Changes: DSM-5

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DSM-5 (formerly known as DSM-V) is the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders. In the United States the DSM serves as a universal authority for the diagnosis of psychiatric disorders. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has significant practical importance.

The DSM-5 was published on May 18, 2013, superseding the DSM-IV-TR, which was published in 2000. The development of the new edition began with a conference in 1999, and proceeded with the formation of a Task Force in 2007, which developed and field-tested a variety of new classifications. In most respects DSM-5 is not greatly changed from DSM-IV-TR. Notable innovations include dropping Asperger syndrome as a distinct classification; loss of subtype classifications for variant forms of schizophrenia; dropping the "bereavement exclusion" for depressive disorders; a revised treatment and naming of gender identity disorder to gender dysphoria, and a new gambling disorder.

The fifth edition was criticized by various authorities before it was formally published, and after it was published. The main thrust of criticism has been that changes in the DSM have not kept pace with advances in scientific understanding of psychiatric dysfunction. Another criticism is that the development of DSM-5 was unduly influenced by input from the psychiatric drug industry. Various scientists have argued that the DSM-5 forces clinicians to make distinctions that are not supported by solid evidence, distinctions that have major treatment implications, including drug prescriptions and the availability of health insurance coverage. General criticism of the DSM-5 ultimately resulted in a petition signed by 13,000, and sponsored by many mental health organizations, which called for outside review of the document.

Changes in DSM-5

Section I

Section I describes DSM-5 chapter organization, its multiaxial system, and Section III's dimensional assessments.^[1] The DSM-5 deleted the chapter that includes disorders usually first diagnosed in infancy, childhood, or adolescence" opting to list them in other chapters.^[1] A note under Anxiety Disorders says that the "sequential order" of at least some DSM-5 chapters has significance that reflects the relationships between diagnoses.^[1]

This introductory section describes the process of DSM revision, including field trials, public and professional review, and expert review. It states its goal is to harmonize with the ICD systems and share organizational structures as much as is feasible. Concern about the categorical system of diagnosis is expressed, but the conclusion is the reality that alternative definitions for most disorders is scientifically premature.

The new version replaces the NOS categories with two options: other specified disorder and unspecified disorder to increase the utility to the clinician. The first allows the clinician to specify the reason that the criteria for a specific disorder are not met; the second allows the clinician the option to forgo specification.

DSM-5 has discarded the multiaxial system of diagnosis (formerly Axis I, Axis II, Axis III), listing all disorders in Section II. It has replaced Axis IV with significant psychosocial and contextual features and dropped Axis V (Global Assessment of Functioning, known as GAF). The World Health Organization's (WHO) Disability Assessment Schedule is added to Section III (Emerging measures and models) under Assessment Mesures.^[2]

Section II: diagnostic criteria and codes

Main article: DSM-5 codes

Neurodevelopmental disorders

"Mental retardation" has a new name: "intellectual disability (intellectual developmental disorder)"^[3]
Phonological disorder and stuttering are now called communication disorders—which include language disorder, speech sound disorder, childhood-onset fluency disorder, and a new condition characterized by impaired social verbal and nonverbal communication called social (pragmatic) communication disorder^[3]
Autism spectrum disorder incorporates Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) - see Diagnosis of Asperger syndrome#Proposed changes to DSM-5^[4]

Schizophrenia spectrum and other psychotic disorders

All subtypes of schizophrenia were deleted (paranoid, disorganized, catatonic, undifferentiated, and residual).^[1]
A major mood episode is required for schizoaffective disorder (for a majority of the disorder's duration after criterion A is met).^[1]
Criteria for delusional disorder changed, and, in DSM-5, delusional disorder is no longer separate from shared delusional disorder.^[1]
In DSM-5, catatonia in all contexts requires 3 of a total of 12 symptoms. Catatonia may be a specifier for depressive, bipolar, and psychotic disorders; part of another medical condition; or an other specified diagnosis.^[1]

Bipolar and related disorders

New specifier "with mixed features" can be applied to bipolar I disorder, bipolar II disorder, bipolar disorder NED (previously called "NOS") and MDD^[5]
Allows other specified bipolar and related disorder for particular conditions.^[1]
Anxiety symptoms are a specifier added to bipolar disorder and to depressive disorders (but are not part of the bipolar diagnostic criteria).^[1]

Depressive disorders

The bereavement exclusion in DSM-IV was removed from depressive disorders in DSM-5.^[6]
New disruptive mood dysregulation disorder (DMDD)^[7] for children up to age 18 years^[1]
Premenstrual dysphoric disorder moved from an appendix for further study, and became a disorder.^[1]
Specifiers were added for mixed symptoms and for anxiety, along with guidance to physicians for suicidality.^[1]

Anxiety disorders

For the various forms of phobias and anxiety disorders, DSM-5 removes the requirement that the subject (formerly, over 18 years old) "must recognize that their fear and anxiety are excessive or unreasonable". Also, the duration of at least 6 months now applies to everyone (not only to children).^[1]
Panic attack became a specifier for all DSM-5 disorders.^[1]
Panic disorder and agoraphobia became two separate disorders in DSM-5.^[1]
Specific types of phobias became specifiers but are otherwise unchanged.^[1]
The generalized specifier for social anxiety disorder (formerly, social phobia) changed in favor of a performance only (i.e., public speaking or performance) specifier.^[1]
Separation anxiety disorder and selective mutism are now classified as anxiety disorders (rather than disorders of early onset).^[1]

Obsessive-compulsive and related disorders

A new chapter on obsessive-compulsive and related disorders includes four new disorders: excoriation (skin-picking) disorder, hoarding disorder, substance-/medication-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition.^[1]
Trichotillomania (hair-pulling disorder) moved from "impulse-control disorders not elsewhere classified" in DSM-IV, to an obsessive-compulsive disorder in DSM-5.^[1]
A specifier was expanded (and added to body dysmorphic disorder and hoarding disorder) to allow for good or fair insight, poor insight, and "absent insight/delusional" (i.e., complete conviction that obsessive-compulsive disorder beliefs are true).^[1]
Criteria were added to body dysmorphic disorder to describe repetitive behaviors or mental acts that may arise with perceived defects or flaws in physical appearance.^[1]
The DSM-IV specifier “with obsessive-compulsive symptoms” moved from anxiety disorders to this new category for obsessive-compulsive and related disorders.^[1]
In DSM-5, other specified obsessive-compulsive and related disorder can include body-focused repetitive behavior disorder (behaviors like nail biting, lip biting, and cheek chewing, other than hair pulling and skin picking), obsessional jealousy, and unspecified obsessive-compulsive and related disorder.^[1]

Trauma- and stressor-related disorders

Posttraumatic stress disorder (PTSD) is now included in a new section titled "Trauma- and Stressor-Related Disorders."^[8]
The PTSD diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of DSM-IV.^[9]
Separate criteria were added for children six years old or younger.^[1]
For the diagnosis of acute stress disorder and PTSD, the stressor criteria (Criterion A1 in DSM-IV) was modified to some extent, and the requirement for specific subjective emotional reactions (Criterion A2 in DSM-IV) was eliminated because it lacked empirical support for its utility and predictive validity^[9] and resulted in certain groups, e.g., military personnel involved in combat, law enforcement officers and other first responders, lacking only the A2 criteria for a PTSD diagnosis because their training prepared them to not react emotionally to traumatic events.^[10] ^[11] ^[12]
Two new disorders that were formerly subtypes were named: reactive attachment disorder and disinhibited social engagement disorder.^[1]
Adjustment disorders were moved to this new section and reconceptualized as stress-response syndromes. DSM-IV subtypes for depressed mood, anxious symptoms, and disturbed conduct are unchanged.^[1]

Dissociative disorders

Depersonalization disorder is now called depersonalization/derealization disorder.^[13]
Dissociative fugue became a specifier for dissociative amnesia.^[1]
In DSM-5, criteria were expanded in dissociative identity disorder to include "possession-form phenomena and functional neurological symptoms" and to say that "transitions in identity may be observable by others or self-reported".^[1] Criterion B was also modified for people who can't recall everyday events (not only trauma).^[1]

Somatic symptom and related disorders

Somatoform disorders are now called somatic symptom and related disorders. Diagnoses of somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder were deleted in DSM-5. In DSM-5, people with chronic pain could be diagnosed with somatic symptom disorder with predominant pain; or psychological factors that affect other medical conditions; or with an adjustment disorder.^[1]
Somatization disorder and undifferentiated somatoform disorder were combined to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms.^[1]
In DSM-5, somatic symptom and related disorders are defined by positive symptoms, and minimize the use of medically unexplained symptoms except in the cases of conversion disorder and pseudocyesis specifically.^[1]
"Psychological factors affecting other medical conditions" (formerly found in the DSM-IV chapter "Other Conditions That May Be a Focus of Clinical Attention") is termed a new mental disorder.^[1]
Criteria for conversion disorder (functional neurological symptom disorder) were changed.^[1]

Feeding and eating disorders

Criteria for pica and rumination disorder were changed and can now refer to people of any age.^[1]
Binge eating disorder graduated from DSM-IV's "Appendix B -- Criteria Sets and Axes Provided for Further Study".^[14]
Requirements for bulimia nervosa and binge eating disorder were changed from "at least twice weekly for 6 months to at least once weekly over the last 3 months".
Anorexia nervosa no longer has a requirement of amenorrhea and its criteria were changed.
What in DSM-IV was called "feeding disorder of infancy or early childhood" and rarely used, is now called avoidant/restrictive food intake disorder with expanded criteria.^[1]

Sleep-wake disorders

"Sleep disorders related to another mental disorder, and sleep disorders related to a general medical condition" were deleted from DSM-IV.^[1]
Primary insomnia became insomnia disorder in DSM-5, and narcolepsy is separate from other hypersomnolence.^[1]
In DSM-5, there are three breathing-related sleep disorders: obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation.^[1]
Circadian rhythm sleep-wake disorders were expanded to include advanced sleep phase syndrome, irregular sleep-wake type, and non-24-hour sleep-wake type.^[1] Jet lag was removed.^[1]
Listed under "dyssomnia not otherwise specified" in DSM-IV, rapid eye movement sleep behavior disorder and restless legs syndrome are each a disorder in DSM-5.^[1]

Sexual dysfunctions

DSM-5 has gender-specific sexual dysfunctions.^[1]
For females, sexual desire and arousal disorders are combined into female sexual interest/arousal disorder.^[1]
DSM-5 sexual dysfunctions (except substance-/medication-induced sexual dysfunction) now require a duration of approximately 6 months and more exact severity criteria.^[1]
New in DSM-5 is genito-pelvic pain/penetration disorder which combines vaginismus and dyspareunia from DSM-IV.^[1]
Sexual aversion disorder was deleted.^[1]
DSM-5 subtypes for all disorders includes only "lifelong versus acquired" and "generalized versus situational" (one subtype was deleted from DSM-IV).^[1]
In DSM-5, two subtypes were deleted: "sexual dysfunction due to a general medical condition" and "due to psychological versus combined factors".^[1]

Gender dysphoria

Further information: Gender dysphoria

DSM-IV gender identity disorder is similar to, but not the same as, gender dysphoria in DSM-5. Separate criteria for children, adolescents and adults that are appropriate for varying developmental states are added.
Subtypes of gender identity disorder based on sexual orientation were deleted.^[1]
Among other wording changes, criterion A and criterion B (cross-gender identification, and aversion toward one’s gender) were combined.^[1] Along with these changes comes the creation of a separate gender dysphoria in children as well as one for adults and adolescents. The grouping has been moved out of the sexual disorders category and into its own. The name change was made in part due to stigmatization of the term "disorder" and the relatively common use of "gender dysphoria" in the GID literature and among specialists in the area.^[15] The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing and ability to express it in the event that they have insight.^[16]

Disruptive, impulse-control, and conduct disorders

Some of these disorders were formerly part of the chapter on early diagnosis, oppositional defiant disorder; conduct disorder; and disruptive behavior disorder not otherwise specified became other specified and unspecified disruptive disorder, impulse-control disorder, and conduct disorders.^[1] Intermittent explosive disorder, pyromania, and kleptomania moved to this chapter from the DSM-IV chapter "Impulse-Control Disorders Not Otherwise Specified".^[1]

Antisocial personality disorder is listed here and in the chapter on personality (neurocognitive) disorders (but ADHD is listed under neurodevelopmental disorders).^[1]
Symptoms for oppositional defiant disorder are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. The conduct disorder exclusion is deleted. The criteria were also changed with a note on frequency requirements and a measure of severity.^[1]
Criteria for conduct disorder are unchanged for the most part from DSM-IV.^[1] A specifier was added for people with limited "prosocial emotion".^[1]
People over the disorder's minimum age of 6 may be diagnosed with intermittent explosive disorder without outbursts of physical aggression.^[1] Criteria were added for frequency and to specify "impulsive and/or anger based in nature, and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences".^[1]

Substance-related and addictive disorders

Gambling disorder and tobacco use disorder are new.^[1]
Substance abuse and substance dependence have been combined into single substance use disorders specific to each substance of abuse within a new "addictions and related disorders" category.^[17] "Recurrent legal problems" was deleted and "craving or a strong desire or urge to use a substance" was added to the criteria.^[1] The threshold of the number of criteria that must be met was changed.^[1] Severity from mild to severe is based on the number of criteria endorsed.^[1] Criteria for cannabis and caffeine withdrawal were added.^[1] New specifiers were added for early and sustained remission along with new specifiers for "in a controlled environment" and "on maintenance therapy".^[1]

Neurocognitive disorders

Dementia and amnestic disorder became major or mild neurocognitive disorder (major NCD, or mild NCD).^[1]^[18] DSM-5 has a new list of neurocognitive domains.^[1] "New separate criteria are now presented" for major or mild NCD due to various conditions.^[1] Substance/medication-induced NCD and unspecified NCD are new diagnoses.^[1]

Paraphilic disorders

New specifiers "in a controlled environment" and "in remission" were added to criteria for all paraphilic disorders.^[1]
Distinguishes between paraphilic behaviors, or paraphilias, and paraphilic disorders.^[19] All criteria sets were changed to add the word disorder to all of the paraphilias, for example, pedophilia is now pedophilic disorder.^[1] There is no change in the basic diagnostic structure since DSM-III-R; however, people now must meet both qualitative (criterion A) and negative consequences (criterion B) criteria to be diagnosed with a paraphilic disorder. Otherwise thay have a paraphilia (and no diagnosis).^[1]

Section III: emerging measures and models

Alternative DSM-5 model for personality disorders

An alternative hybrid dimensional-categorical model for personality disorders is included to stimulate further research on this modified classification system^[20]

Conditions for further study

These conditions and criteria are set forth to encourage future research and are not meant for clinical use.

