Basics Diagnostic and Statistical Manual of Mental Disorders The latest edition of the DSM makes some controversial changes By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on April 02, 2021 Fact checked Verywell Mind content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by Emily Swaim Fact checked by Emily Swaim LinkedIn Emily is a board-certified science editor who has worked with top digital publishing brands like Voices for Biodiversity, Study.com, GoodTherapy, Vox, and Verywell. Learn about our editorial process Print BraunS / Getty Images The long-awaited fifth edition of the Diagnostic and Statistical Manual of Mental Disorders—DSM-5 for short—angered some mental health professionals and patient advocates, both for what it included and didn't include, when it was released by the American Psychiatric Association in May 2013. For years, the DSM has been known as the "psychiatrist's bible." It affects more than just the diagnosis of mental illness. It's also used in determining insurance benefits and disability, affects the availability of special education and social services, and is a staple in court proceedings. This latest edition, the fifth, had been several years in the making—years that saw extreme controversy about some of the proposed changes. Some members of the committees working on the new volume even resigned in protest of particular changes. DSM-5 as a Diagnostic Tool The DSM lists criteria for diagnosing such things as psychotic disorders (like schizophrenia), mood disorders (like bipolar), anxiety disorders, personality disorders (like antisocial personality disorder), trauma- and stress-related disorders (such as PTSD), and many, many more. For each disorder, there's a list of specific symptoms and behaviors that must or must not be present in order for the illness to be diagnosed. Usually, a certain number of the listed items must be present, rather than all of them. For example, in generalized anxiety disorder, a diagnosis requires excessive, hard-to-control worrying for at least six months, plus at least three of the following symptoms or behaviors: RestlessnessBeing easily fatiguedDifficulty concentratingIrritabilityMuscle tensionDifficulty falling or staying asleep How Sociopaths Are Different from Psychopaths DSM-5 Controversies: Autism, ODD, Bipolar There was a big public outcry when four separate autistic disorders that had been listed in the fourth edition of the DSM, including Asperger's syndrome, were combined into a single illness, autism spectrum disorder, for the DSM-5. People diagnosed with Asperger's and their parents feared losing social and educational services. However, the authors of the DSM-5 allowed individuals who met the DSM-IV criteria to continue to receive the autism spectrum disorder diagnosis in the DSM-5 without needing to go through the evaluation process a second time. Others in the mental health community were bitterly opposed to including an illness that was in the previous version, oppositional defiant disorder (ODD). The diagnosis involves children and teens who talk back to parents and teachers, who sometimes refuse to obey authority figures, and who lose their tempers easily, labeling that child or teen "mentally ill" unnecessarily. Pediatric Bipolar Disorder What was not kept from the previous version was a diagnosis for pediatric bipolar disorder (also called child-onset bipolar disorder, or COBPD). Instead, a new diagnosis was created called disruptive mood dysregulation disorder (DMDD). This disorder focuses on frequent, severe temper outbursts and overall irritability or anger between them. Disruptive mood dysregulation disorder can be diagnosed along with major depressive disorder (MDD), but it can not be comorbid with bipolar disorder. The diagnosis is controversial, with some researchers arguing that DMDD cannot be meaningfully differentiated from ODD. Signs of Psychosis in Their Teens NIMH Response The National Institute of Mental Health (NIMH) Director at the time, Dr. Thomas Insel, didn't appear to like the DSM-5's approach, at least initially. When the DSM-5 was released in 2013, he said that going forward, "NIMH will be re-orienting its research away from DSM categories" with the objective of developing a system that includes genetics, biomarkers, brain scans, and other physical aspects of and testing for mental illnesses. "While DSM has been described as a 'Bible' for the field, it is, at best, a dictionary, creating a set of labels and defining each," wrote Insel. Criticizing the "validity" of the DSM, Insel appeared to some to be withdrawing all support for the DSM-5. However, just two weeks later, a press release written jointly by Insel and Jeffrey A. Lieberman, M.D., President-Elect of the APA, clarified Insel's earlier blog post. In particular, the press release said: "Today, the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD), represents the best information currently available for clinical diagnosis of mental disorders. What Are Mental Disorders and How Are They Diagnosed? "Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5." However, NIMH still has plans to go forward with developing a more physically based diagnostic system, although the agency acknowledges that this is a long-term project. So while NIMH acknowledges DSM-5's utility for the purpose of current clinical diagnosis, future research in the field will need to be "based on dimensions of observable behavior and neurobiological measures" in order to qualify for NIMH grant funding. How Mental Illnesses Are Diagnosed and Treated 8 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5. Arlington, VA: American Psychiatric Publishing, 2013. Widiger TA, Crego C. Process and content of DSM-5. Psychopathol Rev. 2015;2(1):162-176. doi:10.5127/pr.035314 Fadus MC, Ginsburg KR, Sobowale K, et al. Unconscious bias and the diagnosis of disruptive behavior disorders and ADHD in African American and Hispanic youth. Acad Psychiatry. 2020;44:95-102. doi:10.1007/s40596-019-01127-6 Dougherty LR, Smith VC, Bufferd SJ, et al. DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children. Psychol Med. 2014;44(11):2339-2350. doi:10.1017/S0033291713003115 Mayes SD, Waxmonsky JD, Calhoun SL, Bixler EO. Disruptive mood dysregulation disorder symptoms and association with oppositional defiant and other disorders in a general population child sample. J Child Adolesc Psychopharmacol. 2016;26(2):101-6. doi:10.1089/cap.2015.0074 Insel T. Transforming diagnosis. National Institute of Mental Health. Insel TR, Lieberman JA. DSM-5 and RDoC: shared interests. Cuthbert BN. The RDoC framework: facilitating transition from ICD/DSM to dimensional approaches that integrate neuroscience and psychopathology. World Psychiatry. 2014;13(1):28-35. doi:10.1002/wps.20087 By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.