(PDF) DSM-5: Diagnostic and Statistical Manual of Mental Disorders

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Meghan A. Marty1and Daniel L. Segal2

1Veterans Aairs 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 denition, organization, and

classication. is entry includes informa-

tion on: (a) the planning and development

oftheheditionofthemanual(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 signicant dysfunction in an

individual’s cognitions, emotions, or behaviors

that reects a disturbance in the psycholog-

ical, biological, or developmental processes

underlying mental functioning” (American

Psychiatric Association, 2012). Diagnosis

refers to the identication 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 ocial

classication 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 renements 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 eort to expand the scientic

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 eort

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 dier-

ent diagnoses, demonstrate the strength of

the empirical evidence for the recommended

changes, and clarify the boundaries among

specic mental disorders and normal psycho-

Early dras 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,

reecting 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-

nied 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 Classication 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, reecting advances

in the scientic 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 Classication 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 specic diagnos-

tic areas, such as depressed mood, anxiety,

substance use, or sleep problems. Such clinical

areas may be relevant for prognosis, treatment

planning,assessmentofoutcome,orrene-

ment of diagnosis, and may be evaluated and

monitored throughout the course of treatment.