Attenuated psychosis syndrome
Depressive episodes with short-duration hypomania
Persistent complex bereavement disorder
Caffeine use disorder
Internet gaming disorder
Neurobehavioral disorder associated with prenatal alcohol exposure
Suicidal behavior disorder
Non-suicidal self-injury^[21]

Development

In 1999, a DSM–5 Research Planning Conference; sponsored jointly by APA and the National Institute of Mental Health (NIMH), was held to set the research priorities. Research Planning Work Groups produced "white papers" on the research needed to inform and shape the DSM-5^[22] and the resulting work and recommendations were reported in an APA monograph^[23] and peer-reviewed literature.^[24] There were six workgroups, each focusing on a broad topic: Nomenclature, Neuroscience and Genetics, Developmental Issues and Diagnosis, Personality and Relational Disorders, Mental Disorders and Disability, and Cross-Cultural Issues. Three additional white papers were also due by 2004 concerning gender issues, diagnostic issues in the geriatric population, and mental disorders in infants and young children.^[25] The white papers have been followed by a series of conferences to produce recommendations relating to specific disorders and issues, with attendance limited to 25 invited researchers.^[25]

On July 23, 2007, the APA announced the task force that would oversee the development of DSM-5. The DSM-5 Task Force consisted of 27 members, including a chair and vice chair, who collectively represent research scientists from psychiatry and other disciplines, clinical care providers, and consumer and family advocates. Scientists working on the revision of the DSM have experience in research, clinical care, biology, genetics, statistics, epidemiology, public health, and consumer advocacy. They have interests ranging from cross-cultural medicine and genetics to geriatric issues, ethics and addiction. The APA Board of Trustees required that all task force nominees disclose any competing interests or potentially conflicting relationships with entities that have an interest in psychiatric diagnoses and treatments as a precondition to appointment to the task force. The APA made all task force members' disclosures available during the announcement of the task force. Several individuals were ruled ineligible for task force appointments due to their competing interests. Future announcements will include naming the workgroups on specific categories of disorders and their research-based recommendations on updating various disorders and definitions.^[26]

The DSM-5 field trials included test-retest reliability which involved different clinicians doing independent evaluations of the same patient—a common approach to the study of diagnostic reliability.^[27]

Criticism

General

Robert Spitzer, the head of the DSM-III task force, has publicly criticized the APA for mandating that DSM-5 task force members sign a nondisclosure agreement, effectively conducting the whole process in secret: "When I first heard about this agreement, I just went bonkers. Transparency is necessary if the document is to have credibility, and, in time, you're going to have people complaining all over the place that they didn't have the opportunity to challenge anything."^[28] Allen Frances, chair of the DSM-IV task force, expressed a similar concern.^[29]

Although the APA has since instituted a disclosure policy for DSM-5 task force members, many still believe the Association has not gone far enough in its efforts to be transparent and to protect against industry influence.^[30] In a 2009 Point/Counterpoint article, Lisa Cosgrove, PhD and Harold J. Bursztajn, MD noted that "the fact that 70% of the task force members have reported direct industry ties---an increase of almost 14% over the percentage of DSM-IV task force members who had industry ties---shows that disclosure policies alone, especially those that rely on an honor system, are not enough and that more specific safeguards are needed."^[31]

David Kupfer, chair of the DSM-5 task force, and Darrel A. Regier, MD, MPH, vice chair of the task force, whose industry ties are disclosed with those of the task force,^[32] countered that "collaborative relationships among government, academia, and industry are vital to the current and future development of pharmacological treatments for mental disorders." They asserted that the development of DSM-5 is the "most inclusive and transparent developmental process in the 60-year history of DSM." The developments to this new version can be viewed on the APA website.^[33] Public input was requested for the first time in the history of the manual.^{[citation needed]} During periods of public comment, members of the general public could sign up at the DSM-5 website^[34] and provide feedback on the various proposed changes.^[35]

In June 2009, Allen Frances issued strongly worded criticisms of the processes leading to DSM-5 and the risk of "serious, subtle, (…) ubiquitous" and "dangerous" unintended consequences such as new "false 'epidemics'". He writes that "the work on DSM-V has displayed the most unhappy combination of soaring ambition and weak methodology" and is concerned about the task force's "inexplicably closed and secretive process".^[36] His and Spitzer's concerns about the contract that the APA drew up for consultants to sign, agreeing not to discuss drafts of the fifth edition beyond the task force and committees, have also been aired and debated.^[37]

The appointment, in May 2008, of two of the taskforce members, Kenneth Zucker and Ray Blanchard, led to an internet petition to remove them.^[38] According to MSNBC, "The petition accuses Zucker of having engaged in 'junk science' and promoting 'hurtful theories' during his career, especially advocating the idea that children who are unambiguously male or female anatomically, but seem confused about their gender identity, can be treated by encouraging gender expression in line with their anatomy."^[39] According to The Gay City News, "Dr. Ray Blanchard, a psychiatry professor at the University of Toronto, is deemed offensive for his theories that some types of transsexuality are paraphilias, or sexual urges. In this model, transsexuality is not an essential aspect of the individual, but a misdirected sexual impulse."^[40] Blanchard responded, "Naturally, it's very disappointing to me there seems to be so much misinformation about me on the Internet. [They didn't distort] my views, they completely reversed my views."^[40] Zucker "rejects the junk-science charge, saying there 'has to be an empirical basis to modify anything' in the DSM. As for hurting people, 'in my own career, my primary motivation in working with children, adolescents and families is to help them with the distress and suffering they are experiencing, whatever the reasons they are having these struggles. I want to help people feel better about themselves, not hurt them.'"^[39]

In 2011, psychologist Brent Robbins co-authored a national letter for the Society for Humanistic Psychology that brought thousands into the public debate about the DSM. Approximately 13,000 individuals and mental health professionals signed a petition in support of the letter. Thirteen other American Psychological Association divisions endorsed the petition.^[41] In a November 2011 article about the debate in the San Francisco Chronicle, Robbins notes that under the new guidelines, certain responses to grief could be labeled as pathological disorders, instead of being recognized as being normal human experiences.^[42] In 2012, a footnote was added to the draft text which explains the distinction between grief and depression.^[43]

DSM-5, has been criticized for purportedly saying nothing about the biological underpinnings of mental disorders.^[44]

Borderline personality disorder controversy

In 2003, the Treatment and Research Advancements National Association for Personality Disorders (TARA-APD) campaigned to change the name and designation of borderline personality disorder in DSM-5.^[45] The paper How Advocacy is Bringing BPD into the Light^[46] reported that "the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing stigma...". Instead, it proposed the name "emotional regulation disorder" or "emotional dysregulation disorder". There was also discussion about changing borderline personality disorder, an Axis II diagnosis (personality disorders and mental retardation), to an Axis I diagnosis (clinical disorders).^[47]

More radical criticisms

Some authors believe that the problem is not simply of a few criteria to be deleted or modified. For example, a Kuhnian reformulation of the diagnostic debate suggested that apparently trivial problems of the DSM, like the extremely high rates of comorbidity, might fruitfully be analysed as Kuhnian anomalies leading the DSM system to a scientific crisis.^[48] As a consequence, a radical rethinking of the concept of mental disorder was proposed, addressing its constructive nature.^[49] Based on similar views, several revolutionary approaches were proposed, ranging from dimensional diagnosis to various forms of etiopathogenetic diagnosis.^[50]

The financial association of DSM-5 panel members with industry continues to be a concern for financial conflict of interest.^[51] Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members.^[51]

British Psychological Society response

The British Psychological Society in the United Kingdom stated in its June 2011 response that it had "more concerns than plaudits".^[52] It criticized proposed diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements... not value-free, but rather reflect[ing] current normative social expectations", noting doubts over the reliability, validity, and value of existing criteria, that personality disorders were not normed on the general population, and that "not otherwise specified" categories covered a "huge" 30% of all personality disorders.

It also expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences... which demand helping responses, but which do not reflect illnesses so much as normal individual variation".

The Society suggested as its primary specific recommendation, a change from using "diagnostic frameworks" to a description based on an individual's specific experienced problems, and that mental disorders are better explored as part of a spectrum shared with normality:

[We recommend] a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are the most strongly-evidenced causal factors. Rather than applying preordained diagnostic categories to clinical populations, we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or 'symptoms' or 'complaints'...... We would like to see the base unit of measurement as specific problems (e.g. hearing voices, feelings of anxiety etc)? These would be more helpful too in terms of epidemiology. While some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their problems are recognised (in both senses of the word) understood, validated, explained (and explicable) and have some relief. Clients often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. Since – for example – two people with a diagnosis of 'schizophrenia' or 'personality disorder' may possess no two symptoms in common, it is difficult to see what communicative benefit is served by using these diagnoses. We believe that a description of a person's real problems would suffice. Moncrieff and others have shown that diagnostic labels are less useful than a description of a person's problems for predicting treatment response, so again diagnoses seem positively unhelpful compared to the alternatives.
—British Psychological Society June 2011 response

National Institute of Mental Health

National Institute of Mental Health director Thomas R. Insel, MD,^[53] wrote in an April 29, 2013 blog post:^[54]

The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. ... Patients with mental disorders deserve better.

Insel also discussed an NIMH effort to develop a new classification system, Research Domain Criteria (RDoC), currently for research purposes only.^[55] Insel's post sparked a flurry of reaction, some of which might be termed sensationalistic, with headlines such as "Goodbye to the DSM-V",^[56] "Federal institute for mental health abandons controversial 'bible' of psychiatry", ^[57] "National Institute of Mental Health abandoning the DSM",^[58] and "Psychiatry divided as mental health 'bible' denounced." ^[59] Other responses provided a more nuanced analysis of the NIMH Director's post.^[60]

In May 2013, Insel, on behalf of NIMH, issued a joint statement with Jeffrey A. Lieberman, MD, president of the American Psychiatric Association,^[61] that emphasized that DSM-5, "...represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5." Insel and Lieberman say that DSM-5 and RDoC "represent complementary, not competing, frameworks" for characterizing diseases and disorders.^[61]

References

↑ ^1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 ^1.10 ^1.11 ^1.12 ^1.13 ^1.14 ^1.15 ^1.16 ^1.17 ^1.18 ^1.19 ^1.20 ^1.21 ^1.22 ^1.23 ^1.24 ^1.25 ^1.26 ^1.27 ^1.28 ^1.29 ^1.30 ^1.31 ^1.32 ^1.33 ^1.34 ^1.35 ^1.36 ^1.37 ^1.38 ^1.39 ^1.40 ^1.41 ^1.42 ^1.43 ^1.44 ^1.45 ^1.46 ^1.47 ^1.48 ^1.49 ^1.50 ^1.51 ^1.52 ^1.53 ^1.54 ^1.55 ^1.56 ^1.57 ^1.58 ^1.59 ^1.60 ^1.61 ^1.62 ^1.63 ^1.64 ^1.65 ^1.66 ^1.67 ^1.68 ^1.69 ^1.70 ^1.71 ^1.72 Highlights of Changes from DSM-IV-TR to DSM-5. (PDF) American Psychiatric Association. URL accessed on May 23, 2013.
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↑ Friedman, M. J., Resick, P. A., Bryant, R. A., Strain, J., Horowitz, M., & Spiegel, D. (2011). Classification of trauma and stressor-related disorders in DSM-5. Depression and Anxiety 28 (9): 737–749.
↑ ^9.0 ^9.1 Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011). Considering PTSD for DSM-5. Depression and Anxiety 28 (9): 750–769.
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↑ A Guide to DSM-5: Paraphilias and Paraphilic Disorders. Medscape.com. URL accessed on 2013-05-26.
↑ A Guide to DSM-5: Personality Disorders. Medscape.com. URL accessed on 2013-05-26.
↑ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth, 783–808, Arlington, VA: American Psychiatric Publishing.
↑ First, Michael B. (2002), A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers Published in May 2002, American Psychiatric Association, Archived from the original on April 13, 2008, http://web.archive.org/web/20080413001720/http://dsm5.org/whitepapers.cfm, retrieved on May 12, 2012
↑ Kupfer, David J., ed. (2002), A Research Agenda for DSM-5, Washington, D.C.: American Psychiatric Association, ISBN 9780890422922, OCLC 49518977, http://appi.org/book.cfm?id=2292
↑ Regier, Darrel A (2002). The APA classification of mental disorders: future perspectives. Psychopathology 35 (2–3): 166–170.
↑ ^25.0 ^25.1 DSM-5 Research Planning, American Psychiatric Association, DSM-V Research White Papers, Archived from the original on April 24, 2008, http://web.archive.org/web/20080424075423/http://dsm5.org/planning.cfm, retrieved on May 12, 2012
↑ Regier, MD, MPH, Darrel A. (2007). Somatic Presentations of Mental Disorders: Refining the Research Agenda for DSM-V. Psychosomatic Medicine 69 (9): 827–828.
↑ Reliability and Prevalence in the DSM-5 Field Trials, January 12, 2012 http://www.dsm5.org/Documents/Reliability_and_Prevalence_in_DSM-5_Field_Trials_1-12-12.pdf
↑ includeonly>Carey, Benedict. "Psychiatrists Revise the Book of Human Troubles", December 17, 2008.
↑ Psychiatrists Propose Revisions to Diagnosis Manual. via PBS Newshour, Feb 10, 2010 (interviews Frances and Alan Schatzberg on some of the main changes proposed to the DSM-5)
↑ Cosgrove, Lisa; Krimsky, Sheldon; Vijayaraghavan, Manisha; Schneider, Lisa (April 2006), "Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry", Psychotherapy and Psychosomatics 75 (3): 154–160, doi:10.1159/000091772, PMID 16636630, http://content.karger.com/ProdukteDB/produkte.asp?doi=91772
↑ Cosgrove L, Bursztajn HJ, Kupfer DJ, Regier DA. "Toward Credible Conflict of Interest Policies in Clinical Psychiatry" Psychiatric Times 26:1.
↑ DSM-V Task Force Member Disclosure Report: David J Kupfer, MD. American Psychiatric Association. and DSM-V Task Force Member Disclosure Report: Darrel Alvin Regier M.D. (PDF) American Psychiatric Association. URL accessed on May 5, 2011.
↑ DSM-5 Overview: The Future Manual | APA DSM-5
↑ Registration page for DSM-5 public comment, page found 2011-06-05.
↑ "Suggestions and ideas for members of the work groups were also solicited through the DSM-5 website. The proposed draft revisions to DSM-5 are posted on the website, and anyone can provide feedback to the work groups during periods of public comment."Question 4 on the DSM-5 FAQ, page found 2011-06-05.
↑ Frances, Allen (26 June 2009). A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences. Psychiatric Times.
↑ includeonly>Lane, Christopher. "The Diagnostic Madness of DSM-V", Slate, July 24, 2009.
↑ includeonly>Lou Chibbaro Jr.. "Activists alarmed over APA: Head of psychiatry panel favors 'change' therapy for some trans teens", Washington Blade, 2008-05-30.
↑ ^39.0 ^39.1 includeonly>Alexander, Brian. "What's 'normal' sex? Shrinks seek definition: Controversy erupts over creation of psychiatric rule book's new edition", MSNBC, 2008-05-22. Retrieved on 2008-06-14.
↑ ^40.0 ^40.1 includeonly>Osborne, Duncan. "Flap Flares Over Gender Diagnosis", Gay City News, 2008-05-15. Retrieved on 2008-06-14. ^{[dead link]}
↑ Professor co-authors letter about America's mental health manual. Point Park University.
↑ Erin Allday. Revision of psychiatric manual under fire. San Francisco Chronicle.
↑ Carey, Benedict (May 8, 2012), "Psychiatry Manual Drafters Back Down on Diagnoses", The New York Times: nytimes.com, http://www.nytimes.com/2012/05/09/health/dsm-panel-backs-down-on-diagnoses.html, retrieved on May 12, 2012
↑ New DSM-5 Ignores Biology of Mental Illness; "The latest edition of psychiatry's standard guidebook neglects the biology of mental illness. New research may change that." May 5, 2013 Scientific American
↑ Treatment and Research Advancements National Association for Personality Disorders (TARA-APD)
↑ How Advocacy is Bringing BPD into the Light
↑ New, Antonia, Triebwasser Joseph, Charney Dennis (October 2008). The case for shifting borderline personality disorder to Axis I. Biol. Psychiatry 64 (8): 653–9.
↑ Aragona M. (2009). The role of comorbidity in the crisis of the current psychiatric classification system PDF. Philosophy, Psychiatry, & Psychology 16: 1-11
↑ Aragona M. (2009) The concept of mental disorder and the DSM-V Dialogues in Philosophy, Mental and Neuro Sciences 2: 1-14
↑ (an example from a cognitive point of view) Sirgiovanni E. (2009) The Mechanistic Approach to Psychiatric Classification Dialogues in Philosophy, Mental and Neuro Sciences 2: 45-49
↑ ^51.0 ^51.1 Cosgrove, Lisa, Drimsky Lisa (March 2012). A comparison of DSM-iv and DSM-5 panel members' financial associations with industry: A pernicous problem persisits. PLoS Medicine 9 (3): 1–5.
↑ British Psychological Society Response, June 2011
↑ Director's Biography. National Institute of Mental Health. URL accessed on 2013-05-22.
↑ Insel, Thomas Transforming Diagnosis. National Institute of Mental Health. URL accessed on 23 May 2013.
↑ NIMH Research Domain Criteria (RDoC) (Draft 3.1). National Institute of Mental Health. URL accessed on May 26, 2013.
↑ Goodbye to the DSM-V. Huffington Post. URL accessed on 23 May 2013.
↑ Federal institute for mental health abandons controversial 'bible' of psychiatry. Verge. URL accessed on 23 May 2013.
↑ National Institute of Mental Health abandoning the DSM. Mind Hacks. URL accessed on 23 May 2013.
↑ Psychiatry divided as mental health 'bible' denounced. NewScientist. URL accessed on 23 May 2013.
↑ Did the NIMH Withdraw Support for the DSM-5? No. PsychCentral. URL accessed on 23 May 2013.
Mental Health Researchers Reject Psychiatry’s New Diagnostic ‘Bible’. Time. URL accessed on 23 May 2013.
THE RATS OF N.I.M.H.. The New Yorker. URL accessed on 23 May 2013.
includeonly>"Psychiatry’s Guide Is Out of Touch With Science, Experts Say", New York Times. Retrieved on 23 May 2013.
↑ ^61.0 ^61.1 DSM-5 and RDoC: Shared Interests. National Institute of Mental Health and American Psychiatric Association. URL accessed on 23 May 2013.

