DSM-5 - Pros and Cons

The launch of DSM-III in 1980 triggered revolutionary changes in the field of psychiatry and associated sciences. The classification of mental disorders moved from partially arbitrary decisions to a reliable system. Before DSM-III, it was more likely that 2 diagnosticians resulted in different diagnoses for the very same patient than that they came to the same conclusion about the diagnostical label for the clinical problem. The introduction of a reliable classification system for mental disorders moved psychiatry, clinical psychology, and several other fields from low scientific recognition to one of the top positions of healthcare research. This also resulted in tremendous improvements in our understanding and treatment options for patients with mental disorders. However, is DSM-5 still on this track of fostering research and treatment for mental disorders? Is science still the major purpose of DSM-5, or did it become the victim of economic interests and power of specific subgroups? The societal impact, but also the money that is made by DSM became tremendous, and this can threaten the scientific purpose. Just a small example: Authors are not allowed to cite DSM-5 criteria for a single disorder without paying fees to the American Psychological Association (APA) press. This means that text books and other publications are not allowed to inform their audience about any DSM-5 diagnosis without paying for it. Is this the way how we want to disseminate scientific approaches? And the content of DSM-5, is it really based on the best of our knowledge? Critique has been expressed that some innovations are arbitrary and misleading [Rief and Martin, 2014]. As editor of the German journal VERHALTENSTHERAPIE (Behavior Therapy), I am proud that we were able to get 2 extremely distinguished experts of the field to discuss the pros and cons of DSM-5. Prof. Dr. Ulrich Wittchen (Technische Universitaet Dresden) was member of different DSM groups during the last 20 years, and no German scientist was more involved in this process. Prof. Dr. Allen Frances (Duke University School of Medicine, Durham, NC, USA) can be considered the main person who started the ‘counterrevolution’ against DSM: As chair of DSM-IV, he had the best insight into these processes, and he considers DSM-5 as a misdevelopment that must be revised. He is our special guest author of this Pro-Con section, and we are extremely delighted to publish this discussion. Winfried Rief, Marburg