For the next 6 weeks we are pleased to once again offer the opportunity to submit comments on the draft fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This commenting period marks the third and final time DSM-5 draft criteria will be available for your feedback. Following this period the site will remain viewable with the draft proposals until DSM-5’s publication.

Following the previous commenting period (May-July 2011), members of the DSM-5 Task Force and Work Groups reviewed feedback submitted to this site and, where appropriate, revised their proposed diagnostic criteria and made other changes. With the completion of the DSM-5 Field Trials, Work Group members have spent the past several months examining data and findings from these important studies. Therefore, the proposed diagnostic criteria found on this site are the result of the DSM-5 Work Groups’ ongoing deliberations, based on findings from scientific field studies, patient and clinician perspectives, and views from the general public. We want to stress that revisions will continue to be made, as necessary, over the next several months.

What’s New?

What specifically has changed on this site over the past year? Visitors may notice differences in the ways in which some proposed disorders are classified. Below are some of the changes.

• Based on concerns about the reliability of the proposed Attenuated Psychosis Syndrome and Mixed Anxiety Depressive Disorder in the field trials, these two conditions are being recommended for further study in Section III, an area of DSM-5 for conditions that require further research before consideration as formal disorders. 
• We also added a footnote to the Major Depressive Disorder criteria to clarify the difference between normal bereavement associated with a significant loss and a diagnosis of a mental disorder.  Many commentators noted the previous criteria erroneously implied that bereavement could be assumed to only last 2 months and we wanted to correct that misunderstanding and provide more information on how bereavement and other loss reactions differ from Major Depressive Disorder.  The extensive public comment also highlighted the need to clarify that use of a checklist of the diagnostic criteria by people without clinical training is insufficient to make a clinical diagnosis.
• Among the other significant changes in this posting is a more extensive Personality Disorders rationale for change with the reliability of dimensional measures and the categorical diagnosis of Borderline Personality Disorder now supported by Field Trial data.  However, additional data analysis in this area is ongoing.
• Diagnostic criteria for Pedophilic Disorder have been modified.  The adjusted boundaries of this disorder are based more on biological developmental indicators of early puberty in victims to avoid implications that the disorder involves post-pubertal adolescent victims and to make the criteria consistent with the International Classification of Diseases. 
• Communication Disorders now include two diagnoses – Language Disorders and Speech Disorders – each with appropriate subtypes to cover all seven of the disorders previously proposed for categorization here.
• Similarly, based on clinical feedback and the field trial documentation that Simple Somatic Symptom Disorder was a milder form of Complex Somatic Symptom Disorder, the two have now been combined as a single disorder: Somatic Symptom Disorder.
• The diagnosis of Suicidal Behavioral Disorder is a newly proposed disorder that is intended to complement the previous proposal for Non-Suicidal Self Injury Disorder. The latter disorder was tested in the Field Trials with highly variable levels of reliability—final decisions about its placement in Section III for further study have not been made.  Another disorder suggested for placement in Section III includes Persistent Complex Bereavement Disorder which has had conflicting disorder criteria proposed from previous studies of this condition.  The Work Group has suggested a new criteria set that builds on previous research prior to full endorsement of this condition.

Readers will also notice changes in specific criteria for some of the disorders, including those in the Neurocognitive Disorders and the Anxiety Disorders chapters. Finally, we have also now included a proposed Cultural Formulation Interview for DSM-5, which also includes some specific questions for visitors to consider in thinking about how the manual can help clinicians more effectively assess cultural aspects of psychiatric diagnosis.

 A detailed listing of changes to draft proposals that have been made since July 2011 can be found on the Recent Updates page. We also encourage readers to visit each diagnostic section, which includes a brief introductory statement about changes within that section, as well as a listing of the proposed disorders for that particular section.

Next Steps

It is important to note that the proposed changes listed here do not represent the final changes for DSM-5. The proposals listed here reflect the most up-to-date drafts, final versions of which will be put forth for review and approval by the Board of Trustees of the American Psychiatric Association (APA) later this year. However,  these proposed changes will undergo further revisions between now and the end of 2012, in part generated from your input, and also because results from the DSM-5 Field Trials continue to be analyzed, discussed, and integrated into proposals, along with an extensive  review process that is taking place for these proposals.  This review process includes:  a Scientific Review Committee which will review the scientific validating evidence for revisions; an extensive peer review process where hundreds of expert reviewers will consider the clinical and public health risks and benefits of making changes from DSM-IV; and a review by an Assembly DSM-5 committee. Revisions will continually be made based on feedback from these various groups.  This represents an unprecedented level of internal and external review for the DSM including the public review via the three postings on the DSM5.org.   

Finally, there will be an overall review by the DSM-5 Task Force that integrates these assessments and sends final recommendations along with all supporting data to the APA’s Board of Trustees for a final review.  The Board of Trustees will consider the recommendations of the Task Force along with those from the Scientific Review Committee as well as other review committees mentioned above and the public comments. The final manual approved by the Board will be submitted to the American Psychiatric Publishing for publication by December 31, 2012. The 166th APA Annual Meeting in San Francisco, May 18-22, 2013, will mark the official release of DSM-5.