Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for DSM-5 and ICD-11 provides a comprehensive summary of the current state of mental health classification in the United States and internationally, fostering a better understanding of primary research and clinical needs and facilitating the efforts of service planners, researchers and trainees to address current use of psychiatric diagnosis in the public health sector. The volume reflects the proceedings of a research planning conference convened by the APA and World Health Organization (WHO) that focused on public health aspects of the diagnosis and classification of mental disorders.

Highly relevant to the ongoing development of DSM-5 and ICD-11, the book includes the background papers prepared and presented by the Conference Expert Groups. The resulting collection: - Discusses the current state of mental illness prevention efforts and the role of public health in supporting them -- critical topics, given that development of effective strategies to reduce mental illness around the world depends on the accuracy with which risk and protective factors can be identified, defined, and understood.- Features international perspectives on public health implications of psychiatric diagnosis, classification, and service, providing viewpoints that are broad and more globally relevant. - Views mental health education, and awareness on a macro level, including its impact on social and economic policy, forensics and the legal system, and education. This approach facilitates the continued development of a research base in community health and promotes the establishment of programs for monitoring, treating, and preventing mental illness.- Addresses many fascinating and clinically relevant issues, such as those raised by the concept and the definition of mental disorders and how these impact psychiatric services and practice by individual providers.

This collection should prove useful to the advisory groups, task forces, and working groups for the revision of these two classifications, as well as for researchers in the area of diagnosis and classification, and more generally in public health.

There is a need to refine our current psychiatric nosology to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience while at the same time enhance clinical utility. Furthermore, dimensional aspects of psychiatric disorders require greater recognition so as to improve our understanding of boundaries between disorders and underscore the heterogeneous nature of psychopathology. The Conceptual Evolution of DSM-5 provides a framework for the evolution of the forthcoming diagnostic system in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which will help advance clinical practice and facilitate ongoing development of diagnostic criteria. This manual: • Highlights recent progress in our understanding of cross-cutting factors relevant to psychiatric diagnosis and symptom presentation • Includes detailed discussions on the role of factors such as age, gender, culture, and disability in the expression of mental disorders • Provides a review of genetic evidence supporting a cross-cutting approach to nosology • Offers suggestions for integrating cross-cutting factors with DSM-5. The Conceptual Evolution of DSM-5 was written to impart a theoretical context for understanding potential revisions to DSM-5. The authors reevaluate the structure of the current manual and discuss cross-cutting approaches to facilitate clinical practice and refine research approaches that will guide clinical trials, genetics, imaging, and treatment guidelines. The authors provide the following insights: • Detailed descriptions of age-, gender-, and culture-specific aspects relevant to psychiatric diagnosis and the need for sensitivity to these factors when making diagnoses • Discussions on the dimensional aspects of mental disorders, including overlapping symptoms relevant to many or most diagnoses • Consideration of alternative classifications of disorders that recognize disorders sharing validating features • Presentation of neuroscientific and epidemiologic evidence to expand understanding of disorders beyond that of the categorical organization presented in DSM-IV • A review of clinical implications, including how clinicians may shift their conceptualization of previously reified diagnostic criteria and their consequences. As presented to the 99th Annual Meeting of the American Psychopathological Association, The Conceptual Evolution of DSM-5 explores the rapidly changing research base for the understanding of neurodevelopmental, neurocognitive, addictive, and other psychiatric disorders. The contributions in this volume confirm that DSM-5 is intended to be a living document that can accommodate revisions to specific diagnostic areas based on new evidence that is replicable and subject to review. This efficient updating process will help researchers and clinicians keep abreast of the latest protocols for the research, diagnosis, and treatment of mental illness.

The five-year process of preparing for the revision of the Diagnostic and Statistical Manual (DSM) has been organized around a series of conferences convened by the American Psychiatric Association, in collaboration with the World Health Organization and the U.S. National Institutes of Health, to address the future of psychiatric diagnosis. Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-V is the fruit of one of those conferences and presents the most academically sound, thought-provoking, and timely papers from the proceedings.

