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Meghan A. Marty1and Daniel L. Segal2
1Veterans Aairs Palo Alto Health Care System, U.S.A.
and 2University of Colorado at Colorado Springs, U.S.A.
e Diagnostic and statistical manual of mental
disorders (DSM),publishedbytheAmerican
PsychiatricAssociation,isacompendiumof
mental disorders, a listing of the diagnostic
criteria used to diagnose them, and a detailed
system for their denition, organization, and
classication. is entry includes informa-
tion on: (a) the planning and development
oftheheditionofthemanual(DSM-5),
(b) the general features of the DSM-5 and
changes from previous editions, (c) multicul-
tural and diversity issues in the DSM-5,and
(d) limitations and criticisms of the DSM-5.
Mental disorder refers to “a health condition
characterized by signicant dysfunction in an
individual’s cognitions, emotions, or behaviors
that reects a disturbance in the psycholog-
ical, biological, or developmental processes
underlying mental functioning” (American
Psychiatric Association, 2012). Diagnosis
refers to the identication and labeling of a
mental disorder by examination and analysis
(Segal & Coolidge, 2001). Mental health pro-
fessionals diagnose individuals based on the
symptoms that they report experiencing and
the signs of disorders with which they present.
Whereas the DSM aids professionals in under-
standing, diagnosing, and communicating
about mental disorders through its provision
of explicit diagnostic criteria and an ocial
classication system, no information about
Planning and Development of the
e DSM-5 is the latest incarnation of the
manual in an evolving process that began with
e Encyclopedia of Clinical Psychology, First Edition. Edited by Robin L. Cautin and Scott O. Lilienfeld.
© 2015 John Wiley & Sons, Inc. Published 2015 by John Wiley & Sons, Inc.
DOI: 10.1002/9781118625392.wbecp0308
publication of the original DSM in 1952. More
recently, the DSM-IV was published in 1994
and in 2000 a “text revision” of the manual
(DSM-IV-TR)waspublished,whichslightly
updated some of the content in the manual.
Empirical research and extensive literature
reviews have guided renements in the diag-
nostic manual and its continued development.
In 1999, an initial DSM-5 research planning
conference was convened, which set research
priorities in an eort to expand the scientic
basis for mental health diagnoses and classi-
cation. Between 2006 and 2008, the diagnostic
workgroups were assembled, comprising more
than 160 clinicians and researchers from psy-
chiatry, psychology, social work, psychiatric
nursing, pediatrics, and neurology. In an eort
to ensure broad perspectives were consid-
ered, the work-group members represented
more than 90 academic and mental health
institutions throughout the world, and approx-
imately 30% of the work-group members
were from countries other than the United
States. Additionally, more than 300 advis-
ers, known for their expertise in a particular
eld,providedknowledgetotheworkgroup
Each of the diagnostic workgroups con-
ducted extensive literature reviews, performed
secondary data analyses, solicited feedback
from colleagues and professionals, and ulti-
mately developed the new diagnostic criteria
in their respective areas. Several general prin-
ciples were established to guide the decisions
made by the workgroups about what should be
included, removed, or changed in the revised
manual. ese principles included consid-
eration of the clinical utility of and research
evidence for the revisions, continuity with
the previous edition of the manual when
possible, and no predetermined constraints
on the amount of change permitted. Addi-
tionally, the workgroups were asked to clarify
the boundaries between mental disorders,
consider symptoms that occur across dier-
ent diagnoses, demonstrate the strength of
the empirical evidence for the recommended
changes, and clarify the boundaries among
specic mental disorders and normal psycho-
Early dras of the DSM-5 were opened
forpublicreview;theAmericanPsychiatric
Association designated three time periods
during which the general public was invited to
comment on the new diagnostic criteria. Field
trials were conducted between 2010 and 2011
to test the new diagnostic criteria for feasibility,
clinical utility, reliability, and validity in both
academic and nonacademic clinical practice
settings. e release of the nal, approved
DSM-5 occurred in May 2013. e manual
is expected to become a living document,
reecting more frequent revisions. us, the
traditional Roman numeral was dropped from
the title so that future changes prior to the
manual’s next complete revision will be sig-
nied as DSM-5.1,DSM-5.2,andsoforth.
Although far from perfect, the DSM functions
as one of the most comprehensive and thor-
ough manuals used to classify and diagnose
mental disorders. e only major competitor
in the developed world is the World Health
Organization’s International Classication of
Diseases (ICD), which is in its tenth edition.
e ICD is also currently undergoing revision
andisexpectedtobewidelycompatiblewith
Section 1 of the DSM-5 provides an introduc-
tion and includes information on how to use
the manual. In Section 2, mental disorders
are grouped into 22 diagnostic categories.
e structural organization of the DSM-5 is
revised from the previous edition, such that
the individual disorders within a category are
arranged in a developmental lifestyle fashion,
with disorders typically associated with child-
hood presented rst. Additionally, the order
ofthediagnosticcategoriesisdesignedto
closely position diagnostic areas that seem to
be related to one another, reecting advances
in the scientic understanding of mental disor-
ders. Section 3 includes conditions that require
further research, assessment measures, cultural
formulations, a glossary, and a description of
an alternative model for diagnosing personality
According to the DSM-5,individualswith
a particular diagnosis (e.g., major depressive
disorder) need not exhibit identical features,
although they should present with certain car-
dinal symptoms (e.g., either depressed mood
or anhedonia). In the DSM-5,thecriteriafor
many mental disorders are polythetic, mean-
ing that an individual must meet a minimum
number of symptoms to be diagnosed, but
not all symptoms need be present (e.g., ve of
nine symptoms must be present to diagnose
depression). Use of polythetic criteria allows
for some variation among people with the
same disorder. However, individuals with the
same disorder should have a similar history in
some areas, for example a typical age of onset,
prognosis, and common comorbid conditions.
Consistent with previous editions, the DSM-5
primarily relies on a categorical approach
to diagnosis so that individuals either have
the disorder (i.e., they meet criteria, they are
diagnosable) or they do not (despite possibly
having several symptoms but not enough to
Notably absent from the DSM-5 is the use
of the multiaxial system. Clinical disorders,
personality disorders, and general medical
conditions (formerly Axes I, II, and III) are
combined into a nonaxial documentation,
with separate notations for psychosocial and
contextual factors (formerly Axis IV) and
disability (formerly Axis V). Regarding the
former Axis V, the Global Assessment of
Functioning scale has been replaced with the
World Health Organization Disability Assess-
ment Schedule (WHODAS) which provides
a global measure of disability. e WHODAS
is based on the International Classication of
Functioning, Disability and Health (ICF) for
use across all of medicine and health care, and
islocatedinSection3oftheDSM-5 with other
new assessment measures. An added feature
in the DSM-5 isthemoreprominentuseof
dimensional and crosscutting assessments.
Dimensional assessments are proposed for
inclusion within some existing categorical
diagnoses, with the goal of providing addi-
tional information that assists clinicians in
assessment, treatment planning, and treatment
monitoring. For example, among individuals
with schizophrenia, the severity of the primary
symptoms of psychosis, including delusions,
hallucinations, disorganized speech, abnormal
psychomotor behavior, and negative symp-
toms, may be rated on a dimensional ve-point
scale ranging from 0 (not present)to4(present
and severe). Cross-cutting assessment refers to
the measurement of important clinical areas
that may be relevant beyond specic diagnos-
tic areas, such as depressed mood, anxiety,
substance use, or sleep problems. Such clinical
areas may be relevant for prognosis, treatment
planning,assessmentofoutcome,orrene-
ment of diagnosis, and may be evaluated and
monitored throughout the course of treatment.