External links

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[highlights-1] 1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 ^1.10 ^1.11 ^1.12 ^1.13 ^1.14 ^1.15 ^1.16 ^1.17 ^1.18 ^1.19 ^1.20 ^1.21 ^1.22 ^1.23 ^1.24 ^1.25 ^1.26 ^1.27 ^1.28 ^1.29 ^1.30 ^1.31 ^1.32 ^1.33 ^1.34 ^1.35 ^1.36 ^1.37 ^1.38 ^1.39 ^1.40 ^1.41 ^1.42 ^1.43 ^1.44 ^1.45 ^1.46 ^1.47 ^1.48 ^1.49 ^1.50 ^1.51 ^1.52 ^1.53 ^1.54 ^1.55 ^1.56 ^1.57 ^1.58 ^1.59 ^1.60 ^1.61 ^1.62 ^1.63 ^1.64 ^1.65 ^1.66 ^1.67 ^1.68 ^1.69 ^1.70 ^1.71 ^1.72 Highlights of Changes from DSM-IV-TR to DSM-5. (PDF) American Psychiatric Association. URL accessed on May 23, 2013.

[DSM-5-indroduction-2] American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth, 5–25, Arlington, VA: American Psychiatric Publishing.

[medscape1-3] 3.0 ^3.1 A Guide to DSM-5: Neurodevelopmental Disorders. Medscape.com. URL accessed on 2013-05-26.

[4] A Guide to DSM-5: Autism Spectrum Disorders. Medscape.com. URL accessed on 2013-05-26.

[5] A Guide to DSM-5: Mixed-Mood Specifier. Medscape.com. URL accessed on 2013-05-26.

[6] A Guide to DSM-5: Removal of the Bereavement Exclusion From MDD. Medscape.com. URL accessed on 2013-05-26.

[7] A Guide to DSM-5: Disruptive Mood Dysregulation Disorder (DMDD). Medscape.com. URL accessed on 2013-05-26.

[8] Friedman, M. J., Resick, P. A., Bryant, R. A., Strain, J., Horowitz, M., & Spiegel, D. (2011). Classification of trauma and stressor-related disorders in DSM-5. Depression and Anxiety 28 (9): 737–749.

[considering-9] 9.0 ^9.1 Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011). Considering PTSD for DSM-5. Depression and Anxiety 28 (9): 750–769.

[10] Adler, A. B., Wright, K. M., Bliese, P. D., Eckford, R., & Hoge, C. W. (2008). A2 diagnostic criterion for combat-related posttraumatic stress disorder. Journal Of Traumatic Stress 21 (3): 301-308.

[11] Hathaway, L. M., Boals, A., & Banks, J. B. (2010). PTSD symptoms and dominant emotional response to a traumatic event: An examination of DSM-IV criterion A2. Anxiety, Stress & Coping: An International Journal 23 (1): 119-126.

[12] Karam, E. G., Andrews, G., Bromet, E., Petukhova, M., Ruscio, A. M., Salamoun, M., … Kessler, R. C. (2010). The Role of Criterion A2 in the DSM-IV Diagnosis of Posttraumatic Stress Disorder. Biological Psychiatry 68 (5): 465–473.

[DSM-5-13] American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth, Arlington, VA: American Psychiatric Publishing.

[14] A Guide to DSM-5: Binge Eating Disorder. Medscape.com. URL accessed on 2013-05-26.

[15] P 01 Gender Dysphoria in Adolescents or Adults. American Psychiatric Association. URL accessed on 2 April 2012.

[16] P 00 Gender Dysphoria in Children. American Psychiatric Association. URL accessed on 2 April 2012.

[17] A Guide to DSM-5: Substance Use Disorder. Medscape.com. URL accessed on 2013-05-26.

[18] A Guide to DSM-5: Neurocognitive Disorder. Medscape.com. URL accessed on 2013-05-26.

[19] A Guide to DSM-5: Paraphilias and Paraphilic Disorders. Medscape.com. URL accessed on 2013-05-26.

[medscape2-20] A Guide to DSM-5: Personality Disorders. Medscape.com. URL accessed on 2013-05-26.

[DSM-5-future-21] American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth, 783–808, Arlington, VA: American Psychiatric Publishing.

[22] First, Michael B. (2002), A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers Published in May 2002, American Psychiatric Association, Archived from the original on April 13, 2008, http://web.archive.org/web/20080413001720/http://dsm5.org/whitepapers.cfm, retrieved on May 12, 2012

[23] Kupfer, David J., ed. (2002), A Research Agenda for DSM-5, Washington, D.C.: American Psychiatric Association, ISBN 9780890422922, OCLC 49518977, http://appi.org/book.cfm?id=2292

[24] Regier, Darrel A (2002). The APA classification of mental disorders: future perspectives. Psychopathology 35 (2–3): 166–170.

[dsm5researchplanning-25] 25.0 ^25.1 DSM-5 Research Planning, American Psychiatric Association, DSM-V Research White Papers, Archived from the original on April 24, 2008, http://web.archive.org/web/20080424075423/http://dsm5.org/planning.cfm, retrieved on May 12, 2012

[26] Regier, MD, MPH, Darrel A. (2007). Somatic Presentations of Mental Disorders: Refining the Research Agenda for DSM-V. Psychosomatic Medicine 69 (9): 827–828.

[27] Reliability and Prevalence in the DSM-5 Field Trials, January 12, 2012 http://www.dsm5.org/Documents/Reliability_and_Prevalence_in_DSM-5_Field_Trials_1-12-12.pdf

[nyt081218-28] udeonly>Carey, Benedict. "Psychiatrists Revise the Book of Human Troubles", December 17, 2008.

[pbsnewhour-29] Psychiatrists Propose Revisions to Diagnosis Manual. via PBS Newshour, Feb 10, 2010 (interviews Frances and Alan Schatzberg on some of the main changes proposed to the DSM-5)

[pmid16636630-30] Cosgrove, Lisa; Krimsky, Sheldon; Vijayaraghavan, Manisha; Schneider, Lisa (April 2006), "Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry", Psychotherapy and Psychosomatics 75 (3): 154–160, doi:10.1159/000091772, PMID 16636630, http://content.karger.com/ProdukteDB/produkte.asp?doi=91772

[31] Cosgrove L, Bursztajn HJ, Kupfer DJ, Regier DA. "Toward Credible Conflict of Interest Policies in Clinical Psychiatry" Psychiatric Times 26:1.

[32] DSM-V Task Force Member Disclosure Report: David J Kupfer, MD. American Psychiatric Association. and DSM-V Task Force Member Disclosure Report: Darrel Alvin Regier M.D. (PDF) American Psychiatric Association. URL accessed on May 5, 2011.

[33] DSM-5 Overview: The Future Manual | APA DSM-5

[34] Registration page for DSM-5 public comment, page found 2011-06-05.

[35] "Suggestions and ideas for members of the work groups were also solicited through the DSM-5 website. The proposed draft revisions to DSM-5 are posted on the website, and anyone can provide feedback to the work groups during periods of public comment."Question 4 on the DSM-5 FAQ, page found 2011-06-05.

[36] Frances, Allen (26 June 2009). A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences. Psychiatric Times.

[37] udeonly>Lane, Christopher. "The Diagnostic Madness of DSM-V", Slate, July 24, 2009.

[38] udeonly>Lou Chibbaro Jr.. "Activists alarmed over APA: Head of psychiatry panel favors 'change' therapy for some trans teens", Washington Blade, 2008-05-30.

[msnbc-39] 39.0 ^39.1 includeonly>Alexander, Brian. "What's 'normal' sex? Shrinks seek definition: Controversy erupts over creation of psychiatric rule book's new edition", MSNBC, 2008-05-22. Retrieved on 2008-06-14.

[GayCity-40] 40.0 ^40.1 includeonly>Osborne, Duncan. "Flap Flares Over Gender Diagnosis", Gay City News, 2008-05-15. Retrieved on 2008-06-14. ^{[dead link]}

[41] Professor co-authors letter about America's mental health manual. Point Park University.

[42] Erin Allday. Revision of psychiatric manual under fire. San Francisco Chronicle.

[carey2012nyt-43] Carey, Benedict (May 8, 2012), "Psychiatry Manual Drafters Back Down on Diagnoses", The New York Times: nytimes.com, http://www.nytimes.com/2012/05/09/health/dsm-panel-backs-down-on-diagnoses.html, retrieved on May 12, 2012

[44] New DSM-5 Ignores Biology of Mental Illness; "The latest edition of psychiatry's standard guidebook neglects the biology of mental illness. New research may change that." May 5, 2013 Scientific American

[45] Treatment and Research Advancements National Association for Personality Disorders (TARA-APD)

[46] How Advocacy is Bringing BPD into the Light

[47] New, Antonia, Triebwasser Joseph, Charney Dennis (October 2008). The case for shifting borderline personality disorder to Axis I. Biol. Psychiatry 64 (8): 653–9.

[48] Aragona M. (2009). The role of comorbidity in the crisis of the current psychiatric classification system PDF. Philosophy, Psychiatry, & Psychology 16: 1-11

[49] Aragona M. (2009) The concept of mental disorder and the DSM-V Dialogues in Philosophy, Mental and Neuro Sciences 2: 1-14

[50] (an example from a cognitive point of view) Sirgiovanni E. (2009) The Mechanistic Approach to Psychiatric Classification Dialogues in Philosophy, Mental and Neuro Sciences 2: 45-49

[Cosgrove-51] 51.0 ^51.1 Cosgrove, Lisa, Drimsky Lisa (March 2012). A comparison of DSM-iv and DSM-5 panel members' financial associations with industry: A pernicous problem persisits. PLoS Medicine 9 (3): 1–5.

[52] British Psychological Society Response, June 2011

[53] Director's Biography. National Institute of Mental Health. URL accessed on 2013-05-22.

[54] Insel, Thomas Transforming Diagnosis. National Institute of Mental Health. URL accessed on 23 May 2013.

[55] NIMH Research Domain Criteria (RDoC) (Draft 3.1). National Institute of Mental Health. URL accessed on May 26, 2013.

[56] Goodbye to the DSM-V. Huffington Post. URL accessed on 23 May 2013.

[57] Federal institute for mental health abandons controversial 'bible' of psychiatry. Verge. URL accessed on 23 May 2013.

[58] National Institute of Mental Health abandoning the DSM. Mind Hacks. URL accessed on 23 May 2013.

[59] Psychiatry divided as mental health 'bible' denounced. NewScientist. URL accessed on 23 May 2013.

[60] Did the NIMH Withdraw Support for the DSM-5? No. PsychCentral. URL accessed on 23 May 2013.
Mental Health Researchers Reject Psychiatry’s New Diagnostic ‘Bible’. Time. URL accessed on 23 May 2013.
THE RATS OF N.I.M.H.. The New Yorker. URL accessed on 23 May 2013.
includeonly>"Psychiatry’s Guide Is Out of Touch With Science, Experts Say", New York Times. Retrieved on 23 May 2013.

[NIMH_and_APA_joint_statement-61] 61.0 ^61.1 DSM-5 and RDoC: Shared Interests. National Institute of Mental Health and American Psychiatric Association. URL accessed on 23 May 2013.

