always been an important concern for the authors of the diagnostic nomenclature. It is stated explicitly in the first paragraph of the introduction to DSM-IV that “our highest priority has been to provide a helpful guide to clinical practice” (APA, 2000, p. xxiii). The authors of DSM-IV addressed matters of clinical utility in some of their revisions to DSM-III-R, such as shortening criterion sets to make them easier to use in clinical practice. Nevertheless, it is evident that the foci of the authors of the current and past editions of the diagnostic manual have been primarily matters of reliability and validity (Frances, Widiger, & Pincus, 1989; Spitzer, Williams, & Skodol, 1980).
First and colleagues (2004) suggested that a valid diagnostic manual that is not being used effectively within clinical practice is unlikely to realize its full potential. They proposed that authors of future editions of DSM “empirically demonstrate improvement in clinical utility to clarify whether the advantages of changing, outweigh potential negative consequences” (First et al., 2004, p. 946). Going further, they concluded that a “crucial target for evaluating the advantages and disadvantages of a particular change is its effect on clinical utility” (p. 953). They delineated in particular six aspects of clinical utility that should be considered in future revisions to the diagnostic manual: 1) Conceptualization of the disorder, 2) communicating information to other mental health professionals, 3) communicating information to clients and their families, 4) ease and acceptability of usage in clinical practice, 5) choosing appropriate and effective interventions, and 6) predicting future course.
The relative importance that should be placed on clinical utility relative to reliability and validity is debatable (First et al., 2004; Verheul, 2005). It is also possible that clinical utility will