The term “diagnostic orphan” (DO) refers to an individual who endorses only one substance use disorder criterion from the DSM (the manual used to diagnose substance use disorders). DOs do not receive a diagnosis, but they may still be at risk for substance-related harms. A recent study examined characteristics of alcohol use disorder (AUD) DOs in a college sample. Participants were 396 U.S. undergraduate students aged 18 to 30 years who reported drinking at least once in the past three months. This sample was 60% White and 52% male. The authors created 13 items to reflect the content of DSM-5 AUD criteria. Participants answered these items, as well as measures of their own substance use, alcohol-related consequences, temptation to drink and attempts to control alcohol use, emotional dysregulation, self-control, and mindful awareness. Those who endorsed only one AUD criterion (24%) were classified as DOs. Results showed 58.9% of DOs were White, 63.2% were freshmen, and 50.5% were female. The majority of DOs were full-time students and lived on campus. 46.25% of DOs reported using marijuana in the past three months. No significant differences with respect to sex, race/ethnicity, class rank, Greek membership, current residence, or employment status were found between DOs and their peers who endorsed either no DSM-5 criteria or two or more criteria. Participants who endorsed two or more AUD criteria reported significantly higher alcohol consumption and drinking frequencies than the other two groups. DOs reported significantly more alcohol-related consequences and social and enhancement drinking motives than participants who did not endorse any AUD criteria. Compared to those who endorsed two or more AUD criteria, DOs reported significantly less frequent drinking, less alcohol consumed, fewer consequences, fewer social, coping, and enhancement motives, less emotional dysregulation, and less drinking restraint.
Take away: “Diagnostic orphans” who endorsed only one DSM-5 alcohol use disorder criterion reported significantly more alcohol-related consequences and social and enhancement drinking motives than their peers who did not endorse any criteria. Compared to their peers who endorsed more than one criterion, diagnostic orphans consumed less alcohol, drank less often, and experienced fewer consequences.