This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Study of Co-occurrence of Hierarchy-Free Syndromes

Jeffrey H. Boyd, MD, MPH; Jack D. Burke, Jr, MD, MPH; Ernest Gruenberg, MD, DrPH; Charles E. Holzer III, PhD; Donald S. Rae, MA; Linda K. George, PhD; Marvin Karno, MD; Roger Stoltzman, MD; Larry McEvoy, MA; Gerald Nestadt, MD, MPH

Arch Gen Psychiatry. 1984;41(10):983-989.

Abstract
• The diagnostic criteria of the third edition of the DSM-III often state that one diagnosis cannot be made If It is "due to" another disorder. Using data from the National Institute of Mental Health Diagnostic Interview Schedule, with a sample of 11,519 subjects from a community population, we found that if two disorders were related to each other according to the DSM-III exclusion criteria, then the presence of a dominant disorder greatly increased the odds of having the excluded disorder. We also found that disorders, which DSM-III says are related to each other, were more strongly associated than disorders, which DSM-III says are unrelated. However, we also found there was a general tendency toward co-occurrence, so that the presence of any disorder increased the odds of having almost any other disorder, even if DSM-III does not list it as a related disorder. We concluded that empirical studies are needed to study the assumptions underlying the use of a diagnostic hierarchy.

Author Affiliations
From the Division of Biometry and Epidemiology, National Institute of Mental Health (NIMH), Rockville, Md (Drs Boyd and Burke and Mr Rae); the Eastern Baltimore Health Survey, School of Hygiene and Public Health and the Department of Psychiatry, The Johns Hopkins University Medical School, Baltimore (Drs Gruenberg and Nestadt); the Yale Greater New Haven (Conn) Health Survey, Department of Psychiatry, Yale University Medical School and Department of Sociology, Yale University (Dr Holzer); the Piedmont Health Survey, Department of Psychiatry, Duke University Medical Center, Durham, NC (Dr George); the Los Angeles ECA Survey, UCLA (Dr Karno); and the St Louis Health Study, Department of Psychiatry, Washington University Medical School (Dr Stoltzman and Mr McEvoy).

Footnotes
Accepted for publication April 2, 1984.

Reprint requests to NIMH, Room 18-105, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857 (Dr Boyd).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Conceptual Development of DSM-V
Regier et al.
Am. J. Psychiatry 2009;166:645-650.
FULL TEXT  

Psychiatric Comorbidities and Schizophrenia
Buckley et al.
Schizophr Bull 2009;35:383-402.
ABSTRACT | FULL TEXT  

Depression and Anxiety as Predictors of 2-Year Cardiac Events in Patients With Stable Coronary Artery Disease
Frasure-Smith and Lesperance
Arch Gen Psychiatry 2008;65:62-71.
ABSTRACT | FULL TEXT  

The Structure of Genetic and Environmental Risk Factors for Common Psychiatric and Substance Use Disorders in Men and Women
Kendler et al.
Arch Gen Psychiatry 2003;60:929-937.
ABSTRACT | FULL TEXT  

Patterns in Work Functioning and Vocational Rehabilitation Associated with Coexisting Psychiatric and Substance Use Disorders
Drebing et al.
Rehabil Couns Bull 2002;46:5-13.
ABSTRACT  

Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being
ANDREWS et al.
Br. J. Psychiatry 2002;181:306-314.
ABSTRACT | FULL TEXT  

Axis I Psychiatric Comorbidity and Its Relationship to Historical Illness Variables in 288 Patients With Bipolar Disorder
McElroy et al.
Am. J. Psychiatry 2001;158:420-426.
ABSTRACT | FULL TEXT  

A Controlled Study of Behavioral Inhibition in Children of Parents With Panic Disorder and Depression
Rosenbaum et al.
Am. J. Psychiatry 2000;157:2002-2010.
ABSTRACT | FULL TEXT  

