic and Statisti cal Manual of Mental Disorders, 3rd edition, revised (DSM-III-R) "odd cluster" personality disorders (including schizotypal personality disorder [SPD] and paranoid personality disorder [PPD]) characterized by phenomenological similarities to schizophrenia. SZD is distinguished from the other two personality disorders by the prominence of social, interpersonal, and affective deficits (i.e., "negative symptoms") in the absence of psychoticlike cognitive/perceptual distortions. Despite a rich and extensive clinical and theoretical tradition regarding the schizoid character, its pre-DSM-III status was handicapped by consider able heterogeneity and lack of clear operationalized criteria for the disorder. The architects ofDSM-III attempted to subdivide and sharpen the boundar ies of this heterogeneous area by the addition of SPD and PPD within the odd cluster, and the avoidant personality disorder (AVD) within the "anx ious" cluster. The narrowing of the SZD diagnosis by reassignment into these additional diagnoses, however, raises additional questions on the location of its diagnostic boundaries, and even whether the diagnosis re mains a valid and separate entity. Evidence of extensive criteria overlap and comorbidity with other personality disorders are of particular concern in this regard. The low prevalence rates of DSM-III SZD further complicate attempts at addressing these issues empirically. Although modifications of the diagnostic criteria in DSM-III-R appear to have increased the sensitivity and prevalence of the diagnosis, the scarcity of empirical data on either DSM-III or DSM-III-R SZD remains a significantly limiting factor in resolv
Hans-ulrich Wittchen - One of the best experts on this subject based on the ideXlab platform.
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the epidemiology of generalized anxiety disorder
Psychiatric Clinics of North America, 2001Co-Authors: Ronald C Kessler, Martin B. Keller, Hans-ulrich WittchenAbstract:The American Psychiatric Association first introduced the diagnosis of generalized anxiety disorder (GAD) 2 decades ago in the DSM-III. 4 Before that time, GAD was conceptualized as one of the two core components of anxiety neurosis, the other being panic. 3 A recognition that GAD and panic, although often occurring together, are sufficiently distinct to be considered independent disorders led to their separation in the DSM-III. The DSM-III definition of GAD required uncontrollable and diffuse (i.e., not focused on a single major life problem) anxiety or worry that is excessive or unrealistic in relation to objective life circumstances and that persists for 1 month or longer. Several related psychophysiologic symptoms also were required to occur with the anxiety or worry for a diagnosis of GAD. Early clinical studies evaluating DSM-III according to this definition in clinical samples found that the disorder seldom occurred in the absence of some other comorbid anxiety or mood disorder. Comorbidity of GAD and major depression was especially strong 16,17 and led some commentators to suggest that GAD might better be conceptualized as a prodrome, residual, or severity marker than as an independent disorder. 19,22,46 The rate of comorbidity of GAD with other disorders decreases as the duration of GAD increases. 18 Based on this finding, the DSM-III-R committee on GAD recommended that the duration requirement for the disorder be increased to 6 months. This change was implemented in the final version of the DSM-III-R. 5 Additional changes in the definition of excessive worry and the required number of associated psychophysiologic symptoms were made in the DSM-IV. 6 These changes in diagnostic criteria led to delays in cumulating data on the epidemiology of GAD. Nonetheless, such data became available over the past decade. As described in more detail later, these new data challenge the view that GAD should be conceptualized as a prodrome, residual, or severity marker of other disorders. Instead, the data suggest that GAD is a common disorder that, although often comorbid with other mental disorders, does not have a rate of comorbidity that is higher than those found in most other anxiety or mood disorders. The new data also challenge the validity of the threshold decisions embodied in the DSM-IV. 6 This article begins by reviewing results from these studies on the prevalence, course, and symptom specificity of GAD. The authors then consider the important issues of comorbidity and impairment. The final section of the article discusses epidemiologic evidence on patterns of help seeking for GAD.
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one year prevalence of subthreshold and threshold dsm iv generalized anxiety disorder in a nationally representative sample
Depression and Anxiety, 2001Co-Authors: Robin M Carter, H Pfister, Hans-ulrich Wittchen, Ronald C KesslerAbstract:Several studies of representative populations have reported prevalence rates of DSM-III and DSM-III-R generalized anxiety disorder (GAD); however, no community study has examined the effect of the stricter DSM-IV criteria on prevalence estimates and patterns of comorbidity. Furthermore, past studies based on “lifetime” symptom assessments might have led to upper-bound 1-year and point prevalence estimates. Data is presented from a national representative sample study of 4,181 adults in Germany, 18–65 years old, who were interviewed for DSM-IV disorders with the 12-month version of the Munich-Composite International Diagnostic Interview. The prevalence rate of strictly defined, 12-month threshold DSM-IV GAD was estimated to be 1.5%; however, 3.6% of respondents presented with at least subthreshold syndromes of GAD during the past 12 months. Higher rates of worrying and GAD were found in women (worrying 10%, GAD 2.7%) and in older respondents (worrying 9.3%, TAD 2.2%). Taking into account a wider scope of diagnoses than previous studies, a high degree of comorbidity in GAD cases was confirmed: 59.1% of all 12-month GAD cases fulfilled criteria for major depression, and 55.9% fulfilled criteria for any other anxiety disorder. In conclusion, prevalence and comorbidity rates found for DSM-IV GAD are not substantially different from rates reported for DSM-III-R GAD. The minor differences in our findings compared to previous reports are more likely attributable to differences in study methodology rather than changes in diagnostic criteria for DSM-IV. Depression and Anxiety 13:78–88, 2001. © 2001 Wiley-Liss, Inc.
