Alternative futures for the DSM revision process: iteration v. paradigm shift

Two major approaches can be used for the up-coming revisions of DSM-V and ICD-10: an 'iterative model' in which incremental changes are made or a 'paradigm shift model' in which the existing approach is jettisoned in favour of a new nosological model. We explore each of these two approaches and conclude that although they both have strengths and limitations, our field is not currently ready for a paradigm shift.