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 {{ClinPsy}}
-The next (fifth) edition of the [[American Psychiatric Association|American Psychiatric Association's]] (APA) ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM), commonly called '''DSM-5''' (previously known as '''DSM-V''' until the APA decided to abandon the Roman Numerals), is currently in consultation, planning and preparation. It is due for publication in May 2013 and will supersede the [[DSM-IV]] which was last revised in 2000.<ref name="DSM-5 Publication Date Moved to May 2013">[http://www.psych.org/MainMenu/Newsroom/NewsReleases/2009NewsReleases/DSM-5-Publication-Date-Moved-.aspx DSM-5 Publication Date Moved to May 2013]</ref> APA has an official development website for posting of draft versions of the DSM-5.<ref>[http://www.dsm5.org/pages/default.aspx Official DSM-5 Development Website]</ref>
+'''DSM-5''' (formerly known as '''DSM-V''') is the fifth edition of the [[American Psychiatric Association|American Psychiatric Association's]] (APA) ''[[Diagnostic and Statistical Manual of Mental Disorders]]''.  In the United States the DSM serves as a universal authority for the diagnosis of psychiatric disorders.  Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has significant practical importance.
+The DSM-5 was published on May 18, 2013, superseding the [[DSM-IV-TR]], which was published in 2000.  The development of the new edition began with a conference in 1999, and proceeded with the formation of a Task Force in 2007, which developed and field-tested a variety of new classifications.  In most respects DSM-5 is not greatly changed from DSM-IV-TR.  Notable innovations include dropping [[Asperger syndrome]] as a distinct classification; loss of subtype classifications for variant forms of [[schizophrenia]]; dropping the "bereavement exclusion" for [[major depressive disorder|depressive disorders]]; a revised treatment and naming of ''gender identity disorder'' to ''[[gender dysphoria]]'', and a new [[gambling disorder]].
-==Development of DSM-5==
-In 1999, a DSM–V Research Planning Conference, sponsored jointly by APA and the [[National Institute of Mental Health]] (NIMH), was held to set the research priorities. Research Planning Work Groups produced "white papers" on the research needed to inform and shape the DSM-V{{Clarify|date=September 2009}},<ref>First, M. (2002) [http://dsm5.org/whitepapers.cfm A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers Published in May 2002]</ref> and the resulting work and recommendations were reported in an APA monograph<ref>Kupfer, First & Regier (2002) [http://appi.org/book.cfm?id=2292 A Research Agenda for DSM-V]</ref> and peer-reviewed literature.<ref>{{cite journal |author=Regier DA, Narrow WE, First MB, Marshall T |title=The APA classification of mental disorders: future perspectives |journal=Psychopathology |volume=35 |issue=2-3 |pages=166–70 |year=2002 |pmid=12145504 |doi= 10.1159/000065139|url=http://openurl.ebscohost.com/linksvc/linking.aspx?genre=article&sid=PubMed&issn=0254-4962&title=Psychopathology&volume=35&issue=2-3&spage=166&atitle=The%20APA%20classification%20of%20mental%20disorders:%20future%20perspectives.&aulast=Regier&date=2002}}</ref> There were six workgroups, each focusing on a broad topic: Nomenclature, Neuroscience and Genetics, Developmental Issues and Diagnosis, Personality and [[Relational Disorder]]s, Mental Disorders and Disability, and Cross-Cultural Issues. Three additional white papers were also due by 2004 concerning gender issues, diagnostic issues in the geriatric population, and mental disorders in infants and young children.<ref>[http://www.dsm5.org/planning.cfm DSM-5 Research Planning]</ref> The white papers have been followed by a series of conferences to produce recommendations relating to specific disorders and issues, with attendance limited to 25 invited researchers.<ref>APA [http://dsm5.org/planning.cfm#conference DSM-V Research Planning Activities]</ref>
+The fifth edition was criticized by various authorities before it was formally published, and after it was published. The main thrust of criticism has been that changes in the DSM have not kept pace with advances in scientific understanding of psychiatric dysfunction. Another criticism is that the development of DSM-5 was unduly influenced by input from the psychiatric drug industry. Various scientists have argued that the DSM-5 forces clinicians to make distinctions that are not supported by solid evidence, distinctions that have major treatment implications, including drug prescriptions and the availability of health insurance coverage. General criticism of the DSM-5 ultimately resulted in a petition signed by 13,000, and sponsored by many mental health organizations, which called for outside review of the document.
-On July 23, 2007, the APA announced the task force that will oversee the development of DSM-5. The DSM-5 Task Force consists of 27 members, including a chair and vice chair, who collectively represent research scientists from psychiatry and other disciplines, clinical care providers, and consumer and family advocates. Scientists working on the revision of the DSM have experience in research, clinical care, biology, genetics, statistics, epidemiology, public health, and consumer advocacy. They have interests ranging from cross-cultural medicine and genetics to geriatric issues, ethics and addiction. The APA Board of Trustees required that all task force nominees disclose any competing interests or potentially conflicting relationships with entities that have an interest in psychiatric diagnoses and treatments as a precondition to appointment to the task force. The APA made all task force members' disclosures available during the announcement of the task force. Several individuals were ruled ineligible for task force appointments due to their competing interests. Future announcements will include naming the workgroups on specific categories of disorders and their research-based recommendations on updating various disorders and definitions.<ref>{{cite journal |last=Regier, MD, MPH |first=Darrel A. |year=2007 |title=Somatic Presentations of Mental Disorders: Refining the Research Agenda for DSM-V |journal=Psychosomatic Medicine |pmid=18040087 |volume=69 |issue=9 |pages=827–828 |publisher=Lippincott Williams and Wilkins |doi=10.1097/PSY.0b013e31815afbe4 |url=http://www.psychosomaticmedicine.org/cgi/reprint/69/9/827.pdf |format=pdf |accessdate=2007-12-21}}</ref>
+==Changes in DSM-5==
-Owing to criticism over the perceived proliferation of diagnoses in the current edition of the DSM, [[David Kupfer, M.D.]], who is the DSM-5 Task Force chair and is shepherding the DSM's revision, said in an interview: "One of the raps against psychiatry is that you and I are the only two people in the U.S. without a psychiatric diagnosis."<ref>{{cite news|title=Psychiatric manual's update needs openness, not secrecy, critics say|first=Ron|last=Grossman|work=Chicago Tribune|date=December 27, 2008|url=http://www.chicagotribune.com/features/lifestyle/health/chi-dsm-controversy-26-dec27,0,3080538.story}}</ref>
+===Section I===
-==First draft diagnostic criteria for DSM-5==
-The first draft diagnostic criteria for DSM-5 has now been released. Revisions include the following:<ref>http://www.dsm5.org/Newsroom/Documents/Diag%20%20Criteria%20General%20FINAL%202.05.pdf</ref>
-# The recommendation of new categories for learning disorders and a single diagnostic category, “autism spectrum disorders” that will incorporate the current diagnoses of autistic disorders, Asperger’s Syndrome, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified). Work group members have also recommended that the diagnostic term “mental retardation” be changed to “intellectual disability,” bringing the DSM criteria into alignment with terminology used by other  disciplines.
-# Eliminating the current categories substance abuse and dependence, replacing them with the new category “addiction and related disorders.” This will include substance use disorders, with each drug identified in its own category. Eliminating the category of dependence will better differentiate between the compulsive drug-seeking behavior of addiction and normal responses of tolerance and withdrawal that some patients experience when using prescribed medications that affect the central nervous system.
-# Creating a new category of “behavioral addictions,” in which gambling will be the sole disorder. Internet addiction was considered for this category, but work group members decided there was insufficient research data to do so, so they recommended it be included in the manual’s appendix instead, with a goal of encouraging additional study.
-# New suicide scales for adults and adolescents to help clinicians identify those individuals most at risk, with a goal of enhancing interventions across a broad range of mental disorders; the scales include research-based criteria such as impulsive behavior and heavy drinking in teens.
-# Consideration of a new “risk syndromes” category, with information to help clinicians identify earlier stages of some serious mental disorders, such as neurocognitive disorder (dementia) and psychosis.
-# A proposed new diagnostic category, temper dysregulation with dysphoria (TDD), within the Mood Disorders section of the manual. The new criteria are based on a decade of research on severe mood dysregulation, and may help clinicians better differentiate children with these symptoms from those with [[bipolar disorder]] or [[oppositional defiant disorder]].
-# New recognition of binge eating disorder and improved criteria for anorexia nervosa and bulimia nervosa, as well as recommended changes in the definitions of some eating disorders now described as beginning in infancy and childhood to emphasize that they may also develop in older individuals.
+Section I describes DSM-5 chapter organization, its multiaxial system, and Section III's dimensional assessments.<ref name=highlights /> The DSM-5 deleted the chapter that includes disorders usually first diagnosed in infancy, childhood, or adolescence" opting to list them in other chapters.<ref name=highlights>{{cite web|title=Highlights of Changes from DSM-IV-TR to DSM-5|url=http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf|format=PDF|date=May 17, 2013|publisher=American Psychiatric Association|accessdate=May 23, 2013}}</ref> A note under Anxiety Disorders says that the "sequential order" of at least some DSM-5 chapters has significance that reflects the relationships between diagnoses.<ref name=highlights />
-'''Dimensional Assessments'''<br>
-In addition to proposed changes to specific diagnostic criteria, the APA is proposing that
-“dimensional assessments” be added to diagnostic evaluations of mental disorders. These would
-permit clinicians to evaluate the severity of symptoms, as well as take into account ”crosscutting” symptoms.
+This introductory section describes the process of DSM revision, including field trials, public and professional review, and expert review. It states its goal is to harmonize with the ICD systems and share organizational structures as much as is feasible. Concern about the categorical system of diagnosis is expressed, but the conclusion is the reality that alternative definitions for most disorders is scientifically premature.
-'''Careful Consideration of Gender, Race and Ethnicity'''<br>
-The process for developing the proposed diagnostic criteria for DSM-5 has included careful
-consideration of how gender, race and ethnicity may affect the diagnosis of mental illness.
+The new version replaces the NOS categories with two options: ''other specified disorder'' and ''unspecified disorder'' to increase the utility to the clinician. The first allows the clinician to specify the reason that the criteria for a specific disorder are not met; the second allows the clinician the option to forgo specification.
-==Proposed changes to DSM-IV diagnoses==
-===Asperger syndrome===
-{{Main|Asperger syndrome}}
-There have been proposals to eliminate Asperger's syndrome as a separate disorder, and instead merge it under [[autism spectrum]] disorders (ASD). Under the proposed new classification, clinicians would rate the severity of clinical presentation of ASD as severe, moderate or mild. However, this proposal has inspired much controversy amongst Asperger's Syndrome specialists such as  [[Tony Attwood]] and [[Simon Baron-Cohen]] and opposition groups, such as "Keep Asperger's Syndrome in the DSM-V."<ref>[http://www.psychologytoday.com/blog/child-myths/200911/away-the-aspergers-diagnosis-whats-it-all-about Away With the Asperger's Diagnosis: What's It All About?]</ref><ref>[http://www.nytimes.com/2009/11/03/health/03asperger.html?_r=1&em A Powerful Identity, a Vanishing Diagnosis]</ref><ref>{{Cite document| title=Proposed Revision - APA DSM-5 - Asperger's Disorder |publisher=''[[American Psychiatric Association]]'' |date=2010-02-13 |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=97#| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref><ref>{{Cite web| title=Keep Asperger's Syndrome in the DSM-V |url=http://www.facebook.com/group.php?gid=346987250688&ref=ts| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>
+DSM-5 has discarded the multiaxial system of diagnosis (formerly Axis I, Axis II, Axis III), listing all disorders in Section II.  It has replaced Axis IV with significant psychosocial and contextual features and dropped Axis V (Global Assessment of Functioning, known as GAF). The World Health Organization's (WHO) Disability Assessment Schedule is added to Section III (Emerging measures and models) under Assessment Mesures.<ref name="DSM-5-indroduction">{{Cite book
-===Attention Deficit Hyperactivity Disorder===
+| first=
-{{Main|Attention Deficit Hyperactivity Disorder}}
+| last= American Psychiatric Association
+| year= 2013
+| title=Diagnostic and Statistical Manual of Mental Disorders
+| edition=Fifth
+| publisher=American Psychiatric Publishing
+| location=Arlington, VA
+| pages=5–25
+| isbn= 978-0-89042-555-8 }}</ref>
+===Section II: diagnostic criteria and codes===
-There has been a proposal to increase the diagnostic criteria for the age when symptoms became present.  The proposal would change the diagnostic criteria from symptoms being present before seven years of age to symptoms being present before twelve years of age.  The new diagnostic criteria would read: "B.   Several noticeable inattentive or hyperactive-impulsive symptoms were present by age 12." <ref>{{Cite document| title=Proposed Revision - APA DSM-5 - 314.0x
+{{main|DSM-5 codes}}
-Attention Deficit/Hyperactivity Disorder |publisher=''[[American Psychiatric Association]]'' |date=2010-05-20 |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=383#| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>
+====Neurodevelopmental disorders====
-There has been a proposal that for the Inattentive type and Hyperactive/Impulsive type, a minimum of only four symptoms need to be met if a person is 17 years of age or older.  The current [[DSM-IV-TR]] criteria of meeting a minimum of six symptoms for the Inattentive type or Hyperactive/Impulsive Type would still apply for those 16 years of age or younger.<ref>{{Cite document| title=Proposed Revision - APA DSM-5 - 314.0x Attention Deficit/Hyperactivity Disorder |publisher=''[[American Psychiatric Association]]'' |date=2010-05-20 |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=383#| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>
+* "[[Mental retardation]]" has a new name: "[[intellectual disability|intellectual disability (intellectual developmental disorder)]]"<ref name="medscape1">{{cite web|url=http://www.medscape.com/viewarticle/803884_3 |title=A Guide to DSM-5: Neurodevelopmental Disorders |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref>
+* [[Phonological disorder]] and [[stuttering]] are now called [[communication disorder]]s—which include [[language disorder]], [[speech sound disorder]], [[childhood-onset fluency disorder]], and a new condition characterized by impaired social verbal and nonverbal communication called [[social (pragmatic) communication disorder]]<ref name="medscape1"/>
+* [[Autism spectrum disorder]] incorporates [[Asperger disorder]], [[childhood disintegrative disorder]], and [[pervasive developmental disorder not otherwise specified]] (PDD-NOS) - see [[Diagnosis of Asperger syndrome#Proposed changes to DSM-5]]<ref>{{cite web|url=http://www.medscape.com/viewarticle/803884_4 |title=A Guide to DSM-5: Autism Spectrum Disorders |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref>