As the conference and book demonstrate, recent advances in psychiatric diagnosis suggest a new approach to obsessive-compulsive disorder (OCD) classification: - Research into the pathogenesis of OCD increasingly supports reclassification out of the anxiety disorders and into a separate group of obsessive-compulsive-related disorders (OCRDs). - The relationships among OCRDs may be better defined, delineated, and understood if the current categorical diagnostic approach is supplemented with a dimensional approach which assesses obsessive-compulsive symptom domains.- Obsessive-compulsive disorders are believed to be underdiagnosed in patients who complain of broad symptoms of anxiety, and reclassification of OCD as an OCRD would promote more careful examination of distinct obsessive-compulsive symptoms, yield more accurate diagnosis, and result in more effective treatments.- Reclassification may facilitate future research directions in examining the biological underpinnings of these disorders.

In addition to examining the genetic, neurological, and ethno-cultural bases for OCRDs, the book gives special attention to disorders that cross current diagnostic categories, including: - Body dysmorphic disorder (BDD)- Tourette's syndrome and trichotillomania- Impulse-control disorders

The process leading to publication of DSM-V is by its nature an exhaustive and complex one, and the conferences play a critical role in reviewing relevant research, assessing the status of scientific knowledge, and advancing that knowledge base. Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-V represents the cutting-edge thinking that will culminate in new diagnoses, classifications, and standards of practice for this debilitating set of disorders. Clinicians and academicians will be fascinated by this glimpse into the next generation of the DSM-V.

Generalized anxiety disorder (GAD) and major depression (MD) form the largest group of common mental disorders. These two conditions often occur together, and emerging evidence suggests several similarities between them. As we move toward revising the Diagnostic and Statistical Manual of Mental Disorders for DSM-V, Diagnostic Issues in Depression and Generalized Anxiety Disorder: Refining the Research Agenda for DSM-V explores the nosologic relationship between GAD and MD. In this comprehensive manual, more than 45 contributors cover a wide range of empirical and conceptual issues that face clinicians and researchers working with GAD and MD today.

This book acts as a guidepost for the entire DSM process. It reviews recent scientific advances in our understanding of the interrelationship between GAD and MD, summarizes the body of evidence into a few broad conclusions, and reflects on the implications of these findings for future nosologic efforts. The contributing authors review empirical data from a variety of perspectives -- including genetics, biology, treatment, development, course, predictors, disability, and psychosocial stressors -- and then integrate results from research on all these diverse validators to come up with a single "bottom-line" recommendation regarding the relationship between GAD and MD. In addition, the book considers conceptual issues, such as criteria for results from validators, the relevance of results on symptoms of anxiety and depression, weights of different classes of validators, and the rules for assigning disorders into categories. And finally, it addresses the question of what new kinds of data could be gathered that would help to clarify the relationship between MD and GAD more definitively. Each chapter includes tables, charts, and references to enhance the evidence presented on such diverse topics as: - A thorough review of the genetics of GAD and MD- The role of psychotropics in distinguishing between GAD and MD- Biological and treatment aspects of GAD and MD- Psychometric aspects of GAD and MD- Childhood risk factors associated with GAD and MD- Common mental disorders across cultures

Diagnostic Issues in Depression and Generalized Anxiety Disorder: Refining the Research Agenda for DSM-V develops operationalized criteria for nosologic decisions that enable clinicians to bridge the gap between data to diagnostic recommendations. Not only does the methodology of investigating an active interchange between empirical and conceptual perspectives shed new light on the relationship between GAD and MD, but it also carries implications for the rest of DSM-V.

Sometimes described as "the nemesis of the primary care physician," somatoform disorders are frustrating, expensive to treat, and under-investigated. Somatic Presentations of Mental Disorders provides a fascinating and practical review of the epidemiology, diagnosis, and treatment of this ill-defined category of disease. Somatic Presentations of Mental Disorders summarizes the proceedings of a unique international conference that convened experts from across disciplines to review perspectives on somatoform disorders. The broad range of experience and specialization results in a compendium that addresses both theoretical and practical issues presented in somatoform disorders. For the researcher, the book offers a thorough and critical overview of the research landscape, surveying and synthesizing the available literature from around the world on all aspects of the disorder. Acknowledging the unique challenges presented in studying such a heterogeneous collection of disorders, the authors identify specific gaps in the research literature. Somatic Presentations of Mental Disorders also addresses controversial issues of nosology in advance of the publication of DSM-V.

