Assessment of a modified DSM-5 diagnosis of alcohol use disorder in a genetically informative population.
- Authors
- Edwards, Alexis C; Gillespie, Nathan A; Aggen, Steven H; Kendler, Kenneth S
- Year
- 2013
- Journal
- Alcoholism, clinical and experimental research
- PMID
- 23347196
- DOI
- 10.1111/j.1530-0277.2012.01954.x
- PMCID
- PMC3586296
BACKGROUND: Proposed changes to the upcoming DSM-5 include the following: (i) combining criteria for DSM-IV alcohol abuse (AA) and alcohol dependence (AD) into 1 diagnostic category (alcohol use disorder [AUD]); (ii) exclusion of the "legal problems" (LP) criterion; and (iii) addition of a "craving" criterion. Few published studies empirically assess the potential consequences of the proposed changes. METHODS: Using a population-based sample of twins assessed for lifetime AA/AD diagnoses, we explored phenotypic differences across DSM-IV and a modified DSM-5 diagnoses without craving because of its unavailability in the data set. We used factor analysis and item response theory (IRT) to evaluate the potential consequences of excluding the LP criterion from AUD and used twin modeling to examine genetic differences between DSM-IV and the modified DSM-5 diagnoses. RESULTS: The prevalence of AUD was slightly higher than that of DSM-IV diagnoses. Individuals meeting DSM-IV or DSM-5 criteria, but not both, exhibit fewer comorbid diagnoses than those meeting both sets of criteria. Individuals meeting only DSM-5 criteria were slightly less severely affected than those meeting only DSM-IV criteria. Factor analysis indicated that the LP criterion loading is the lowest of all symptoms; IRT analysis suggested that this criterion has low discriminatory power. The genetic correlation between DSM-IV and DSM-5 diagnoses was slightly but significantly lower than unity. CONCLUSIONS: The proposed DSM-5 AUD criteria are unlikely to result in significant changes in prevalence of diagnosed alcohol problems. However, it is unclear whether the new criteria represent a more valid diagnosis: new cases are no more severely affected than DSM-IV-only cases. Given the psychometric properties of LP, its exclusion should not negatively impact diagnostic validity. Similarly, the stable heritability across DSM-IV and DSM-5 diagnoses suggests that the proposed changes will not have substantial negative consequences in terms of familial influences, a key validator. These results provide equivocal empirical support for the proposed DSM-5 changes for AUDs.
Bivariate twin model. For simplicity, only genetic factors contributing to variance are shown; an identical structure exists for shared (C) and non-shared (E) environmental factors. Qualitative genetic sex effects are not included in this depiction. See methods for a description of the manifest variables. The significance of genetic influences specific to AUD can be assessed by testing whether the path estimates for the dashed lines can be set to 0. If this does not compromise model fit, then the genetic correlation between AA/AD and AUD is not significantly different from unity. rMZ=genetic correlation of monozygotic twins; rDZ=genetic correlation of dizygotic twins
Proportions of the total sample that are consistently unaffected or fall into D4-only, D5-only, and D4D5.
Item characterization curves. Each of the 11 symptoms included in the DSMIV for AA and AD are included. LP (“A3” in the legend) is depicted by a dotted line without symbols. The position of the line across the x-axis corresponds to the item difficulty (1.526), which is relatively high; the slope of the line is related to its discriminatory power (1.101), which is lower than that of any other item. A1=failing obligations; A2=hazardous use; A3=legal problems; A4=use despite social problems; D1=tolerance; D2=withdrawal; D3=loss of control; D4=trying to cut down; D5=time spent; D6=activities given up; D7=use despite physical problems
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| 40 | Discussion — Limitations | ideal, and can result in unstable parameter estimates. In addition, for some of our analyses, we… |
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| High Polygenic Risk Scores Are Associated With Early Age of Onset of Alcohol Use Disorder in Adolescents and Young Adults at Risk. | 2022 | 36324664 |
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|---|---|---|---|---|
| Phenome-wide Association Analysis of Substance Use Disorders in a Deeply Phenotyped Sample. | Kember RL et al. | — | 2023 | → |
| High Polygenic Risk Scores Are Associated With Early Age of Onset of Alcohol Use Disorder in Adolescents and Young Adults at Risk. | Nurnberger JI et al. | — | 2022 | → |
| Reliability of Differential Item Functioning in Alcohol Use Disorder: Bayesian Meta-Analysis of Criteria Discrimination Estimates. | Vize CE et al. | — | 2022 | → |
| Differential correlation of serum BDNF and microRNA content in rats with rapid or late onset of heavy alcohol use. | Ehinger Y et al. | — | 2021 | → |
| Alcohol Tolerance in Human Laboratory Studies for Development of Medications to treat Alcohol Use Disorder. | Haass-Koffler CL et al. | — | 2020 | → |
| A Cross-National Examination of Differences in Classification of Lifetime Alcohol Use Disorder Between DSM-IV and DSM-5: Findings from the World Mental Health Survey. | Slade T et al. | — | 2016 | → |
| Meta-analysis of DSM alcohol use disorder criteria severities: structural consistency is only 'skin deep'. | Lane SP et al. | — | 2016 | → |
| Validity of Alcohol Use Disorder Identification Test-Korean Revised Version for Screening Alcohol Use Disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criteria. | Chang JW et al. | — | 2016 | → |
| Which alcohol use disorder criteria contribute to the association of ADH1B with alcohol dependence? | Hart AB et al. | — | 2016 | → |
| Commonalities and Differences Across Substance Use Disorders: Phenomenological and Epidemiological Aspects. | Shmulewitz D et al. | — | 2015 | → |
| DSM-5 reviewed from different angles: goal attainment, rationality, use of evidence, consequences—part 2: bipolar disorders, schizophrenia spectrum disorders, anxiety disorders, obsessive-compulsive disorders, trauma- and stressor-related disorders, personality disorders, substance-related and addictive disorders, neurocognitive disorders. | Möller HJ et al. | — | 2015 | → |
| DSM-IV and DSM-5 alcohol use disorder among young Swiss men. | Mohler-Kuo M et al. | — | 2015 | → |
| From DSM-IV to DSM-5 alcohol use disorder: an overview of epidemiological data. | Bartoli F et al. | — | 2015 | → |
| Genetic overlap between alcohol use disorder and bulimic behaviors in European American and African American women. | Munn-Chernoff MA et al. | — | 2015 | → |
| Investigating dimensionality and measurement bias of DSM-5 alcohol use disorder in a representative sample of the largest metropolitan area in South America. | Castaldelli-Maia JM et al. | — | 2015 | → |
| The Impact of the Proposed Changes for the DSM-5 on Diagnoses of First-time DUI/DWI Offenders. | Baley JW et al. | — | 2015 | → |
| Comparing factor, class, and mixture models of cannabis initiation and DSM cannabis use disorder criteria, including craving, in the Brisbane longitudinal twin study. | Kubarych TS et al. | — | 2014 | → |
| How Many People have Alcohol Use Disorders? Using the Harmful Dysfunction Analysis to Reconcile Prevalence Estimates in Two Community Surveys. | Wakefield JC et al. | — | 2014 | → |
| Pharmacological approaches to reducing craving in patients with alcohol use disorders. | Haass-Koffler CL et al. | — | 2014 | → |
| Sex differences in alcohol-related neurobehavioral consequences. | Nixon SJ et al. | — | 2014 | → |
| Bacchus by Caravaggio as the Visual Diagnosis of Alcohol Use Disorder from the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). | Haass-Koffler CL et al. | — | 2013 | → |