+====Schizophrenia spectrum and other psychotic disorders====
-===Bipolar disorder===
+* All subtypes of [[schizophrenia]] were deleted (paranoid, disorganized, catatonic, undifferentiated, and residual).<ref name=highlights />
-{{Main|Bipolar disorder}}
+* A major mood episode is required for [[schizoaffective disorder]] (for a majority of the disorder's duration after criterion A is met).<ref name=highlights />
+* Criteria for [[delusional disorder]] changed, and, in DSM-5, delusional disorder is no longer separate from [[shared delusional disorder]].<ref name=highlights />
+* In DSM-5, [[catatonia]] in all contexts requires 3 of a total of 12 symptoms. Catatonia may be a specifier for depressive, bipolar, and psychotic disorders; part of another medical condition; or an other specified diagnosis.<ref name=highlights />
+====Bipolar and related disorders====
-There have been proposals to include further and more accurate sub-typing for bipolar disorder (Akiskal and Ghaemi, 2006).
+* New specifier "with mixed features" can be applied to [[bipolar I disorder]], [[bipolar II disorder]], bipolar disorder NED (previously called "NOS") and MDD<ref>{{cite web|url=http://www.medscape.com/viewarticle/803884_12 |title=A Guide to DSM-5: Mixed-Mood Specifier |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref>
+* Allows [[other specified bipolar and related disorder]] for particular conditions.<ref name=highlights />
+* [[Anxiety]] symptoms are a specifier added to bipolar disorder and to depressive disorders (but are not part of the bipolar diagnostic criteria).<ref name=highlights />
+====Depressive disorders====
-There have been proposals for more stringent criteria for the diagnosis of [[bipolar disorder in children]]<ref name="nyt">{{Cite document| title=Revising Book on Disorders of the Mind  |author=Benedict Carey |date=2009-02-10 |publisher=''[[The New York Times]]'' |url=http://www.nytimes.com/2010/02/10/health/10psych.html| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> with a new diagnosis temper dysregulation disorder with dysphoria proposed.<ref>{{Cite document| title=Proposed Revision - APA DSM-5 - Temper Dysregulation Disorder with Dysphoria |date=2010-02-13 |publisher=''[[American Psychiatric Association]]'' |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=397| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref><ref>{{Cite document| title=Revising Book on Disorders of the Mind |date=2010-02-10 |publisher=''[[The New York Times]]'' |url=http://www.nytimes.com/2010/02/10/health/10psych.html | first=Benedict | last=Carey | accessdate=2010-05-01| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>
+* The [[Grief|bereavement]] exclusion in DSM-IV was removed from [[depression (mood)|depressive]] disorders in DSM-5.<ref>{{cite web|url=http://www.medscape.com/viewarticle/803884_10 |title=A Guide to DSM-5: Removal of the Bereavement Exclusion From MDD |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref>
+* New [[disruptive mood dysregulation disorder]] (DMDD)<ref>{{cite web|url=http://www.medscape.com/viewarticle/803884_6 |title=A Guide to DSM-5: Disruptive Mood Dysregulation Disorder (DMDD) |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref> for children up to age 18 years<ref name=highlights />
+* [[Premenstrual dysphoric disorder]] moved from an appendix for further study, and became a disorder.<ref name=highlights />
+* Specifiers were added for mixed symptoms and for anxiety, along with guidance to physicians for suicidality.<ref name=highlights />
+====Anxiety disorders====
-===Dissociative identity disorder===
+* For the various forms of [[phobia]]s and [[anxiety]] disorders, DSM-5 removes the requirement that the subject (formerly, over 18 years old) "must recognize that their fear and anxiety are excessive or unreasonable". Also, the duration of at least 6 months now applies to everyone (not only to children).<ref name=highlights />
-{{Main|Dissociative identity disorder}}
+* [[Panic attack]] became a specifier for all DSM-5 disorders.<ref name=highlights />
-Proposed changes to the controversial dissociative identity disorder diagnosis include adding a new diagnostic criterion: "C. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning." This phrase, which occurs in several other diagnostic criteria, is proposed for inclusion in 300.14 as part of a proposed merger of [[dissociative trance disorder]] with DID. Criterion C would be included to "help differentiate normative cultural experiences from psychopathology". For example, professionals would be able to take [[shaman]]ism, which involves voluntary possession trance states, into consideration, rather than diagnosing those who report it as having a mental disorder.<ref>[http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=57 Dissociative identity disorder at the DSM-V] showing proposed revision, page found 2011-06-05.</ref><ref>[http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=436# Dissociative Trance Disorder at the DSM-V] showing proposed merger with Dissociative Identity Disorder, page found 2011-06-05.</ref>
+* [[Panic disorder]] and [[agoraphobia]] became two separate disorders in DSM-5.<ref name=highlights />
+* Specific types of phobias became specifiers but are otherwise unchanged.<ref name=highlights />
+* The generalized specifier for [[social anxiety disorder]] (formerly, social phobia) changed in favor of a performance only (i.e., public speaking or performance) specifier.<ref name=highlights />
+* [[Separation anxiety disorder]] and [[selective mutism]] are now classified as anxiety disorders (rather than disorders of early onset).<ref name=highlights />
+====Obsessive-compulsive and related disorders====
-===Hypersexual disorder===
+* A new chapter on [[Obsessive–compulsive disorder|obsessive-compulsive]] and related disorders includes four new disorders: [[excoriation (skin-picking) disorder]], [[hoarding disorder]], substance-/medication-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition.<ref name=highlights />
-{{Main|Hypersexual disorder}}
+* [[Trichotillomania]] (hair-pulling disorder) moved from "impulse-control disorders not elsewhere classified" in DSM-IV, to an obsessive-compulsive disorder in DSM-5.<ref name=highlights />
-Hypersexual Disorder is proposed as a new category to be added. The diagnosis would apply when a person experiences several of the indicated symptoms (extreme amounts of time spent in the sexual activity, using the sexual activity in response to low mood or stress, failed attempts to reduce the behaviors, etc.).<ref name=APApage/> Moreover, it would apply only when the problem lasted six months or more, when person experienced significant distress or impairment in major life areas because of it, and when the problem was not directly caused by a medication or drugs, as well as other criteria. Under the proposal, an official diagnosis would also specify which behavior(s) are problematic in the case: [[masturbation]], pornography use, [[cybersex]], etc. <ref name=APApage>[http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=415 American Psychiatric Association DSM-5 Development Page for Hypersexual Disorder]</ref>
+* A specifier was expanded (and added to [[body dysmorphic disorder]] and hoarding disorder) to allow for good or fair insight, poor insight, and "absent insight/delusional" (i.e., complete conviction that obsessive-compulsive disorder beliefs are true).<ref name=highlights />
+* Criteria were added to body dysmorphic disorder to describe repetitive behaviors or mental acts that may arise with perceived defects or flaws in physical appearance.<ref name=highlights />
+* The DSM-IV specifier “with obsessive-compulsive symptoms” moved from anxiety disorders to this new category for obsessive-compulsive and related disorders.<ref name=highlights />
+* In DSM-5, [[other specified obsessive-compulsive and related disorder]] can include [[body-focused repetitive behavior disorder]] (behaviors like nail biting, lip biting, and cheek chewing, other than hair pulling and skin picking), [[obsessional jealousy]], and [[unspecified obsessive-compulsive and related disorder]].<ref name=highlights />
+====Trauma- and stressor-related disorders====
-The label “hypersexual disorder” was reportedly chosen because it did not imply any specific theory for what causes [[hypersexuality]], which remains unknown.<ref name=Kafka2010>Kafka, M. P. (2010). Hypersexual Disorder: A proposed diagnosis for DSM-V. ''Archives of Sexual Behavior, 39,'' 377–400.</ref>  A proposal to add [[sexual addiction]] to the DSM system has been rejected by the APA, as not enough evidence suggested to them that the condition is analogous to substance addictions, as that name would imply.<ref>{{cite news| url=http://www.usatoday.com/news/health/2010-02-10-dsm10_ST_N.htm | work=USA Today | first=Rita | last=Rubin | title=Psychiatry's bible: Autism, binge-eating updates proposed for 'DSM' | date=2010-02-09}}</ref><ref>{{cite news| url=http://articles.nydailynews.com/2010-02-10/entertainment/27055937_1_autism-mental-disorders-mental-illness | location=New York | work=Daily News}}</ref><ref>http://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2010/02/10/new-diagnostic-guidelines-for-mental-illnesses-proposed</ref>
+* [[Posttraumatic stress disorder]] (PTSD) is now included in a new section titled "Trauma- and Stressor-Related Disorders."<ref>{{cite journal|last=Friedman|first=M. J.|coauthors=Resick, P. A., Bryant, R. A., Strain, J., Horowitz, M., & Spiegel, D.|title=Classification of trauma and stressor-related disorders in DSM-5|journal=Depression and Anxiety|year=2011|volume=28|issue=9|pages=737–749|doi=10.1002/da.20845}}</ref>
+* The PTSD diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of DSM-IV.<ref name="considering">{{cite journal|last=Friedman|first=M. J.|coauthors=Resick, P. A., Bryant, R. A., & Brewin, C. R.|title=Considering PTSD for DSM-5|journal=Depression and Anxiety|year=2011|volume=28|issue=9|pages=750–769|doi=10.1002/da.20767}}</ref>
+* Separate criteria were added for children six years old or younger.<ref name=highlights />
+* For the diagnosis of [[Acute stress reaction|acute stress disorder]] and PTSD, the stressor criteria (Criterion A1 in DSM-IV) was modified to some extent, and the requirement for specific subjective emotional reactions (Criterion A2 in DSM-IV) was eliminated because it lacked empirical support for its utility and predictive validity<ref name="considering" /> and resulted in certain groups, e.g., military personnel involved in combat, law enforcement officers and other first responders, lacking only the A2 criteria for a PTSD diagnosis because their training prepared them to not react emotionally to traumatic events.<ref>{{cite journal|last=Adler|first=A. B.|coauthors=Wright, K. M., Bliese, P. D., Eckford, R., & Hoge, C. W.|title=A2 diagnostic criterion for combat-related posttraumatic stress disorder|journal=Journal Of Traumatic Stress|year=2008|volume=21|issue=3|pages=301-308|doi=10.1002/jts.20336}}</ref> <ref>{{cite journal|last=Hathaway|first=L. M.|coauthors=Boals, A., & Banks, J. B.|title=PTSD symptoms and dominant emotional response to a traumatic event: An examination of DSM-IV criterion A2|journal=Anxiety, Stress & Coping: An International Journal|year=2010|volume=23|issue=1|pages=119-126|doi=10.1080/10615800902818771}}</ref> <ref>{{cite journal|last=Karam|first=E. G.|coauthors=Andrews, G., Bromet, E., Petukhova, M., Ruscio, A. M., Salamoun, M., … Kessler, R. C.|title=The Role of Criterion A2 in the DSM-IV Diagnosis of Posttraumatic Stress Disorder|journal=Biological Psychiatry|year=2010|volume=68|issue=5|pages=465–473|doi=10.1016/j.biopsych.2010.04.032|pmid=20599189|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228599/}}</ref>
+* Two new disorders that were formerly subtypes were named: [[reactive attachment disorder]] and [[disinhibited social engagement disorder]].<ref name=highlights />
+* [[Adjustment disorders]] were moved to this new section and reconceptualized as stress-response syndromes. DSM-IV subtypes for depressed mood, anxious symptoms, and disturbed conduct are unchanged.<ref name=highlights />
+====Dissociative disorders====
-The [[DSM-IV-TR]] includes "Sexual Disorder—Not Otherwise Specified" (Sexual Disorder NOS), which applies to, among other conditions, “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used.”<ref name=APA2000>American Psychiatric Association. (2000). ''Diagnostic and statistical manual of mental disorders'' (4th ed., text revision). Washington, DC: Author.</ref>
+* [[Depersonalization disorder]] is now called [[Depersonalization disorder|depersonalization]]/[[derealization]] disorder.<ref name="DSM-5">{{Cite book
+| first=
+| last= American Psychiatric Association
+| year= 2013
+| title=Diagnostic and Statistical Manual of Mental Disorders
+| edition=Fifth
+| publisher=American Psychiatric Publishing
+| location=Arlington, VA
+| page= 302
+| isbn= 978-0-89042-555-8 }}</ref>
+* [[Dissociative fugue]] became a specifier for [[dissociative amnesia]].<ref name=highlights />
+* In DSM-5, criteria were expanded in [[dissociative identity disorder]] to include "possession-form phenomena and functional neurological symptoms" and to say that "transitions in identity may be observable by others or self-reported".<ref name=highlights /> Criterion B was also modified for people who can't recall everyday events (not only trauma).<ref name=highlights />
+====Somatic symptom and related disorders====
-===Oppositional Defiant Disorder===
+* [[Somatoform disorder]]s are now called somatic symptom and related disorders. Diagnoses of [[somatization disorder]], [[hypochondriasis]], [[pain disorder]], and undifferentiated somatoform disorder were deleted in DSM-5. In DSM-5, people with chronic pain could be diagnosed with somatic symptom disorder with predominant pain; or psychological factors that affect other medical conditions; or with an adjustment disorder.<ref name=highlights />
-{{Main|Oppositional Defiant Disorder}}
+* [[Somatization disorder]] and [[undifferentiated somatoform disorder]] were combined to become [[somatic symptom disorder]], a diagnosis which no longer requires a specific number of somatic symptoms.<ref name=highlights />
+* In DSM-5, somatic symptom and related disorders are defined by positive symptoms, and minimize the use of medically unexplained symptoms except in the cases of [[conversion disorder]] and [[pseudocyesis]] specifically.<ref name=highlights />
+* "Psychological factors affecting other medical conditions" (formerly found in the DSM-IV chapter "Other Conditions That May Be a Focus of Clinical Attention") is termed a new mental disorder.<ref name=highlights />
+* Criteria for [[conversion disorder]] (functional neurological symptom disorder) were changed.<ref name=highlights />
+====Feeding and eating disorders====
-It is proposed that the eight symptoms of Oppositional Defiant Disorder should be divided into the following categories: Angry/Irritable Mood; Defiant/Headstrong Behavior; and Vindictiveness. However, just as in the [[DSM-IV-TR]], four of these symptoms need to be present to meet diagnostic criteria.  The minimum four symptoms can come from all (or even just one or two) of the three categories.<ref>{{Cite document| title=Proposed Revision - APA DSM-5 - 313.81 Oppositional Defiant Disorder |publisher=''[[American Psychiatric Association]]'' |date=2010-05-20 |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=106#| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>
+* Criteria for [[Pica (disorder)|pica]] and [[rumination disorder]] were changed and can now refer to people of any age.<ref name=highlights />
+* [[Binge eating disorder]] graduated from DSM-IV's "Appendix B -- Criteria Sets and Axes Provided for Further Study".<ref>{{cite web|url=http://www.medscape.com/viewarticle/803884_5 |title=A Guide to DSM-5: Binge Eating Disorder |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref>
+* Requirements for [[bulimia nervosa]] and binge eating disorder were changed from "at least twice weekly for 6 months to at least once weekly over the last 3 months".
+* [[Anorexia nervosa]] no longer has a requirement of [[amenorrhea]] and its criteria were changed.
+* What in DSM-IV was called "feeding disorder of infancy or early childhood" and rarely used, is now called [[avoidant/restrictive food intake disorder]] with expanded criteria.<ref name=highlights />
+====Sleep-wake disorders====