Despite its utility for researchers, the book primarily serves as an invaluable reference and resource for the practitioner. Organized with the clinician in mind, Somatic Presentations of Mental Disorders surveys the latest data on phenomenology; etiology and clinical course; and treatment options. Unlike other literature on this difficult topic, the authors thoroughly explore the entire range of this category of disorders, including conversion disorder, chronic pain and fatigue, and the multitude of presentations of medically unexplained symptoms. Aimed at both primary care and mental health practitioners, the book addresses crucial issues for effective diagnosis and treatment, including: - Comorbidity and association with anxiety and depressive disorders- Unique insights into cultural factors affecting the presentation and treatment of somatic disorders around the globe- The prevalence of misdiagnosis, and contemporary diagnostic tools and techniques to help avoid a missed organic diagnosis- The complicated interrelationship of somatoform disorders and substance abuse- The efficacy of various treatment modalities, including pharmacology and cognitive behavioral therapy- Collaboration between primary care and mental health providers to maximize treatment outcomes

Comprehensive, thoughtful, and up-to-date, Somatic Presentations of Mental Disorders is a must-have both for researchers in the field and for clinicians with somatizing patients.

As disorders in which stress or fear play major roles present an increasing need for psychiatric care around the world, this volume summarizes current research to determine whether a specific group of stress-induced and fear-based disorders form a distinct syndrome independent from other anxiety disorders such as obsessive-compulsive disorder or generalized anxiety. Intended to suggest DSM-V revisions regarding the classification of these disorders, Stress-Induced and Fear Circuitry Disorders reflects findings that may lead to more refined treatments for these specific anxiety disorders based on a better understanding of the biological and environmental factors that contribute to their development and symptoms.

Thirty contributors, all international authorities on this group of mental illnesses, clarify how these disorders develop and what factors contribute to symptomatology. Focusing on posttraumatic stress disorder, panic disorder and agoraphobia, social phobias, and specific phobia, the authors explore the possibility of linking the classification and etiology of these conditions by showing that they may be closely related in terms of brain pathophysiology. In addition to assessing the stability of disorders across patient lifespans and determining whether they form a cohesive and distinct group, the authors examine shared etiologies and biopsychosocial correlates, as well as aspects unique to each disorder. Among the book's specific insights: - How minority populations, particularly African Americans, are differentially affected by these disorders.- The neuronal mechanisms of normal fear and anxiety, including how changes in the genetics of the serotonin system can increase the risk of anxiety.- The role of cognition in symptom presentation and treatment, revealing cognitive biases that favor the processing of threat-related information.- The contribution of stress and psychosocial factors, such as peer victimization and childhood sexual abuse.- The use of neuroimaging to analyze neural structure and function for each of the four disorder groups.- How neurochemistry and neuroendocrine markers may aid in classification of anxiety disorders.- The contribution of substance abuse to the pathophysiology of these disorders.

Given the importance of changes to DSM for professional education and public health, this book offers important new ways of thinking about stress-induced and fear-based disorders. It not only allows researchers to more accurately assess their diagnostic classifications, but also can help clinicians more effectively communicate with patients regarding the nature of their illness and the importance of adhering to treatment regimens.

Advancing the Research Agenda for DSM-V, Diagnostic Issues in Dementia comprises nine chapters with research suggestions for consideration for the upcoming DSM-V process, reflecting the nascent effort toward a new diagnostic nomenclature in the still rapidly evolving field of dementia.

Here, 18 experts provide critical pieces of the dementia diagnostic story: - The all-important neuropathological criteria of Alzheimer's disease and the aging brain; current epidemiologic literature and the challenges of making even minor changes in the general definition of dementia; and a scholarly review of the diagnostic nomenclature across the existing criteria, with numerous critiques and suggestion for future research- The growing evidence for mild cognitive impairment as an identifiable entity suitable for inclusion in DSM-V; the current neuropsychological profiling that serves as the centerpiece of the diagnostic criteria for dementia and suggests that new instruments evaluating even broader aspects of cognition, including executive function, will be important in helping to identify dementia at an earlier stage of development- The various behavioral syndromes associated with dementia, with emphasis on the need for great diagnostic clarity to help focus appropriate therapy in this area of increased burden for patients and family caregivers- Biomarkers in dementia that may already be appropriate for inclusion in our diagnostic criteria; the current diagnostic utility of specific imaging modalities, which, combined with expanding ligand technology or markers of genetic predisposition, might further enhance diagnostic accuracy- A review of the tremendous explosion of information in this field, asserting that, with the exception of the rare Mendelian disorders, genetic profiles are not yet ready to make substantial contributions to nosology

Despite all of these exciting findings, the editors state that we are still dealing with primarily clinical syndromes and therefore are still using clinical diagnostic criteria established at consensus conferences. In the spirit of scientific humility, they assert that these experts' views must be considered within the vast and expanding literature related to the dementias. Given the associated but still generally nonspecific biological mechanisms underlying these syndromes, new scientific developments might occur at any time and immediately affect the interpretations and considerations presented here.

