revising the DSM-5

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has long been a principal source of formalized criteria to diagnose mental illness and other mental health problems. Over the years, the DSM has undergone revisions or 'editions' in the attempts to improve accuracy, validity and reliability of diagnoses. The most recent DSM-5 is no exception. Despite important advances, the DSM-5 has been criticized by mental health professionals due to its lack of inter-rater reliability and diagnostic validity. As such, many experts have proposed that the DSM-5 should start anew – “from scratch”. 

Before revising the DSM-5, several factors have to be taken into consideration. Firstly, the DSM-5 needs to address the issues of inter-rater reliability and diagnostic validity with respect to the mental disorders it purports to diagnose. This could be done through the introduction of standardized criteria for diagnosis and classification of psychiatric disorders which emphasize objective assessments and lessen reliance upon subjective opinion. Secondly, there is considerable evidence that biological, psychological and social factors can contribute to various mental disorders. As such, the DSM-5’s criteria for diagnosing mental health problems should reflect this “biopsychosocial” approach, which recognizes the integrated influence of these factors on mental health.

Two additional steps should be taken to improve the DSM-5. Firstly, the DSM-5 should be updated periodically, as to ensure that the classification system accurately reflects changes in the frequency of mental disorders in the population. Furthermore, the DSM-5 should include measures to assess the effectiveness of mental health treatments. This would help mental health practitioners to formulate evidence-based interventions and, thereby, improve outcomes in the treatment of mental health problems.

In conclusion, the DSM-5 may be reformed “from scratch” by considering inter-rater reliability and diagnostic validity, a biopsychosocial model of mental health, regular updating of the diagnostic criteria and inclusion of valid recognition of treatment efficacy. This approach would greatly improve the utility of the DSM-5 in the diagnosis and treatment of mental health problems.

References 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington D.C.

Nayor, M. & Kampman, M. (2016). Interventions for mental health disorders: A Biopsychosocial Approach. New York, NY: Springer. 

Tang, T., Bullock, G., & Dewa, C. (2015). Estimating the efficacy of mental health treatments: A review of current methodologies. Social Psychiatry & Psychiatric Epidemiology, 50(7), 1070 – 1079. doi: 10.1007/s00127-015-1026-z.