???????? Do we really need an authoritative diagnostic manual? Why or why not? If you are a clinical psychologist, there are probably many reasons to dislike the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. First, it is under the control of a profession with which clinical psychologists are in professional and economic competition. Second, it can be perceived as being used by, or perhaps is in fact used by, insurance companies as a means of limiting coverage of clinical practice. For example, a managed care company might limit the number of sessions they will cover depending on the patient’s diagnosis. (They might not even cover the treatment of some disorders.) I am not too sure that these are necessarily valid reasons for disliking the DSM, but I do believe they contribute to some of the criticism that it receives. But, third, and most fundamentally important, it doesn’t really work that well. A diagnosis of a disorder should lead to the identification of that specific disorder that has a specific pathology that accounts for it and a specific therapy that can be used to cure the patient of that pathology. That hasn’t been the case for mental disorders diagnosed by the DSM system, not yet at least.

Despite its shortcomings, the DSM is a necessary document.

Clinicians and researchers need a common language with which to communicate with each other about patterns of psychopathology, and that is the primary function of the DSM. Before the DSM’s first edition, the clinical practice was awash with a confusing plethora of different names for the same thing and the same name for quite different things. It was, simply put, chaotic.