-It is proposed that a section be added to the diagnostic criteria for Oppositional Defiant Disorder stating that for children under 5 years of age, oppositional behavior "must occur on most days for a period of at least six months".  For children 5 years or older, oppositional behavior "must occur at least once per week for at least six months".<ref>{{Cite document| title=Proposed Revision - APA DSM-5 - 313.81 Oppositional Defiant Disorder |publisher=''[[American Psychiatric Association]]'' |date=2010-05-20 |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=106#| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> The current criteria states that four or more symptoms must be present for at least 6 months.  The proposed change adds the criterion of frequency of symptoms and also delineates required frequency by the age of the child.
+* "Sleep disorders related to another mental disorder, and sleep disorders related to a general medical condition" were deleted from DSM-IV.<ref name=highlights />
+* Primary insomnia became [[insomnia disorder]] in DSM-5, and [[narcolepsy]] is separate from other [[hypersomnolence]].<ref name=highlights />
+*In DSM-5, there are three breathing-related sleep disorders: obstructive sleep apnea [[hypopnea]], [[central sleep apnea]], and sleep-related [[hypoventilation]].<ref name=highlights />
+* Circadian rhythm sleep-wake disorders were expanded to include [[Advanced sleep phase disorder|advanced sleep phase syndrome]], irregular sleep-wake type, and non-24-hour sleep-wake type.<ref name=highlights /> [[Jet lag]] was removed.<ref name=highlights />
+* Listed under "dyssomnia not otherwise specified" in DSM-IV, [[rapid eye movement sleep behavior disorder]] and [[restless legs syndrome]] are each a disorder in DSM-5.<ref name=highlights />
-===Personality disorders===
+====Sexual dysfunctions====
+* DSM-5 has gender-specific sexual dysfunctions.<ref name=highlights />
-{{Main|Personality disorder}}
+* For females, sexual desire and arousal disorders are combined into [[female sexual interest/arousal disorder]].<ref name=highlights />
+* DSM-5 sexual dysfunctions (except substance-/medication-induced sexual dysfunction) now require a duration of approximately 6 months and more exact severity criteria.<ref name=highlights />
+* New in DSM-5 is [[genito-pelvic pain/penetration disorder]] which combines [[vaginismus]] and [[dyspareunia]] from DSM-IV.<ref name=highlights />
+* [[Sexual aversion disorder]] was deleted.<ref name=highlights />
+* DSM-5 subtypes for all disorders includes only "lifelong versus acquired" and "generalized versus situational" (one subtype was deleted from DSM-IV).<ref name=highlights />
+* In DSM-5, two subtypes were deleted: "sexual dysfunction due to a general medical condition" and "due to psychological versus combined factors".<ref name=highlights />
+====Gender dysphoria====
-Major changes have been proposed in the assessment and diagnosis of personality disorders.<ref>{{Cite document| title=Personality and Personality Disorders |date=2010-02-13 |publisher=''[[American Psychiatric Association]]'' |url=http://www.dsm5.org/ProposedRevisions/Pages/PersonalityandPersonalityDisorders.aspx| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> These include a revamped definition of personality disorder and a dimensional rather than a categorical approach based on the severity of dysfunctional personality trait domains ([[Neuroticism|negative emotionality]], [[introversion]], [[antagonism]], [[disinhibition]], [[Conscientiousness|compulsivity]], and [[schizotypy]]). In addition, patients would be assessed on how much they match each of five prototypic personality disorder types: [[Antisocial personality disorder|antisocial]]/[[Psychopathy|psychopathic]], [[Avoidant personality disorder|avoidant]], [[Borderline personality disorder|borderline]], [[Obsessive-compulsive personality disorder|obsessive-compulsive]], and [[Schizotypal personality disorder|schizotypal]] with their criteria being derived directly from the dimensional personality trait domains. Some former personality disorders, like [[narcissistic personality disorder]] and [[histrionic personality disorder]], will be submerged under facets of various personality type domains (in this case, the narcissism and histrionism facets of antagonism).
+{{Further|Gender dysphoria}}
+* DSM-IV [[gender identity disorder]] is similar to, but not the same as, [[gender dysphoria]] in DSM-5. Separate criteria for children, adolescents and adults that are appropriate for varying developmental states are added.
+*Subtypes of gender identity disorder based on sexual orientation were deleted.<ref name=highlights />
+* Among other wording changes, criterion A and criterion B (cross-gender identification, and aversion toward one’s gender) were combined.<ref name=highlights /> Along with these changes comes the creation of a separate gender dysphoria in children as well as one for adults and adolescents. The grouping has been moved out of the sexual disorders category and into its own. The name change was made in part due to stigmatization of the term "disorder" and the relatively common use of "gender dysphoria" in the GID literature and among specialists in the area.<ref>{{cite web|title=P 01 Gender Dysphoria in Adolescents or Adults|url=http://www.dsm5.org/ProposedRevision/Pages/GenderDysphoria.aspx|publisher=American Psychiatric Association|accessdate=2 April 2012}}</ref>  The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing and ability to express it in the event that they have insight.<ref>{{cite web|title=P 00 Gender Dysphoria in Children|url=http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=192#|publisher=American Psychiatric Association|accessdate=2 April 2012}}</ref>
+====Disruptive, impulse-control, and conduct disorders====
-===Pica===
-{{Main|Pica (disorder)}}
+Some of these disorders were formerly part of the chapter on early diagnosis, [[oppositional defiant disorder]]; [[conduct disorder]]; and [[disruptive behavior disorder not otherwise specified]] became [[other specified and unspecified disruptive disorder]], [[impulse-control disorder]], and [[conduct disorder]]s.<!-- needs clarification, are there multiple conduct disorders in DSM-5? Multiple impulse-control disorders? --><ref name=highlights /> [[Intermittent explosive disorder]], [[pyromania]], and [[kleptomania]] moved to this chapter from the DSM-IV chapter "Impulse-Control Disorders Not Otherwise Specified".<ref name=highlights />
-It is proposed that Pica is reclassified from the "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" classification to the "Eating Disorders" classification.<ref>{{Cite document| title=Proposed Revision - APA DSM-5 - 307.52 Pica |publisher=''[[American Psychiatric Association]]'' |date=2010-05-20 |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=108#| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>
+* [[Antisocial personality disorder]] is listed here ''and'' in the chapter on personality (neurocognitive) disorders (but ADHD is listed under neurodevelopmental disorders).<ref name=highlights />
+* Symptoms for [[oppositional defiant disorder]] are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness.<!-- the three types is inaccurate --> The conduct disorder exclusion is deleted. The criteria were also changed with a note on frequency requirements and a measure of severity.<ref name=highlights />
+* Criteria for conduct disorder are unchanged for the most part from DSM-IV.<ref name=highlights /> A specifier was added for people with limited "prosocial emotion".<ref name=highlights />
+* People over the disorder's minimum age of 6 may be diagnosed with [[intermittent explosive disorder]] without outbursts of physical aggression.<ref name=highlights /> Criteria were added for frequency and to specify "impulsive and/or anger based in nature, and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences".<ref name=highlights />
+====Substance-related and addictive disorders====
-It is proposed that the wording of "non-food substances" be added alongside the current [[DSM-IV-TR]] wording of "non-nutritive substances".  "Non-food" was added to further clarify that items consumed are not just merely lacking nutrients (diet soda, according to the DSM-V committee, is an example of a non-nutritive substance), but are actual non-foodstuffs.<ref>{{Cite document| title=Proposed Revision - APA DSM-5 - 307.52 Pica |publisher=''[[American Psychiatric Association]]'' |date=2010-05-20 |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=108#| postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>
+* [[Gambling disorder]] and [[tobacco use disorder]] are new.<ref name=highlights />
+* [[Substance abuse]] and [[substance dependence]] have been combined into single substance use disorders specific to each substance of abuse within a new "addictions and related disorders" category.<ref>{{cite web|url=http://www.medscape.com/viewarticle/803884_11 |title=A Guide to DSM-5: Substance Use Disorder |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref> "Recurrent legal problems" was deleted and "craving or a strong desire or urge to use a substance" was added to the criteria.<ref name=highlights /> The threshold of the number of criteria that must be met was changed.<ref name=highlights /> Severity from mild to severe is based on the number of criteria endorsed.<ref name=highlights /> Criteria for [[cannabis]] and [[caffeine]] withdrawal were added.<ref name=highlights /> New specifiers were added for early and sustained [[Cure|remission]] along with new specifiers for "in a controlled environment" and "on maintenance therapy".<ref name=highlights />
+====Neurocognitive disorders====
-===Posttraumatic stress disorder===
+* [[Dementia]] and [[amnestic disorder]] became major or mild [[neurocognitive disorder]] (major NCD, or mild NCD).<ref name=highlights /><ref>{{cite web|url=http://www.medscape.com/viewarticle/803884_13 |title=A Guide to DSM-5: Neurocognitive Disorder |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref> DSM-5 has a new list of neurocognitive domains.<ref name=highlights /> "New separate criteria are now presented" for major or mild NCD due to various conditions.<ref name=highlights /> [[Substance/medication-induced NCD]] and [[unspecified NCD]] are new diagnoses.<ref name=highlights />
-{{Main|Posttraumatic_stress_disorder#DSM-5_proposed_diagnostic_criteria_changes}}
-Various criteria changes are proposed.
-===Schizophrenia===
+====Paraphilic disorders====
+* New specifiers "in a controlled environment" and "in remission" were added to criteria for all paraphilic disorders.<ref name=highlights />
-{{Main|Schizophrenia}}
+* Distinguishes between paraphilic behaviors, or [[paraphilia]]s, and paraphilic disorders.<ref>{{cite web|url=http://www.medscape.com/viewarticle/803884_14 |title=A Guide to DSM-5: Paraphilias and Paraphilic Disorders |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref> All criteria sets were changed to add the word disorder to all of the paraphilias, for example, [[pedophilia]] is now [[pedophilic disorder]].<ref name=highlights /> There is no change in the basic diagnostic structure since DSM-III-R; however, people now must meet both qualitative (criterion A) and negative consequences (criterion B) criteria to be diagnosed with a paraphilic disorder. Otherwise thay have a paraphilia (and no diagnosis).<ref name=highlights />
-The following disorders are proposed for deletion from DSM-5:<ref>{{cite web|title=Schizophrenia and Other Psychotic Disorders|url=http://www.dsm5.org/ProposedRevisions/Pages/SchizophreniaandOtherPsychoticDisorders.aspx|publisher=American Psychiatric Association|accessdate=May 6, 2010}}</ref>
-*295.30 Schizophrenia - Paranoid Type
-*295.10 Schizophrenia - Disorganized Type
-*295.20 Schizophrenia - Catatonic Type
-*295.90 Schizophrenia - Undifferentiated Type
-*295.60 Schizophrenia - Residual Type
-*297.3 Shared Psychotic Disorder
+===Section III: emerging measures and models===
-===Somatoform disorder===
-{{Main|Somatoform disorder}}
+====Alternative DSM-5 model for personality disorders====
-Additional proposed somatoform disorders are:
+An alternative hybrid dimensional-categorical model for [[personality disorders]] is included to stimulate further research on this modified classification system<ref name="medscape2">{{cite web|url=http://www.medscape.com/viewarticle/803884_8 |title=A Guide to DSM-5: Personality Disorders |publisher=Medscape.com |date= |accessdate=2013-05-26}}</ref>
-* Abridged somatization disorder<ref name="pmid2918297">{{cite journal |author=Escobar JI, Rubio-Stipec M, Canino G, Karno M |title=Somatic symptom index (SSI): a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples |journal=J. Nerv. Ment. Dis. |volume=177 |issue=3 |pages=140–6 |year=1989 |pmid=2918297 |doi=}}</ref> - at least 4 unexplained somatic complaints in men and 6 in women
-* Multisomatoform disorder<ref name="pmid9107152">{{cite journal |author=Kroenke K, Spitzer RL, deGruy FV, ''et al.'' |title=Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care |journal=Arch. Gen. Psychiatry |volume=54 |issue=4 |pages=352–8 |year=1997 |pmid=9107152 |doi=}}</ref> - at least 3 unexplained somatic complaints from the PRIME-MD scale for at least 2 years of active symptoms
+==Conditions for further study==
-These disorders have been proposed because the recognized somatoform disorders are either too restrictive or too broad. In a study of 119 primary care patients, the following prevalences were found:<ref name="pmid15014690">{{cite journal |author=Lynch DJ, McGrady A, Nagel R, Zsembik C |title=Somatization in Family Practice: Comparing 5 Methods of Classification |journal= Primary care companion to the Journal of clinical psychiatry|volume=1 |issue=3 |pages=85–89 |year=1999 |pmid=15014690 |pmc=181067 |doi=}}</ref>
+These conditions and criteria are set forth to encourage future research and are not meant for clinical use.
-* [[Somatization disorder]] - 1%
+* [[Attenuated psychosis syndrome]]
-* Abridged somatization disorder - 6%
+* [[Depressive episodes with short-duration hypomania]]
-* Multisomatoform disorder - 24%
-* Undifferentiated somatoform disorder - 79%
+* [[Persistent complex bereavement disorder]]
+* [[Caffeine use disorder]]
+* [[Internet gaming disorder]]
+* [[Neurobehavioral disorder associated with prenatal alcohol exposure]]
+* [[Suicidal behavior disorder]]
+* [[Non-suicidal self-injury]]<ref name="DSM-5-future">{{Cite book
+| first=
+| last= American Psychiatric Association
+| year= 2013
+| title=Diagnostic and Statistical Manual of Mental Disorders
+| edition=Fifth
+| publisher=American Psychiatric Publishing
+| location=Arlington, VA
+| pages= 783–808
+| isbn= 978-0-89042-555-8 }}</ref>
+==Development==
-==Proposed new DSM-5 diagnoses==
+In 1999, a DSM–5 Research Planning Conference; sponsored jointly by APA and the [[National Institute of Mental Health]] (NIMH), was held to set the research priorities. Research Planning Work Groups produced "white papers" on the research needed to inform and shape the DSM-5<ref>{{Citation |last=First |first=Michael B. |year=2002
-The proposed new DSM-5 diagnoses include the following:
+ |title=A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers Published in May 2002
-*[[Absexual]]
+ |work=DSM-V Prelude Project |publisher=[[American Psychiatric Association]]
-*[[Complex post-traumatic stress disorder]]
+ |url=http://dsm5.org/whitepapers.cfm |accessdate=May 12, 2012 |archivedate=April 13, 2008
-*[[Depressive personality disorder]]
+ |archiveurl=http://web.archive.org/web/20080413001720/http://dsm5.org/whitepapers.cfm }}</ref> and the resulting work and recommendations were reported in an APA monograph<ref>{{Citation
-*[[Passive–aggressive behavior|Negativistic (passive-aggressive) personality disorder]]
+ |editor=Kupfer, David J. |editor2=First, Michael B. |editor3=Regier, Darrel A. |year=2002
-*[[Relational disorder]]
+ |title=A Research Agenda for DSM-5 |publisher=[[American Psychiatric Association]] |publication-place=Washington, D.C.
-*[[Sluggish cognitive tempo]]
+ |isbn=9780890422922 |oclc=49518977 |url=http://appi.org/book.cfm?id=2292 }}</ref> and peer-reviewed literature.<ref>{{cite journal |last=Regier |first=Darrel A |last2=Narrow |first2=William E |last3=First |first3=Michael B |last4=Marshall
-*[[Binge Eating]]
+ |first4=Tina |title=The APA classification of mental disorders: future perspectives
+ |journal=[[Psychopathology (journal)|Psychopathology]] |volume=35 |issue=2&ndash;3 |pages=166&ndash;170 |year=2002
