Attenuated psychosis syndrome (APS) was introduced in DSM-5 as a condition for further study. A number of concerns have been raised regarding APS, including its validity as a clinical entity, issues relating to stigma, the potential that it is an unnecessary diagnosis of what might be a self-limiting phase of attenuated psychotic symptoms, and treatment implications of the diagnosis. The current paper presents a number of conceptual and practical issues that should be addressed in deciding whether APS should be accepted as an official diagnosis in subsequent editions of DSM. These include the problem of transferring the established validity of ‘at-risk' criteria to APS given some non-trivial differences between the criteria sets, the relationship between attenuated psychotic symptoms and other presenting non-psychotic disorders, the difficulties of operationalising the subthreshold or ‘attenuated' concept in standard clinical practice, and the likelihood of the diagnosis leading to overprescription of antipsychotic medication for this group of patients.