The revision of axis V in DSM-III-R: should symptoms have been included?

The authors studied the relationship of psychological symptoms to clinicians' ratings on DSM-III's axis V. A total of 355 patients received multiaxial assessments and were reinterviewed under blind conditions with the Psychiatric Epidemiology Research Interview, which contains scales to measure aspects of social and occupational functioning and various symptom dimensions. The majority of symptom scales were correlated significantly with axis V ratings. Axis I diagnosis explained 19.0% of the variance in axis V; demographics, 6.5%; and symptoms, 7%. Symptoms had a larger effect, in terms of explained variance, than adaptive functioning variables and tended to detract from the latter's significance. These results have implications for axis V in DSM-III-R and for planning DSM-IV.