+ |pmid=12145504 |doi=10.1159/000065139 |url=http://content.karger.com/ProdukteDB/produkte.asp?doi=10.1159/000065139 }}</ref>  There were six workgroups, each focusing on a broad topic: Nomenclature, Neuroscience and Genetics, Developmental Issues and Diagnosis, Personality and [[Relational Disorder]]s, Mental Disorders and Disability, and Cross-Cultural Issues. Three additional white papers were also due by 2004 concerning gender issues, diagnostic issues in the geriatric population, and mental disorders in infants and young children.<ref name=dsm5researchplanning>{{Citation
+ |title=DSM-5 Research Planning |work=DSM-V Prelude Project |publisher=[[American Psychiatric Association]]
+ |url=http://www.dsm5.org/planning.cfm |at=DSM-V Research White Papers |accessdate=May 12, 2012
+ |archiveurl=http://web.archive.org/web/20080424075423/http://dsm5.org/planning.cfm |archivedate=April 24, 2008 }}</ref>  The white papers have been followed by a series of conferences to produce recommendations relating to specific disorders and issues, with attendance limited to 25 invited researchers.<ref name=dsm5researchplanning/>
+On July 23, 2007, the APA announced the task force that would oversee the development of DSM-5. The DSM-5 Task Force consisted of 27 members, including a chair and vice chair, who collectively represent research scientists from psychiatry and other disciplines, clinical care providers, and consumer and family advocates. Scientists working on the revision of the DSM have experience in research, clinical care, biology, genetics, statistics, epidemiology, public health, and consumer advocacy. They have interests ranging from cross-cultural medicine and genetics to geriatric issues, ethics and addiction. The APA Board of Trustees required that all task force nominees disclose any competing interests or potentially conflicting relationships with entities that have an interest in psychiatric diagnoses and treatments as a precondition to appointment to the task force. The APA made all task force members' disclosures available during the announcement of the task force. Several individuals were ruled ineligible for task force appointments due to their competing interests. Future announcements will include naming the workgroups on specific categories of disorders and their research-based recommendations on updating various disorders and definitions.<ref>{{cite journal |last=Regier, MD, MPH |first=Darrel A. |year=2007 |format=PDF |accessdate=2007-12-21
-==Criticism of DSM-5==
+ |title=Somatic Presentations of Mental Disorders: Refining the Research Agenda for DSM-V
-[[Robert Spitzer (psychiatrist)|Robert Spitzer]], the head of the DSM-III task force, has publicly criticized the APA for mandating that DSM-5 task force members sign a [[nondisclosure agreement]], effectively conducting the whole process in secret: “When I first heard about this agreement, I just went bonkers. Transparency is necessary if the document is to have credibility, and, in time, you’re going to have people complaining all over the place that they didn’t have the opportunity to challenge anything.”<ref name=nyt081218>{{cite news|url=http://www.nytimes.com/2008/12/18/health/18psych.html?pagewanted=all|title=Psychiatrists Revise the Book of Human Troubles|first=Benedict|last=Carey|date=December 17, 2008|work=New York Times}}</ref> [[Allen Frances]] expressed a similar concern.<ref name=pbsnewhour>[http://www.pbs.org/newshour/bb/health/jan-june10/mentalillness_02-10.html Psychiatrists Propose Revisions to Diagnosis Manual.] via [[PBS Newshour]], Feb 10, 2010 (interviews Frances and [[Alan Schatzberg]] on some of the main changes proposed to the DSM-5)</ref>
+ |journal=[[Psychosomatic Medicine (journal)|Psychosomatic Medicine]] |pmid=18040087 |volume=69 |issue=9 |pages=827&ndash;828
+ |publisher=Lippincott Williams and Wilkins |doi=10.1097/PSY.0b013e31815afbe4
+ |url=http://www.psychosomaticmedicine.org/cgi/reprint/69/9/827.pdf }}</ref>
+The DSM-5 field trials included [[test-retest reliability]] which involved different clinicians doing independent evaluations of the same patient—a common approach to the study of diagnostic reliability.<ref>Reliability and Prevalence in the DSM-5 Field Trials, January 12, 2012 http://www.dsm5.org/Documents/Reliability_and_Prevalence_in_DSM-5_Field_Trials_1-12-12.pdf</ref>
-Although the APA has since instituted a disclosure policy for DSM-5 task force members, many still believe the Association has not gone far enough in its efforts to be transparent and to protect against industry influence.<ref>[Lisa Cosgrove, Sheldon Krimsky, Manisha Vijayaraghavan, and Lisa Schneider [http://www.tufts.edu/~skrimsky/PDF/DSM%20COI.PDF]"Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry"]Psychother Psychosom 2006;75:154–160 DOI: 10.1159/000091772]</ref> In a recent Point/Counterpoint article,<ref>[Cosgrove L, Bursztajn HJ, Kupfer DJ, Regier DA. [http://www.psychiatrictimes.com/dsm-v/article/10168/1364672?pageNumber=1 "Toward Credible Conflict of Interest Policies in Clinical Psychiatry"] Psychiatric Times 26:1.]</ref> Lisa Cosgrove, PhD and Harold J. Bursztajn, MD noted that "the fact that 70% of the task force members have reported direct industry ties---an increase of almost 14% over the percentage of DSM-IV task force members who had industry ties---shows that disclosure policies alone, especially those that rely on an honor system, are not enough and that more specific safeguards are needed."
+==Criticism==
-David Kupfer, MD, chair of the DSM-5 task force, and Darrel A. Regier, MD, MPH, Vice Chair of the task force, whose industry ties are disclosed with those of the task force,<ref>{{cite web|title=DSM-V Task Force Member Disclosure Report: David J Kupfer, MD|url=http://www.dsm5.org/MeetUs/Documents/Task%20Force/Kupfer%20Disclosure%201-20-10.pdf|publisher=American Psychiatric Association}} and {{cite web|title=DSM-V Task Force Member Disclosure Report: Darrel Alvin Regier M.D. |url=http://www.dsm5.org/MeetUs/Documents/Task%20Force%202011/Regier%204-28-11.pdf|format=PDF|publisher=American Psychiatric Association|date=May 2, 2011|accessdate=May 5, 2011}}</ref> countered that "collaborative relationships among government, academia, and industry are vital to the current and future development of pharmacological treatments for mental disorders." They asserted that the development of DSM-5 is the "most inclusive and transparent developmental process in the 60-year history of DSM." The developments to this new version can be viewed on [http://www.psych.org/MainMenu/Research/DSMIV/DSMV.aspx].  Perhaps as an effort towards this transparency, public input is requested for the first time in the history of the manual. Until June 15, 2011, members of the general public can sign up at the DSM-V website<ref>[http://www.dsm5.org/Pages/Registration.aspx Registration page for DSM-5 public comment], page found 2011-06-05.</ref> and provide feedback on the various proposed changes.<ref>"Suggestions and ideas for members of the work groups were also solicited through the DSM-5 website. The proposed draft revisions to DSM-5 are posted on the website, and anyone can provide feedback to the work groups during periods of public comment."[http://www.dsm5.org/about/Pages/faq.aspx#4 Question 4 on the DSM-5 FAQ], page found 2011-06-05.</ref>
+===General===
+[[Robert Spitzer (psychiatrist)|Robert Spitzer]], the head of the DSM-III task force, has publicly criticized the APA for mandating that DSM-5 task force members sign a [[nondisclosure agreement]], effectively conducting the whole process in secret: "When I first heard about this agreement, I just went bonkers. Transparency is necessary if the document is to have credibility, and, in time, you're going to have people complaining all over the place that they didn't have the opportunity to challenge anything."<ref name=nyt081218>{{cite news |url=http://www.nytimes.com/2008/12/18/health/18psych.html?pagewanted=all |title=Psychiatrists Revise the Book of Human Troubles |first=Benedict |last=Carey |date=December 17, 2008 |newspaper=[[The New York Times]] }}</ref>  [[Allen Frances]], chair of the DSM-IV task force, expressed a similar concern.<ref name=pbsnewhour>[http://www.pbs.org/newshour/bb/health/jan-june10/mentalillness_02-10.html Psychiatrists Propose Revisions to Diagnosis Manual.] via [[PBS Newshour]], Feb 10, 2010 (interviews Frances and [[Alan Schatzberg]] on some of the main changes proposed to the DSM-5)</ref>
+Although the APA has since instituted a disclosure policy for DSM-5 task force members, many still believe the Association has not gone far enough in its efforts to be transparent and to protect against industry influence.<ref name=pmid16636630>{{Citation
-In June 2009 Allen Frances, head of the DSM-IV task force, issued strongly worded criticisms of the processes leading to DSM-5 and the risk of "serious, subtle, (…) ubiquitous" and "dangerous" unintended consequences such as new "false 'epidemics'".  He writes that "the work on DSM-V has displayed the most unhappy combination of soaring ambition and weak methodology" and is concerned about the task force's "inexplicably closed and secretive process.".<ref>{{cite journal | last = Frances | first = Allen | date = 26 June 2009 | year = | month = | title = A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences | journal = Psychiatric Times | volume = | issue = | pages = | publisher = | pmid = | doi = | url = http://www.psychiatrictimes.com/display/article/10168/1425378?verify=0A | format = Full text | accessdate = 2009-09-06 | quote = }}</ref> His and Spitzer's concerns about the contract that the APA drew up for consultants to sign, agreeing not to discuss drafts of the fifth edition beyond the task force and committees, have also been aired and debated.<ref>{{cite news|first=Christopher|last=Lane|title=The Diagnostic Madness of DSM-V|work=Slate|date=July 24, 2009|url=http://www.slate.com/id/2223479/}}</ref>
+ |first1=Lisa |last1=Cosgrove |first2=Sheldon |last2=Krimsky |first3=Manisha |last3=Vijayaraghavan |first4=Lisa
+ |last4=Schneider |year=2006 |month=April |title=Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry
+ |journal=Psychotherapy and Psychosomatics|volume=75 |issue=3 |pages=154&ndash;160 |pmid=16636630 |doi=10.1159/000091772
+ |url=http://content.karger.com/ProdukteDB/produkte.asp?doi=91772
+}}</ref>  In a 2009 Point/Counterpoint article, Lisa Cosgrove, PhD and Harold J. Bursztajn, MD noted that "the fact that 70% of the task force members have reported direct industry ties---an increase of almost 14% over the percentage of DSM-IV task force members who had industry ties---shows that disclosure policies alone, especially those that rely on an honor system, are not enough and that more specific safeguards are needed."<ref>Cosgrove L, Bursztajn HJ, Kupfer DJ, Regier DA. [http://www.psychiatrictimes.com/dsm-v/article/10168/1364672?pageNumber=1 "Toward Credible Conflict of Interest Policies in Clinical Psychiatry"] [[Psychiatric Times]] 26:1.</ref>
+David Kupfer, chair of the DSM-5 task force, and Darrel A. Regier, MD, MPH, vice chair of the task force, whose industry ties are disclosed with those of the task force,<ref>{{cite web|title=DSM-V Task Force Member Disclosure Report: David J Kupfer, MD|url=http://www.dsm5.org/MeetUs/Documents/Task%20Force/Kupfer%20Disclosure%201-20-10.pdf|publisher=American Psychiatric Association}} and {{cite web|title=DSM-V Task Force Member Disclosure Report: Darrel Alvin Regier M.D |url=http://www.dsm5.org/MeetUs/Documents/Task%20Force%202011/Regier%204-28-11.pdf|format=PDF|publisher=American Psychiatric Association|date=May 2, 2011|accessdate=May 5, 2011}}</ref> countered that "collaborative relationships among government, academia, and industry are vital to the current and future development of pharmacological treatments for mental disorders." They asserted that the development of DSM-5 is the "most inclusive and transparent developmental process in the 60-year history of DSM." The developments to this new version can be viewed on the APA website.<ref>[http://www.psych.org/MainMenu/Research/DSMIV/DSMV.aspx DSM-5 Overview: The Future Manual | APA DSM-5]</ref>  Public input was requested for the first time in the history of the manual.{{citation needed|date=May 2013}} During periods of public comment, members of the general public could sign up at the DSM-5 website<ref>[http://www.dsm5.org/Pages/Registration.aspx Registration page for DSM-5 public comment], page found 2011-06-05.</ref> and provide feedback on the various proposed changes.<ref>"Suggestions and ideas for members of the work groups were also solicited through the DSM-5 website. The proposed draft revisions to DSM-5 are posted on the website, and anyone can provide feedback to the work groups during periods of public comment."[http://www.dsm5.org/about/Pages/faq.aspx#4 Question 4 on the DSM-5 FAQ], page found 2011-06-05.</ref>
-The appointment, in May 2008, of two of the taskforce members, [[Kenneth Zucker]] and [[Ray Blanchard]], has led to an internet petition to remove them.<ref>{{cite news |title=Activists alarmed over APA: Head of psychiatry panel favors ‘change’ therapy for some trans teens |author=Lou Chibbaro Jr. |date=2008-05-30 |work=Washington Blade}}</ref>  According to MSNBC, "The petition accuses Zucker of having engaged in 'junk science' and promoting 'hurtful theories' during his career."<ref name=msnbc>{{cite news |first=Brian |last=Alexander |title=What's ‘normal’ sex? Shrinks seek definition: Controversy erupts over creation of psychiatric rule book's new edition |url=http://www.msnbc.msn.com/id/24664654/ |work=MSNBC |publisher= |date=2008-05-22 |accessdate=2008-06-14 }}</ref>  According to ''The Gay City News'', "Dr. Ray Blanchard, a psychiatry professor at the University of Toronto, is deemed offensive for his theories that some types of transsexuality are paraphilias, or sexual urges. In this model, transsexuality is not an essential aspect of the individual, but a misdirected sexual impulse."<ref name=GayCity>{{cite news |first=Duncan |last=Osborne |title=Flap Flares Over Gender Diagnosis |url=http://www.gaycitynews.com/site/news.cfm?newsid=19693908&BRD=2729&PAG=461&dept_id=568864&rfi=6 |work=Gay City News |publisher= |date=2008-05-15 |accessdate=2008-06-14 }} {{Dead link|date=October 2010|bot=H3llBot}}</ref>  Blanchard responded, "Naturally, it's very disappointing to me there seems to be so much misinformation about me on the Internet. [They didn't distort] my views, they completely reversed my views."<ref name=GayCity/>  Zucker "rejects the junk-science charge, saying there 'has to be an empirical basis to modify anything' in the DSM. As for hurting people, 'in my own career, my primary motivation in working with children, adolescents and families is to help them with the distress and suffering they are experiencing, whatever the reasons they are having these struggles. I want to help people feel better about themselves, not hurt them.'"<ref name=msnbc/>
+In June 2009, Allen Frances issued strongly worded criticisms of the processes leading to DSM-5 and the risk of "serious, subtle, (…) ubiquitous" and "dangerous" unintended consequences such as new "false 'epidemics'".  He writes that "the work on DSM-V has displayed the most unhappy combination of soaring ambition and weak methodology" and is concerned about the task force's "inexplicably closed and secretive process".<ref>{{cite journal | last = Frances | first = Allen | date = 26 June 2009 | year = | month = | title = A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences | journal = Psychiatric Times | volume = | issue = | pages = | publisher = | pmid = | doi = | url = http://www.psychiatrictimes.com/display/article/10168/1425378?verify=0A | format = Full text | accessdate = 2009-09-06 | quote = }}</ref> His and Spitzer's concerns about the contract that the APA drew up for consultants to sign, agreeing not to discuss drafts of the fifth edition beyond the task force and committees, have also been aired and debated.<ref>{{cite news|first=Christopher|last=Lane|title=The Diagnostic Madness of DSM-V|work=Slate|date=July 24, 2009|url=http://www.slate.com/id/2223479/}}</ref>
