he says, adding that this approach means thinking about
what disorders have in common instead of what makes them
• Increased emphasis on culture and gender. The DSM- 5
will also feature greater attention to cultural factors that may
affect diagnosis. In addition to tools for cultural assessment, a
new section will describe common cultural syndromes, how
they are expressed and possible causes. The new information
will not only encourage clinicians to take into account
such individual differences, but will help standardize such
information across clinicians, says Hopwood.
• A new section on areas that need further research. The
DSM- 5 will include three sections: an introduction with
instructions on using the manual, a section with diagnoses
and diagnostic criteria and a new section with information on
conditions that require additional research before they can be
incorporated into the official diagnoses.
• A commitment to more frequent updating. The switch
to an Arabic numeral in the manual’s name is more than just
a design change, says Hopwood. “The idea is that there will be
versions 5. 1, 5. 2 and 5. 3 and that these sorts of mini-editions
can come along more frequently than they had in the past so
that the manual can be more responsive to research as things
unfold,” he says.
• Inclusion of International Classification of Diseases
(ICD) codes. The DSM- 5 includes equivalent ICD-9-Clinical
Modification (CM) codes and equivalent ICD-10-CM codes. As
of Oct. 1, 2014, the ICD-10-CM will become the official health
classification of the U.S. government, says psychologist Geoffrey
M. Reed, PhD, senior project officer in the World Health
Organization’s Department of Mental Health and Substance
Abuse. “That means ICD-10-CM codes will be required for
all electronic health care transactions, such as billing and
reimbursement,” he says. And unlike the DSM- 5, which costs
$199, the ICD-10-CM is available free at the National Center
for Health Statistics website at www.cdc.gov/nchs/icd/icd10cm.
htm, he adds.
For Hopwood, that last point suggests an interesting
question: Why does the field need two diagnostic systems?
“It’s obviously inefficient to have two different systems for
diagnosis — one for the United States and one for the rest of
the world,” he says. “One wonders whether there is really a need,
frankly, for the DSM given the ICD.”
There are other concerns with the DSM- 5, as well. Many
within the mental health community expressed strong concerns
about the process and the anticipated revisions, says Rhea
K. Farberman, executive director for public and member
communications at APA. While APA did not take an official
position on the DSM- 5, it did encourage members to lend their
expertise to the process. In a December 2011 statement, APA’s
Board of Directors expressed concerns about the potential harm
any diagnostic system can have if it increases the potential for
over-identification of illness and therefore the possibility of
unnecessary treatment. APA called upon the DSM- 5 Task Force
to adhere to an open, transparent process based on the best
For more information, visit the American Psychiatric
Association’s DSM- 5 website at www.psychiatry.org/dsm5. n
Rebecca A. Clay is a writer in Washington, D.C.