Basics Disorders Missing in the DSM-5 By Kendra Cherry Kendra Cherry Facebook Twitter Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology. Learn about our editorial process Updated on July 11, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Roy Scott / Getty Images Table of Contents View All Table of Contents Conditions Not Listed How New Disorders Are Added If Your Condition Isn't in the DSM Changes in the DSM-5 Changes in the DSM-5-TR The DSM Moving Forward The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and is used by psychiatrists, clinical psychologists, and other mental health professionals to diagnose mental disorders. The first edition of the DSM was published in 1952. While it has gone through a number of revisions over the intervening years, it remains the definitive text on mental disorders. The DSM-5, published in May 2013, describes many different disorders, including depressive disorders, bipolar and related disorders, anxiety disorders, feeding and eating disorders, and substance use disorders. Despite the number of disorders included in the DSM-5, there are still some that cannot be found in the manual. Certain conditions, while still diagnosed by doctors and psychiatrists, are not formally recognized as distinct disorders in the DSM-5. The DSM-5 text revision (also known as the DSM-5-TR), modified some information from the DSM-5 and even added a new disorder. However, many in the mental health community want to see changes happen more quickly to DSM editions. Conditions Not Listed While the DSM contains a large number of disorders, it is not necessarily an exhaustive list of every condition that might exist. Some of the conditions currently not recognized in the DSM-5 include: Orthorexia Sex addiction Parental alienation syndrome Pathological demand avoidance Internet addiction Sensory processing disorder Misophonia Why are some conditions listed in the DSM while others are not? In many cases, it comes down to the amount of research available on the suspected disorder. For example, while internet addiction is a proposed diagnosis, there is still a great deal of controversy over whether it should be considered a discrete condition or if it may be a manifestation of another disorder. Some experts argue that internet addiction features many of the symptoms associated with other substance-related and addictive disorders that are recognized by the DSM, including excessive use, negative consequences associated with use, withdrawal, and tolerance. Others suggest that it is premature to consider it a distinct diagnosis and that the term "addiction" itself has become overused. Conditions listed in the DSM typically have a long history of research with plenty of empirical data on symptoms, prevalence, and treatments to back up their inclusion. For many of the proposed disorders missing in the DSM, this research simply is not there—at least not yet. Orthorexia As an Example Consider the condition orthorexia. The term orthorexia was first coined in the late 1990s and is usually defined as an obsession with healthy eating. According to the proposed diagnostic criteria presented by the doctor who first identified the condition, orthorexia symptoms include a preoccupation with a restrictive diet designed to achieve optimal health. Such dietary restrictions often involve the elimination or restriction of entire food groups. When these self-imposed rules are violated, the person may be left with extreme feelings of anxiety, shame, and fear of disease. Such symptoms can lead to severe weight loss, malnutrition, stress, and body image issues. But you won't find these symptoms discussed in the DSM-5, because orthorexia is not recognized as an official disorder in the DSM. Why is this? Orthorexia is a relatively new label applied to a condition that has not received a tremendous amount of research. Stephen Bratman, MD, the physician who initially proposed the condition, did not think of it as a serious diagnosis until he discovered that people not only identified with the proposed diagnosis but that some might actually be dying from it. While there is a lack of empirical studies on the symptoms and prevalence of orthorexia, Dr. Bratman and others suggest that there is sufficient anecdotal evidence to encourage further research and possible consideration as a distinct condition. How New Disorders Make It Into the DSM What does the DSM committee look for when determining which disorders should be included in the diagnostic manual? Revisions to the manual are influenced by the latest research in neuroscience, problems that had been identified in the previous version of the manual, and a desire to better align the manual with the latest version of the International Classification of Diseases (ICD). Early on in the revision process that produced the DSM-5, more than 400 experts from diverse fields including psychiatry, psychology, epidemiology, primary care, neurology, pediatrics, and research participated in a series of international conferences that resulted in the production of monographs designed to help inform the DSM-5 Task Force as it built proposals for changes to the diagnostic manual. Once a disorder has been proposed for inclusion, the committee reviews