+The appointment, in May 2008, of two of the taskforce members, [[Kenneth Zucker]] and [[Ray Blanchard]], led to an internet petition to remove them.<ref>{{cite news |title=Activists alarmed over APA: Head of psychiatry panel favors 'change' therapy for some trans teens |author=Lou Chibbaro Jr. |date=2008-05-30 |work=[[Washington Blade]]}}</ref>  According to MSNBC, "The petition accuses Zucker of having engaged in 'junk science' and promoting 'hurtful theories' during his career, especially advocating the idea that children who are unambiguously male or female anatomically, but seem confused about their [[gender identity]], can be treated by encouraging gender expression in line with their anatomy."<ref name=msnbc>{{cite news |first=Brian |last=Alexander |title=What's 'normal' sex? Shrinks seek definition: Controversy erupts over creation of psychiatric rule book's new edition |url=http://www.msnbc.msn.com/id/24664654/ |work=MSNBC |publisher= |date=2008-05-22 |accessdate=2008-06-14 }}</ref>  According to ''The Gay City News'', "Dr. Ray Blanchard, a psychiatry professor at the University of Toronto, is deemed offensive for his theories that some types of transsexuality are paraphilias, or sexual urges. In this model, transsexuality is not an essential aspect of the individual, but a misdirected sexual impulse."<ref name=GayCity>{{cite news |first=Duncan |last=Osborne |title=Flap Flares Over Gender Diagnosis |url=http://www.gaycitynews.com/site/news.cfm?newsid=19693908&BRD=2729&PAG=461&dept_id=568864&rfi=6 |work=Gay City News |publisher= |date=2008-05-15 |accessdate=2008-06-14 }} {{Dead link|date=October 2010|bot=H3llBot}}</ref>  Blanchard responded, "Naturally, it's very disappointing to me there seems to be so much misinformation about me on the Internet. [They didn't distort] my views, they completely reversed my views."<ref name=GayCity/>  Zucker "rejects the junk-science charge, saying there 'has to be an empirical basis to modify anything' in the DSM. As for hurting people, 'in my own career, my primary motivation in working with children, adolescents and families is to help them with the distress and suffering they are experiencing, whatever the reasons they are having these struggles. I want to help people feel better about themselves, not hurt them.'"<ref name=msnbc/>
+In 2011, psychologist [[Brent Robbins]] co-authored a national letter for the [[Society for Humanistic Psychology]] that brought thousands into the public debate about the DSM. Approximately 13,000 individuals and [[mental health]] professionals signed a petition in support of the letter. Thirteen other [[American Psychological Association]] divisions endorsed the petition.<ref>{{cite web |url=http://www.pointpark.edu/NewsArtsSciences.aspx?id=467 |title=Professor co-authors letter about America's mental health manual |author= |date=December 12, 2011 |work=Point Park University }}</ref> In a November 2011 article about the debate in the ''San Francisco Chronicle'', Robbins notes that under the new guidelines, certain responses to [[grief]] could be labeled as pathological disorders, instead of being recognized as being normal human experiences.<ref>{{cite web |url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/11/26/MNJJ1M3DFK.DTL |title=
+Revision of psychiatric manual under fire|author=Erin Allday |date=November 26, 2011 |work=San Francisco Chronicle }}</ref> In 2012, a footnote was added to the draft text which explains the distinction between grief and depression.<ref name=carey2012nyt>{{Citation |last=Carey |first=Benedict |publication-date=May 8, 2012 |title=Psychiatry Manual Drafters Back Down on Diagnoses
+ |newspaper=[[The New York Times]] |at=nytimes.com |accessdate=May 12, 2012
+ |url=http://www.nytimes.com/2012/05/09/health/dsm-panel-backs-down-on-diagnoses.html }}</ref>
+DSM-5, has been criticized for purportedly saying nothing about the biological underpinnings of mental disorders.<ref>[http://www.scientificamerican.com/article.cfm?id=new-dsm5-ignores-biology-mental-illness ''New DSM-5 Ignores Biology of Mental Illness'']; "The latest edition of psychiatry's standard guidebook neglects the biology of mental illness. New research may change that." May 5, 2013 [[Scientific American]]</ref>
 ===Borderline personality disorder controversy===
-The Treatment and Research Advancements National Association for Personality Disorders (TARA-APD) campaigns to change the name and designation of [[borderline personality disorder]] in DSM-5.<ref>[http://www.tara4bpd.org Treatment and Research Advancements National Association for Personality Disorders (TARA-APD)]</ref> The paper ''How Advocacy is Bringing BPD into the Light''<ref>[http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=32&Itemid=35 How Advocacy is Bringing BPD into the Light]</ref> reports that "the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing [[Social stigma|stigma]]...". There is also discussion about changing Borderline Personality Disorder, an Axis II diagnosis (personality disorders and mental retardation), to an Axis I diagnosis (clinical disorders).
+In 2003, the Treatment and Research Advancements National Association for Personality Disorders (TARA-APD) campaigned to change the name and designation of [[borderline personality disorder]] in DSM-5.<ref>[http://www.tara4bpd.org Treatment and Research Advancements National Association for Personality Disorders (TARA-APD)]</ref> The paper ''How Advocacy is Bringing BPD into the Light''<ref>[http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=32&Itemid=35 How Advocacy is Bringing BPD into the Light]</ref> reported that "the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing [[Social stigma|stigma]]...". Instead, it proposed the name "emotional regulation disorder" or "emotional dysregulation disorder". There was also discussion about changing borderline personality disorder, an Axis II diagnosis (personality disorders and mental retardation), to an Axis I diagnosis (clinical disorders).<ref>{{cite journal|last=New|first=Antonia|coauthors=Triebwasser Joseph, Charney Dennis|title=The case for shifting borderline personality disorder to Axis I|journal=Biol. Psychiatry|year=2008|month=October|volume=64|issue=8|pages=653–9|url=http://apsychoserver.psych.arizona.edu/JJBAReprints/PSYC621/New%20Triebwasser%20Charney%20Bio%20Psychiatry%20In%20Press%20(BPD%20to%20Axis%20I).pdf|doi=10.1016/j.biopsych.2008.04.020|accessdate=8 May 2013}}</ref>
 ===More radical criticisms===
-Some authors believe that the problem is not simply of a few criteria to be deleted or modified. For example, a [[Kuhnian]] reformulation of the diagnostic debate suggested that apparently trivial problems of the DSM, like the extremely high rates of comorbidity, might fruitfully be analysed as Kuhnian anomalies leading the DSM system to a scientific crisis.<ref>Aragona M. (2009). [http://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/v016/16.1.aragona.pdf The role of comorbidity in the crisis of the current psychiatric classification system] Philosophy, Psychiatry & Psychology  16: 1-11</ref> As a consequence, a radical rethinking of the concept of mental disorder, acknowledging for its constructive nature, was proposed.<ref>Aragona M. (2009) [http://www.crossingdialogues.com/Ms-A08-02.pdf The concept of mental disorder and the DSM-V] Dialogues in Philosophy, Mental and Neuro Sciences  2: 1-14</ref> Based on similar views, several revolutionary approaches were proposed, ranging from dimensional diagnosis to various forms of etiopathogenetic diagnosis (a nice example from a cognitive point of view can be found in <ref>Sirgiovanni E. (2009) [http://www.crossingdialogues.com/Ms-C09-02.pdf The Mechanistic Approach to Psychiatric Classification] Dialogues in Philosophy, Mental and Neuro Sciences  2: 45-49</ref>).
+Some authors believe that the problem is not simply of a few criteria to be deleted or modified. For example, a [[Kuhnian]] reformulation of the diagnostic debate suggested that apparently trivial problems of the DSM, like the extremely high rates of [[comorbidity]], might fruitfully be analysed as Kuhnian anomalies leading the DSM system to a scientific crisis.<ref>Aragona M. (2009). [http://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/v016/16.1.aragona.pdf The role of comorbidity in the crisis of the current psychiatric classification system] PDF. [[Philosophy, Psychiatry, & Psychology]]  16: 1-11</ref> As a consequence, a radical rethinking of the concept of mental disorder was proposed, addressing its constructive nature.<ref>Aragona M. (2009) [http://www.crossingdialogues.com/Ms-A08-02.pdf The concept of mental disorder and the DSM-V] Dialogues in Philosophy, Mental and Neuro Sciences  2: 1-14</ref> Based on similar views, several revolutionary approaches were proposed, ranging from dimensional diagnosis to various forms of etiopathogenetic diagnosis.<ref>(an example from a cognitive point of view) Sirgiovanni E. (2009) [http://www.crossingdialogues.com/Ms-C09-02.pdf The Mechanistic Approach to Psychiatric Classification] Dialogues in Philosophy, Mental and Neuro Sciences  2: 45-49</ref>
+The financial association of DSM-5 panel members with industry continues to be a concern for financial conflict of interest.<ref name=Cosgrove>{{cite journal|last=Cosgrove|first=Lisa|coauthors=Drimsky Lisa|title=A comparison of DSM-iv and DSM-5 panel members' financial associations with industry: A pernicous problem persisits|journal=PLoS Medicine|year=2012|month=March|volume=9|issue=3|pages=1–5|url=http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001190|accessdate=28 November 2012}}</ref> Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members.<ref name=Cosgrove />
+===British Psychological Society response===
+The [[British Psychological Society]] in the United Kingdom stated in its June 2011 response that it had "more concerns than plaudits".<ref>[http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5%202011%20-%20BPS%20response.pdf British Psychological Society Response, June 2011]</ref> It criticized proposed diagnoses as ''"clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements... not value-free, but rather reflect[ing] current normative social expectations"'', noting doubts over the reliability, validity, and value of existing criteria, that personality disorders were not normed on the general population, and that "not otherwise specified" categories covered a "huge" 30% of all personality disorders.
+It also expressed a major concern that ''"clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences... which demand helping responses, but which do not reflect illnesses so much as normal individual variation"''.
+The Society suggested as its primary specific recommendation, a change from using "diagnostic frameworks" to a description based on an individual's specific experienced problems, and that mental disorders are better explored as part of a spectrum shared with [[normality (behavior)|normality]]:
+{{quote|[We recommend] a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience, and that psychosocial factors such as [[poverty]], [[unemployment]] and [[trauma]] are the most strongly-evidenced [[causal factors]]. Rather than applying preordained diagnostic categories to clinical populations, we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or 'symptoms' or 'complaints'...... We would like to see the base unit of measurement as specific problems (e.g. hearing voices, feelings of anxiety etc)? These would be more helpful too in terms of epidemiology.
+While some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their problems are recognised (in both senses of the word) understood, validated, explained (and explicable) and have some relief. Clients often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. Since – for example – two people with a diagnosis of 'schizophrenia' or 'personality disorder' may possess no two symptoms in common, it is difficult to see what communicative benefit is served by using these diagnoses. We believe that a description of a person's real problems would suffice. Moncrieff and others have shown that diagnostic labels are less useful than a description of a person's problems for predicting treatment response, so again diagnoses seem positively unhelpful compared to the alternatives.|[[British Psychological Society]] June 2011 response}}
+===National Institute of Mental Health===
+[[National Institute of Mental Health]] director Thomas R. Insel, MD,<ref>{{cite web |url=http://www.nimh.nih.gov/about/director/directors-biography.shtml | title=Director's Biography | publisher=National Institute of Mental Health | accessdate=2013-05-22}}</ref> wrote in an April 29, 2013 blog post:<ref>{{cite web|last=Insel|first=Thomas|title=Transforming Diagnosis|url=http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml|publisher=National Institute of Mental Health|accessdate=23 May 2013}}</ref>
+<blockquote>The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. ... Patients with mental disorders deserve better.</blockquote>
+Insel also discussed an NIMH effort to develop a new classification system, Research Domain Criteria (RDoC), currently for research purposes only.<ref>{{cite web|title=NIMH Research Domain Criteria (RDoC) (Draft 3.1)|url=http://www.nimh.nih.gov/research-priorities/rdoc/nimh-research-domain-criteria-rdoc.shtml|date=June 2011|publisher=National Institute of Mental Health|accessdate=May 26, 2013}}</ref> Insel's post sparked a flurry of reaction, some of which might be termed [[sensationalism|sensationalistic]], with headlines such as "Goodbye to the DSM-V",<ref>{{cite web|title=Goodbye to the DSM-V|url=http://www.huffingtonpost.com/new-harbinger-publications-inc/goodbye-to-the-dsmv_b_3307510.html|publisher=Huffington Post|accessdate=23 May 2013}}</ref> "Federal institute for mental health abandons controversial 'bible' of psychiatry",
+<ref>{{cite web|title=Federal institute for mental health abandons controversial 'bible' of psychiatry|url=http://www.theverge.com/2013/5/3/4296626/nimh-abandons-controversial-bible-of-psychiatry|publisher=Verge|accessdate=23 May 2013}}</ref> "National Institute of Mental Health abandoning the DSM",<ref>{{cite web|title=National Institute of Mental Health abandoning the DSM|url=http://mindhacks.com/2013/05/03/national-institute-of-mental-health-abandoning-the-dsm/|publisher=Mind Hacks|accessdate=23 May 2013}}</ref> and "Psychiatry divided as mental health 'bible' denounced." <ref>{{cite web|title=Psychiatry divided as mental health 'bible' denounced|url=http://www.newscientist.com/article/dn23487-psychiatry-divided-as-mental-health-bible-denounced.html|publisher=NewScientist|accessdate=23 May 2013}}</ref> Other responses provided a more nuanced analysis of the NIMH Director's post.<ref>{{cite web|title=Did the NIMH Withdraw Support for the DSM-5? No|url=http://psychcentral.com/blog/archives/2013/05/07/did-the-nimh-withdraw-support-for-the-dsm-5-no/|publisher=PsychCentral|accessdate=23 May 2013}}<br />
+{{cite web|title=Mental Health Researchers Reject Psychiatry’s New Diagnostic ‘Bible’|url=http://healthland.time.com/2013/05/07/as-psychiatry-introduces-dsm-5-research-abandons-it/|publisher=Time|accessdate=23 May 2013}}<br />
+{{cite web|title=THE RATS OF N.I.M.H.|url=http://www.newyorker.com/online/blogs/elements/2013/05/the-scientific-backlash-against-the-dsm.html|publisher=The New Yorker|accessdate=23 May 2013}}<br />
+{{cite news|title=Psychiatry’s Guide Is Out of Touch With Science, Experts Say|url=http://www.nytimes.com/2013/05/07/health/psychiatrys-new-guide-falls-short-experts-say.html?partner=rss&emc=rss&_r=2&|publisher=New York Times|accessdate=23 May 2013}}
+</ref>
+In May 2013, Insel, on behalf of NIMH, issued a joint statement with [[Jeffrey Lieberman|Jeffrey A. Lieberman]], MD, president of the American Psychiatric Association,<ref name="NIMH and APA joint statement">{{cite web|title=DSM-5 and RDoC: Shared Interests|url=http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-shared-interests.shtml|publisher=National Institute of Mental Health and American Psychiatric Association|accessdate=23 May 2013}}</ref> that emphasized that DSM-5, "...represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5." Insel and Lieberman say that DSM-5 and RDoC "represent complementary, not competing, frameworks" for characterizing diseases and disorders.<ref name="NIMH and APA joint statement" />
 ==References==
+{{reflist|colwidth=30em}}
-{{Reflist}}
 ==External links==
 *[http://www.dsm5.org/pages/default.aspx Official DSM-5 Development Website]
-*[http://www.psychiatrictimes.com/dsm-v Topic Center from Psychiatric Times: DSM-V]
+{{Psychiatry}}
 {{DEFAULTSORT:Diagnostic And Statistical Manual Of Mental Disorders}}
 [[Category:Medical manuals]]
-[[Category:Mental illness diagnosis by DSM and ICD| ]]
 [[Category:Abnormal psychology]]
 [[Category:Clinical psychology]]
@@ Line 148: / Line 267: @@
 [[Category:Diagnostic and Statistical Manual of Mental Disorders]]
-<!--
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 {{enWP|DSM-V}}