Assessment and Classification of Patients With Psychiatric and Substance Abuse Syndromes
Lehman et al.
Psychiatr. Serv. 2000;51:1119-1125.
FULL TEXT  

Frequency of Anxiety Disorders in Psychiatric Outpatients With Major Depressive Disorder
Zimmerman et al.
Am. J. Psychiatry 2000;157:1337-1340.
ABSTRACT | FULL TEXT  

The Structure of Common Mental Disorders
Krueger
Arch Gen Psychiatry 1999;56:921-926.
ABSTRACT | FULL TEXT  

Toward the Identification of Core Psychopathological Processes?
Wittchen et al.
Arch Gen Psychiatry 1999;56:929-931.
FULL TEXT  

Schizophrenia and Comorbid Substance Abuse
Littrell and Littrell
J Am Psychiatr Nurses Assoc 1999;5:S17-S24.
ABSTRACT  

A Review of Bipolar Disorder Among Adults
Hilty et al.
Psychiatr. Serv. 1999;50:201-213.
ABSTRACT | FULL TEXT  

Treatment Typically Provided for Comorbid Anxiety Disorders
Meredith et al.
Arch Fam Med 1997;6:231-237.
ABSTRACT  

Lifetime Prevalence, Demographic Risk Factors, and Diagnostic Validity of Nonaffective Psychosis as Assessed in a US Community Sample: The National Comorbidity Survey
Kendler et al.
Arch Gen Psychiatry 1996;53:1022-1031.
ABSTRACT  

Comorbid Anxiety Disorder and the Functioning and Well-being of Chronically Ill Patients of General Medical Providers
Sherbourne et al.
Arch Gen Psychiatry 1996;53:889-895.
ABSTRACT  

Prevalence of Psychiatric Disorders Among Incarcerated Women: I. Pretrial Jail Detainees
Teplin et al.
Arch Gen Psychiatry 1996;53:505-512.
ABSTRACT  

Imipramine Treatment of Alcoholics With Primary Depression: A Placebo-Controlled Clinical Trial
McGrath et al.
Arch Gen Psychiatry 1996;53:232-240.
ABSTRACT  

Prevalence of Comorbid Anxiety Disorders in Primary Care Outpatients
Sherbourne et al.
Arch Fam Med 1996;5:27-34.
ABSTRACT  

Psychiatric Screening in Geriatric Primary Care: Should It Be for Depression Alone?
Lish et al.
J Geriatr Psychiatry Neurol 1995;8:141-153.
ABSTRACT  

Specificity in Familial Aggregation of Phobic Disorders
Fyer et al.
Arch Gen Psychiatry 1995;52:564-573.
ABSTRACT  

Psychiatric Disorders in Relatives of Probands With Panic Disorder and/or Major Depression
Goldstein et al.
Arch Gen Psychiatry 1994;51:383-394.
ABSTRACT  

The Relationship Between Panic Disorder and Major Depression: A New Family Study
Weissman et al.
Arch Gen Psychiatry 1993;50:767-780.
ABSTRACT  

Alcoholism and Major Depression in Women: A Twin Study of the Causes of Comorbidity
Kendler et al.
Arch Gen Psychiatry 1993;50:690-698.
ABSTRACT  

Progress in Psychiatry- Second of Two Parts
Michels and Marzuk
NEJM 1993;329:628-638.
FULL TEXT  

Suicide Attempts in Patients With Panic Disorder
Lepine et al.
Arch Gen Psychiatry 1993;50:144-149.
ABSTRACT  

Major Depression and Generalized Anxiety Disorder: Same Genes, (Partly) Different Environments?
Kendler et al.
Arch Gen Psychiatry 1992;49:716-722.
ABSTRACT  

The Genetic Epidemiology of Phobias in Women: The Interrelationship of Agoraphobia, Social Phobia, Situational Phobia, and Simple Phobia
Kendler et al.
Arch Gen Psychiatry 1992;49:273-281.
ABSTRACT  