the existing research on the condition and may even commission studies to further explore the proposed disorder. The decision then ultimately rests with the DSM Task Force. The process of adding new disorders is not without controversy. According to one study, more than half of the experts in charge of compiling the DSM-IV had financial ties to the pharmaceutical industry. Such connections trouble critics, who feel that the inclusion of some disorders may be more linked to their potential to generate income for drug companies. Disorders such as generalized anxiety disorder and social anxiety disorder, these critics charge, may be present at least in part because they encourage prescribing high-profit anti-depressant and anti-anxiety drugs. What If You Have a Condition That Isn't in the DSM? So what does it mean for people who have symptoms of a condition not recognized by the official diagnostic manual? For some, it might mean the difference between receiving mental health treatment and not having access to care. The DSM helps provide clinicians, doctors, and psychiatrists a shared language for discussing mental disorders, but it also plays an important role in insurance reimbursement. A diagnosis is often a requirement in order to receive insurance payment for mental health services. In some cases, patients may only be able to pay for treatment if they receive a diagnosis recognized by the DSM. For some, not seeing their condition in the DSM can add to feelings of alienation. While there are people who find the labeling of mental conditions limiting and overly stigmatizing, others find it helpful and feel that inclusion in the DSM represents that their symptoms are recognized by the medical community. An official diagnosis offers hope to these patients, who may finally feel that they have found not only an explanation that accounts for their symptoms but also the possibility that they can successfully cope with or recover from their disorder. Changes in the DSM-5 In the DSM-5, some previously recognized disorders were not included. Asperger's syndrome, for example, was considered a separate diagnosis in the DSM-IV but was absorbed under the umbrella of autism spectrum disorders in the DSM-5. This decision created considerable controversy, as many feared it might potentially mean losing their diagnosis and ultimately lead to a loss of various types of essential services. Another change was leaving out the "not otherwise specified" diagnosis from the DSM-5. This diagnosis covered patients who had some of the symptoms of a disorder but did not meet the full set of criteria. In the DSM-5, the "not otherwise specified" option has either been removed (for most categories of disorders) or replaced with "other specified disorder" or "unspecified disorder." Symptoms that fail to meet the diagnostic criteria for a recognized mental disorder may fall under the broad category of "other mental disorders." The DSM-5 recognizes four disorders in this category: Other specified mental disorder due to a medical conditionUnspecified mental disorder due to a medical conditionOther specified mental disorderUnspecified mental disorder The catch-all category of "unspecified mental disorder" also drew criticism from some psychiatrists and psychologists for what they feel is a lack of precision. The only criterion for receiving the diagnosis is that the patient does not "meet the full criteria for any mental disorder." This, they suggest, might mean that people fail to receive a correct and more specific diagnosis which might ultimately lead to them not receiving the right treatment for their condition. Provisional and Differential Diagnoses Conditions for Further Study in the DSM-5 The manual also includes a section on "conditions for further study." This means the APA recognizes that further investigation is needed—these conditions may be included in later editions of the DSM depending upon the evidence presented. This section of the DSM-5 can be thought of as almost something of a waiting list. Research on these conditions is considered limited at the time they are published in this section of the book, but further study into things such as prevalence, diagnostic criteria, and risk factors is encouraged. At the time of its publication in 2013, the DSM-5 listed eight different conditions as needing further study: Attenuated psychosis syndrome Caffeine use disorder Depressive episodes with short-duration hypomania Neurobehavioral disorder associated with prenatal alcohol exposure Nonsuicidal self-injury (addressed in the DSM-5-TR) Internet gaming disorder Persistent complex bereavement disorder (renamed and included in the DSM-5-TR) Suicidal behavior disorder (addressed in the DSM-5-TR) If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Changes in the DSM-5-TR The fifth edition of the DSM-5, text revision (DSM-5-TR), was issued in 2022. It contains revised criteria for 70 disorders. Persistent complex bereavement disorder (listed above as a condition for further study in the DSM-5) was listed as an official diagnosis in the DSM-5-TR, but it was renamed prolonged grief disorder (PGD). PGD is classified as a trauma- and stressor-related disorder. Someone with PGD experiences an extreme yearning