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DSM-5 Overview: The Future Manual 

 

The process for revising Diagnostic and Statistical Manual of Mental Disorders (DSM) began with a brief discussion between Steven Hyman, M.D., (then-director of the National Institute of Mental Health [NIMH]), Steven M. Mirin, M.D. (then-medical director of the American Psychiatric Association [APA]), and David J. Kupfer, M.D., (then-chair of the American Psychiatric Association Committee on Psychiatric Diagnosis and Assessment) at the NIMH in 1999. They believed it was important for the APA and NIMH to work together on an agenda to expand the scientific basis for psychiatric diagnosis and classification.

Under the joint sponsorship of the two organizations, an initial DSM-5 Research Planning Conference was convened in 1999 to set research priorities. Participants included experts in family and twin studies, molecular genetics, basic and clinical neuroscience, cognitive and behavioral science, development throughout the life-span, and disability. To encourage thinking beyond the current DSM-IV framework, many participants closely involved in the development of DSM-IV were not included at this conference. Through this process, participants recognized the need for a series of white papers that could guide future research and promote further discussion, covering over-arching topic areas that cut across many psychiatric disorders. Planning work groups were created, including groups covering developmental issues, gaps in the current system, disability and impairment, neuroscience, nomenclature, and cross-cultural issues.

In early 2000, Darrel A. Regier, M.D., M.P.H., was recruited from the NIMH to serve as the research director for the APA and to coordinate the development of DSM-5. Additional conferences were held later in July and October of 2000 to set the DSM-5 research agenda, propose planning the work groups’ membership, and to hold the first face-to-face meetings. These groups, which included liaisons from the National Institutes of Health (NIH) and the international psychiatric community, developed the series of white papers, published in “A Research Agenda for DSM-5” (2002, APA). A second series of cross-cutting white papers, entitled “Age and Gender Considerations in Psychiatric Diagnosis,” was subsequently commissioned and published by APA in 2007.

Leaders from the APA, the World Health Organization (WHO), and the World Psychiatric Association (WPA) determined that additional information and research planning was needed for specific diagnostic areas. Hence, in 2002, the American Psychiatric Institute for Research and Education (APIRE), with Executive Director Darrel A. Regier, M.D., M.P.H., as the Principal Investigator, applied for a grant from the NIMH to implement a series of research planning conferences that would focus on the scientific evidence for revisions of specific diagnostic areas. A $1.1 million cooperative agreement grant was approved with support provided by NIMH, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcoholism and Alcohol Abuse (NIAAA).

Under the guidance of a steering committee comprised of representatives from APIRE, the three NIH institutes, and the WHO, 13 conferences were held from 2004 to 2008. Expertise represented at these conferences spanned the globe: each conference had co-chairs from both the U.S. and another nation, and approximately half of the 397 participants were from outside the U.S. In each conference, participants wrote papers addressing specific diagnostic questions, based on a review of the literature, and from these papers and the conference proceedings, a research agenda was developed on the topic. The results of 11 of these conferences have been published to date in peer-reviewed journals or American Psychiatric Publishing, Inc. (APPI) monographs, with the remainder of the publications anticipated in 2011 and 2012. Findings from all 13 conferences are available to serve as a substantial contribution to the research base for the DSM-5 Task Force and Work Groups and for the WHO as it develops revisions of the International Classification of Diseases.

In 2006, APA President Dr. Steven Sharfstein announced Dr. Kupfer as chair and Dr. Regier as vice-chair of the task force to oversee the development of DSM-5. They, along with other leaders at the APA, nominated additional members to the task force, which includes the chairs of the diagnostic work groups that will review the research and literature base to form the content for DSM-5. These task force nominees were reviewed for potential conflicts of interest, approved by the APA Board of Trustees, and announced in 2007. In turn, the work group chairs, together with the task force chair and vice-chair, recommended to the successive APA Presidents, Drs. Pedro Ruiz and Carolyn Robinowitz, nominees widely viewed as leading experts in their field, who were then formally nominated as members of the work groups. All work group members were also reviewed for potential conflicts of interest, approved by the APA Board, and were announced in 2008.

From 2007 until the end of 2012, each work group met regularly in person and on conference calls. They reviewed DSM-IV’s strengths and problems, from which research questions and hypotheses were developed, followed by thorough investigations of literature reviews and analyses of existing data. Based on their comprehensive review of scientific advancements, targeted research analyses, and clinical expertise, the work groups developed draft DSM-5 diagnostic criteria. The the final, approved DSM-5 was released in May 2013 at APA's Annual Meeting.

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