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one year prevalence of subthreshold and threshold dsm iv generalized anxiety disorder in a nationally representative sample
Depression and Anxiety, 2001Co-Authors: Robin M Carter, H Pfister, Hans-ulrich Wittchen, Ronald C KesslerAbstract:Several studies of representative populations have reported prevalence rates of DSM-III and DSM-III-R generalized anxiety disorder (GAD); however, no community study has examined the effect of the stricter DSM-IV criteria on prevalence estimates and patterns of comorbidity. Furthermore, past studies based on "lifetime" symptom assessments might have led to upper-bound 1-year and point prevalence estimates. Data is presented from a national representative sample study of 4,181 adults in Germany, 18-65 years old, who were interviewed for DSM-IV disorders with the 12-month version of the Munich-Composite International Diagnostic Interview. The prevalence rate of strictly defined, 12-month threshold DSM-IV GAD was estimated to be 1.5%; however, 3.6% of respondents presented with at least subthreshold syndromes of GAD during the past 12 months. Higher rates of worrying and GAD were found in women (worrying 10%, GAD 2.7%) and in older respondents (worrying 9.3%, TAD 2.2%). Taking into account a wider scope of diagnoses than previous studies, a high degree of comorbidity in GAD cases was confirmed: 59.1% of all 12-month GAD cases fulfilled criteria for major depression, and 55.9% fulfilled criteria for any other anxiety disorder. In conclusion, prevalence and comorbidity rates found for DSM-IV GAD are not substantially different from rates reported for DSM-III-R GAD. The minor differences in our findings compared to previous reports are more likely attributable to differences in study methodology rather than changes in diagnostic criteria for DSM-IV.
Deborah S. Hasin - One of the best experts on this subject based on the ideXlab platform.
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Withdrawal and tolerance: prognostic significance in DSM-IV alcohol dependence.
Journal of Studies on Alcohol, 2000Co-Authors: Deborah S. Hasin, Andrea Paykin, J Meydan, Bridget F GrantAbstract:Objective: The clinical and research importance of tolerance and/or withdrawal in the diagnosis of substance dependence has been identified as a key area needing clarification. Earlier longitudinal studies did not identify whether diagnoses of alcohol dependence were current or lifetime. In this study, the prognostic significance of the DSM-IV physiological specifier was investigated among cases of alcohol dependence current at the baseline interview. The role of tremors, required in DSM-III and DSM-III-R, was investigated as well. Method: Household residents (N = 130; 57% men) meeting full criteria for current DSM-IV alcohol dependence in a baseline interview were re-interviewed a year later and DSM-IV alcohol dependence was again evaluated. Reliable structured interviews were used to make the diagnoses. The DSM-IV physiologic specifier and its components were tested as predictors of outcome of DSM-IV alcohol dependence, and included an additional definition of alcohol withdrawal that required tremors. C...
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nosological comparisons of dsm iii r and dsm iv alcohol abuse and dependence in a clinical facility comparison with the 1988 national health interview survey results
Alcoholism: Clinical and Experimental Research, 1994Co-Authors: Deborah S. Hasin, Bridget F GrantAbstract:The purpose of this study was to compare DSM-III-R and proposed formulations of DSM-IV diagnoses of alcohol use disorders in a clinical sample with the same assessment methods used in a large national survey previously reported. Issues included the number of symptoms required for abuse and dependence diagnoses, the effects of requiring evidence of physiological dependence to make the dependence diagnosis (Option 1 vs. Option 2), whether to require a duration criterion, and the concept of alcohol abuse. The diagnostic criteria proposed in the 1991 DSM-IV options book were the criteria investigated in this study. Concordance between DSM-III-R and DSM-IV was closest when the form of DSM-IV used was most similar to DSM-III-R. The duration criterion had much less effect on a dependence diagnosis in this clinical sample than in the general population. DSM-IV Option 2 for alcohol dependence excluded a number of cases from the dependence diagnosis who received such a diagnosis under DSM-III-R and DSM-IV Option 1. Abuse continued to function as a residual category, especially noticeable under increasingly restrictive definitions of dependence, and was rare in both the clinical and general population sample. Implications of the findings for research and other purposes are discussed.
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the dimensionality of alcohol abuse and dependence factor analysis of dsm iii r and proposed dsm iv criteria in the 1988 national health interview survey
Addiction, 1993Co-Authors: Bengt O Muthen, Bridget F Grant, Deborah S. HasinAbstract:Decisions on the final version of the DSM-IV alcohol abuse and dependence criteria will be determined largely by the APA's substance abuse field trials, conducted primarily in treated, clinical samples. Among the major objectives of the field trials are to study the boundaries between abuse and dependence, and to identify specific criteria that define the abuse category. The decisions on revisions of the abuse and dependence criteria in DSM-IV should, however, be informed by data from non-treated or general population samples as well. The present study addresses the field trial objectives using recent data from a large general population survey, the 1988 National Health Interview Survey (NHIS88). The paper reports on factor analyses to assess the dimensions underlying the DSM-III-R and DSM-IV dependence and abuse criteria as operationalized in the NHIS88. The focus of the analyses is on whether models with more than one dimension are needed and if so, the correspondence of the dimensions to criteria sets defined in the DSM-III-R and DSM-IV. The analyses show that a two-dimensional model is required. The dimensions are interpreted as abuse and dependence, but the sets of criteria that define each of the dimensions show important deviations from the criteria sets used in the DSM definitions.