for the person they lost, thoughts that are occupied by the person they lost, and grief that disrupts everyday life. As mentioned, suicidal behavior disorder and nonsuicidal injury were conditions for further study in the DSM-5. While these are not official diagnoses in the DSM-5-TR, the text revision does include new diagnostic codes for suicidal behavior and self-injury in people who don't have mental health conditions. The DSM-5-TR revised the name of various conditions as well. For instance, social anxiety disorder was listed as "social anxiety disorder (social phobia)" in the DSM-5. The parenthetical reference, "social phobia" was removed. It is now simply listed as social anxiety disorder in the DSM-5-TR. Similarly, the DSM-5 lists "persistent depressive disorder (dysthymia)," whereas the DSM-5-TR lists just persistent depressive disorder—meaning dysthymia is no longer an official term used for this condition, according to the DSM. The DSM-5-TR also replaced specific terms pertaining to gender dysphoria. Instead of "desired gender," used in the DSM-5, the DSM-5-TR uses "experienced gender." The DSM-5 uses "cross-sex medical procedure," but the DSM-5-TR updated this term to "gender affirming medical procedure." Addressing Racism and Discrimination The DSM-5-TR revised several terms in order to address and avoid racism and discrimination in healthcare. For instance, the DSM-5-TR doesn't use the term "race." Instead, this was replaced with "racialized," to emphasize that race is a social construct. The term Latinx was adopted (instead of Latina/Latino) for gender inclusivity in the DSM-5-TR. The terms "non-White" and "minority" are avoided as well because these terms describe social groups only in the context of Whiteness. The DSM-5-TR also includes information on the symptoms, causes, and risk factors of conditions that are associated with certain demographic groups. In addition, the DSM-5-TR reports on the risk that clinicians face in misdiagnosing people from socially oppressed ethnoracial groups. Cultural biases and racism play huge roles in determining whether or not someone receives an adequate diagnosis and appropriate treatment, and the DSM-5-TR aims to acknowledge this and spread awareness. Racial Disparities Cause Poor Health Care for Black Americans The DSM Moving Forward One criticism of the DSM is that the manual itself often does not keep pace with current research on different disorders. When the DSM-5 was published in 2013, for instance, the DSM-IV was nearly 20 years old already. Writing for STAT, psychiatrist Michael B. First , MD, explains that the APA's goal is to make it easier to update the manual in order to reflect the latest research and other changes in the field of psychiatry. First is a member of the APA's new DSM Steering Committee, which hopes to take advantage of the immediacy of digital publishing to keep the DSM more up-to-date. The goal is to develop a model that allows the diagnostic manual to continually improve and base updates upon solid data and empirical evidence. In doing so, they hope that the future of the DSM will fully reflect scientific advances more quickly than the older revision processes, which will ultimately serve to help psychiatrists, clinical psychologists, and other mental health care providers better serve their patients. A Word From Verywell While the DSM-5 may not include every condition that might exist, it is an important tool for accurately diagnosing and treating mental illness. Some conditions may not currently appear in the manual, but that has already begun changing with the publication of the DSM-5-TR. We will likely continue to see the addition and revision of conditions in future editions. If you feel that you have the symptoms of a disorder that may or may not be listed in the DSM, consult your healthcare provider for further evaluation in order to receive a diagnosis and treatment. 7 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. Jorgenson AG, Hsiao RC, Yen CF. Internet addiction and other behavioral addictions. Child Adolesc Psychiatr Clin N Am. 2016;25(3):509-20. doi:10.1016/j.chc.2016.03.004 Pies R. Should DSM-V designate "internet addiction" a mental disorder?. Psychiatry (Edgmont). 2009;6(2):31-7. Dunn TM, Bratman S. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eat Behav. 2016;21:11-7. doi:10.1016/j.eatbeh.2015.12.006 Cosgrove L, Krimsky S, Vijayaraghavan M, Schneider L. Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychother Psychosom. 2006;75(3):154-60. doi:10.1159/000091772 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed, text revision). American Psychiatric Association. Boelen PA, Lenferink LI. Prolonged grief disorder in DSM-5-TR: Early predictors and longitudinal measurement invariance. Aust N Z J Psychiatry. 2021;48674211025728. doi:10.1177/00048674211025728 STAT. Psychiatry's list of disorders needs real-time updates. Additional Reading American Psychiatric Association. DSM history. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association. Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013;12(2):92-8. doi:10.1002/wps.20050 By Kendra Cherry Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology. 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.