HealthDay News — The newly released revised fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not adequately account for social and population influences on psychiatric illness and diagnosis, researchers suggest.

“The DSM-5 revisions are taking place at a time when there is increasing public scrutiny of the accuracy and integrity of psychiatric diagnoses and growing awareness of the role that social and economic influences can play, both in the incidence of disease and in its diagnosis,” Helena B. Hansen, PhD, of New York University in New York City and colleagues argue online in Health Affairs.

These factors are “not adequately accounted for in the understanding of disease currently promoted by the DSM and its revision process,” the researchers wrote, adding the DSM’s focus on the role of biology in mental illness is too narrow to inform clinical diagnostic processes.

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Hansen and colleagues suggest the DSM-5 authors missed several issues in their most recent revision process, including:

  • Social determinants of mental health disorders and their diagnosis
  • Environmental factors triggering biological responses that manifest in behavior
  • Differing cultural perceptions about what is normal and what is abnormal behavior
  • Institutional pressures related to such matters as insurance reimbursements, disability benefits and pharmaceutical marketin.
  • A systematic way to take population-level variations in diagnoses into account

Although, they cited no specific evidence that the DSM-5 task force did not consider such factors, the researchers propose the creation of an independent research review body to address these shortcomings. The review body would monitor variations in diagnostic patterns, inform future DSM revisions, identify needed changes in mental health policy and practice and recommend new avenues of research.

The researchers also suggested the American Psychiatric Association (APA), which develops the DSM, has a conflict of interest, as the publication is a “substantial source of income” for the organization. Because of this, Hansen and collegues recommend the panel be appointed and governed independent of the APA to “insulate the review body from pressure to consider the sales potential of the DSM in various mental health provider markets when making future revisions.” 


  1. Hansen H et al. Health Affairs. 2013; doi: 10.1377/hlthaff.2011.0596.