Psychiatric Comorbidity in DSM-III-R Hypochondriasis
Barsky et al.
Arch Gen Psychiatry 1992;49:101-108.
ABSTRACT  

Psychopathologic Precursors and Sociodemographic Risk Factors for the Schizophrenia Syndrome
Tien and Eaton
Arch Gen Psychiatry 1992;49:37-46.
ABSTRACT  

Comparing Age at Onset of Major Depression and Other Psychiatric Disorders by Birth Cohorts in Five US Community Populations
Burke et al.
Arch Gen Psychiatry 1991;48:789-795.
ABSTRACT  

A Practical Update on Anxiety Disorders and Their Pharmacologic Treatment
Brown et al.
Arch Intern Med 1991;151:873-884.
ABSTRACT  

Psychiatric Diagnoses of Treatment-Seeking Cocaine Abusers
Rounsaville et al.
Arch Gen Psychiatry 1991;48:43-51.
ABSTRACT  

Comorbidity of Mental Disorders With Alcohol and Other Drug Abuse: Results From the Epidemiologic Catchment Area (ECA) Study
Regier et al.
JAMA 1990;264:2511-2518.
ABSTRACT  

Panic Disorder, Comorbidity, and Suicide Attempts
Johnson et al.
Arch Gen Psychiatry 1990;47:805-808.
ABSTRACT  

Age at Onset of Selected Mental Disorders in Five Community Populations
Burke et al.
Arch Gen Psychiatry 1990;47:511-518.
ABSTRACT  

Reliability of Anxiety Assessment: II. Symptom Agreement
Fyer et al.
Arch Gen Psychiatry 1989;46:1102-1110.
ABSTRACT  

Linkage Studies of Bipolar Disorder: Methodologic and Analytic Issues: Report of MacArthur Foundation Workshop on Linkage and Clinical Features in Affective Disorders
Merikangas et al.
Arch Gen Psychiatry 1989;46:1137-1141.
ABSTRACT  

The Prevalence of Specific Psychiatric Disorders Among Homeless Individuals in the Inner City of Los Angeles
Koegel et al.
Arch Gen Psychiatry 1988;45:1085-1092.
ABSTRACT  

The Epidemiology of Obsessive-Compulsive Disorder in Five US Communities
Karno et al.
Arch Gen Psychiatry 1988;45:1094-1099.
ABSTRACT  

One-Month Prevalence of Mental Disorders in the United States: Based on Five Epidemiologic Catchment Area Sites
Regier et al.
Arch Gen Psychiatry 1988;45:977-986.
ABSTRACT  

What Is a Case? A 45-Year Study of Psychiatric Impairment Within a College Sample Selected for Mental Health
Vaillant and Schnurr
Arch Gen Psychiatry 1988;45:313-319.
ABSTRACT  

Six-Month Prevalence of Specific Psychiatric Disorders Among Mexican Americans and Non-Hispanic Whites in Los Angeles
Burnam et al.
Arch Gen Psychiatry 1987;44:687-694.
ABSTRACT  

Somatization in the Community
Escobar et al.
Arch Gen Psychiatry 1987;44:713-718.
ABSTRACT  

The Prevalence of Specific Psychiatric Disorders in Puerto Rico
Canino et al.
Arch Gen Psychiatry 1987;44:727-735.
ABSTRACT  

Comparison of the Lay Diagnostic Interview Schedule and a Standardized Psychiatric Diagnosis: Experience in Eastern Baltimore
Anthony et al.
Arch Gen Psychiatry 1985;42:667-675.
ABSTRACT  

Psychiatric Epidemiology Counts
Arch Gen Psychiatry 1984;41:931-933.
ABSTRACT  

Lifetime Prevalence of Specific Psychiatric Disorders in Three Sites
Robins et al.
Arch Gen Psychiatry 1984;41:949-958.
ABSTRACT