In his article “Revising Book on Disorders of the Mind,” The New York Times reporter Benedict Carey looks at the ongoing development of fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (referred to as DSM-5), due for release in May of 2013. DSM is the big book of psychiatric diagnoses. The current version – DSM-IV TR – has been around for a decade.

This new diagnostic manual is long overdue. In the last ten years, we’ve learned a great deal about brains and psychiatric illness, and this knowledge should be part of our diagnostic process and the way we describe and discuss mental illness. The importance of this new information extends well beyond the practices of diagnosing and treating mental illness. It also has repercussions in the pharmaceutical industry, health insurance, disability law, criminal law, and other areas. Deciding what is and what isn’t mental illness carries a great deal of responsibility, so having clearer and more precise diagnostic guidelines in place is certainly beneficial.

From what little I have seen, the new criteria appear to allow for more specificity and flexibility in describing an individual’s patterns of symptoms within a given diagnosis. From my own very particular point of view, I am pleased to see several changes in the DSM-5, most notably the following:

• More precise language for understanding children with mood regulation problems that doesn’t result in labeling them all with a bipolar disorder diagnosis.
• Changes in the autism spectrum diagnostic story and in the area of personality disorders and impulse control disorders.
• An increase in gender and cultural sensitivity in the diagnoses themselves and in the language used to describe them.

I am anticipating these changes and many others and look forward to following the information as it’s released. I plan to check in on the evolving criteria, and you can do so, too, at DSM5.org.

I remain hesitant to get too excited about any of this, because we won’t really be able to have a true diagnostic lexicon until we have clearer understanding of the neural pathways and events that cause the range of mental illnesses. Only then will we have more clarity on what is actually going on, how to treat these conditions most effectively with our current tools, and how to develop better treatments.

Until that happens (and it will happen slowly and incrementally), I applaud the efforts of the DSM-5 Task Force and Work Group in developing more effective and specific ways of describing and quantifying mental illness and symptoms. The fruit of their efforts, DSM-5, holds out hope for improving our ability to communicate with our patients and each other with clearer language and criteria. In my book, these are welcome changes.

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    Last reviewed: 16 Feb 2010