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Arch Gen Psychiatry. 1998;55:119.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

REGIER ET al¹ summarize discrepancies in prevalence rates between the Epidemiological Catchment Area (ECA) study and the National Comorbidity Survey (NCS) and provide a useful overview of plausible explanations. I will extend their comments by emphasizing 3 inherent limitations to defining clinical cases in epidemiological studies: (1) the definition of mental disorder in DSM-IV² fails to provide a clear boundary between psychopathology and normality; (2) the concepts "clinical significance" and "medical necessity" are difficult to operationalize and to assess reliably; and (3) lay interviewers do not have the experience necessary to judge clinical significance.

In DSM-IV, the mental disorders are defined as clinically significant behavioral or psychological syndromes causing distress or disability (ie, impairment in functioning). The syndrome must not be an expected response to a particular event (eg, the death of a loved one).

Although this definition assists in decisions on what should be included in the manual, . . . [Full Text of this Article]

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