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The reduction in threshold from five to four criteria was based on three studies in three different countries, USA StinchfieldCanada Stinchfield et al. The cut score of four crkteria as well or better than a cut score of five in all samples. The ten DSM-IV diagnostic criteria were found to exhibit satisfactory reliability, validity, and classification accuracy; however, lowering the cut score to four and using item weights yielded improved classification accuracy over the standard cut score of five.

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