Clinical Utility in the Revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM)

According to the DSM-5 Task Force improving clinical utility is among the top priorities for the DSM revision Psychiatric classifications are used to help clinicians (1) communicate (2) select effective interventions (3) predict course prognosis and future management needs and (4) differentiate disorder from non disorder for the purpose of determining who might benefit from treatment Any change in the DSM that improves clinicians ability to achieve any of these goals can be said to improve its clinical utility The types of potential changes to the DSM that might serve each of these goals are reviewed (e g the addition of specifiers to facilitate the communication of clinically salient features of disorders) The paper emphasizes the importance of user acceptability when making proposals to improve clinical utility If proposed changes make the DSM too complicated for clinicians to use then the purported benefits will be moot Changes are also more likely to be accepted if they address flaws in the DSM that clinicians themselves consider to be problematic In order to be generalizable across DSM users assessments of clinical utility require a large and diverse sample drawn from a wide variety of settings professional backgrounds and levels of experience The paper concludes by reviewing changes proposed for DSM-5 (i e specifiers for Not Otherwise Specified (NOS) and other categories dimensional assessments and the addition and deletion of categories) to evaluate their possible impact on clinical utility and the likelihood of their being accepted by clinicians