Clinical applications of DSM-III in consultation-liaison psychiatry

The authors examine the clinical application of DSM-III from the perspective of the consultation-liaison psychiatrist. They discuss contributions of DSM-III that have refined psychiatric diagnosis in medical-surgical settings, including the multiaxial system, a broader approach to the organic mental disorders, introduction of the category of psychological factors affecting physical condition, and an improved classification of disorders that present with physical symptoms. However, some areas of continuing ambiguity remain, such as how much discretion a clinician has to discount somatic symptoms related to physical illness in the diagnosis of depression, the implications of exempting bereavement from diagnostic status, and uncertainty about what constitutes evidence of an etiological relationship.