How the Diagnostic and Statistical Manual of Mental Disorders Works


The Addition of Section III

DSM-5 also introduced Section III, which is for conditions where there is not enough scientific data yet to determine whether they should be classified as psychiatric disorders. Among these conditions are Internet Gaming Disorder, Caffeine Use Disorder (see sidebar) and Persistent Complex Bereavement Disorder [source: APA].

Section III also contains measures and models that have potential to help clinicians better evaluate patients. "There's been a push that there are dimensions that run across disorders," Wang says. "Some patients have symptoms or signs that appear across many diagnostic categories. That's why they're ending up with lot of comorbid diagnoses."

So, the DSM-5 introduced the cross-cutting dimensional measure, which helps clinicians determine if there are underlying dimensions that could be present in multiple disorders. Although this approach is still in need of validation before it can be permanently included in the main DSM-5, Wang notes that many physicians already follow this line of thought. "It's like when primary care doctors do a review of systems," he explains. "They probe further if there's a positive. In mental health we need a mental health review of systems. That's what the DSM cross-cutting measure is."

Section III also includes a cultural formulation interview guide, with questions to help clinicians identify how a patient's cultural background affects their perception and presentation of psychiatric symptoms, treatment and diagnosis. "The interview provides an opportunity for individuals to define their distress in their own words and then relate this to how others, who may not share their culture, see their problems. This gives the clinician a more complete foundation on which to base both diagnosis and care," APA explains in a Section III Fact Sheet.

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