This remarkably concise and insightful collection reviews today's -- and suggests directions for tomorrow's -- important diagnostic and research issues in dementia, and as such is a "must read" for clinicians and researchers alike.

Since its initial publication more than 50 years ago, the DSM has systematized the complex intellectual and clinical process of diagnosing mentally ill persons through the use of categories and classification. The manuals have provided a consistent diagnostic language for clinical work, research, and teaching; have established a common international taxonomic standard; and have provided psychiatrists with a means of communicating with patients and the public. With a new iteration of the DSM on the horizon, the APA has initiated a multiphase research review process designed to set the stage for the fifth revision, due to be published in 2013.

This book brings together the most promising research presented at the conference "The Future of Psychiatric Diagnosis: Refining the Research Agenda," which was convened by the APA, in collaboration with the World Health Organization and the U.S. National Institutes of Health. Conferees were challenged to go beyond the current categorical definitions set forth in DSM-III and DSM-IV and suggest ways of incorporating more quantitative, dimensional concepts into DSM-V. The resulting work: - Addresses the challenge of creating dimensional measures that are compatible with existing categorical definitions and do not unduly disrupt clinical practice- Applies a dimensional approach to a broad range of diagnoses, including substance dependence, major depressive episode, psychosis, anxiety disorders, developmental psychopathology, and personality disorders- Facilitates the development of broadly agreed upon criteria that researchers worldwide can use in planning and conducting future research exploring the etiology and pathophysiology of mental disorders- Identifies and encourages the empirical research necessary to allow informed decision making regarding deficiencies acknowledged in DSM-IV- Promotes international collaboration with the objective of eliminating the remaining disparities between DSM-V and the International Classification of Diseases Mental and Behavioural Disorders Section, the next edition of which is due to be released in 2014.

The book's painstaking scholarship and thoughtful conclusions should stimulate interest in finding new ways of combining categorical and dimensional approaches in psychiatric nosology. Clinicians and researchers in the United States and the international psychiatric community will discover, in these pages, the beginnings of a new, quantitative methodology that represents the next stage in the evolution of DSM.

Written to help identify major gaps in our knowledge of how gender and age affect psychiatric diagnoses and to stimulate much-needed research to fill these gaps, Age and Gender Considerations in Psychiatric Diagnosis serves as both a valuable short-term source for the DSM-V Task Force and its disorder-specific workgroups, and a long-term guide for future studies that will contribute to revised psychiatric classifications in these three areas.

Here, 47 experts present findings in three areas of psychiatric research that historically have been neglected but rightfully have received increasing attention in recent years and thus are worthy of investigation into their clinical features, etiology, and course:

1. Significant gender differences in prevalence, symptom profiles, and risk factors for mental disorders, including neurodevelopmental, neurophysiological, and environmental factors for men and women that cut across diagnostic categories-for example, the critical importance of gender in how psychiatric illness develops and presents; DSM's approach to gender to date; and relevant research findings and gaps in the epidemiology, etiology, and pathophysiology of disorders and the gender-related expression of psychopathology, including the controversial and complex question of whether DSM should have different diagnostic criteria for men and women.

2. Mental disorders in infancy and early childhood, including diagnosis and measurement of psychopathology; PTSD and social and cognitive factors related to the experience of stress; reactive attachment disorder (unique in part because of its specificity to early childhood); mood and anxiety disorders and difficulties in diagnosis; sleep disorders, including two new disorders, Night-Waking Dysomnia and Sleep-Onset Dysomnia; feeding disorders, including the need to address overeating and overfeeding (especially given the alleged U.S. epidemic of obesity); early childhood manifestations of behavior disorders; and early symptoms and diagnosis of autism.

3. Mental disorders in the elderly, such as dementia and depression, once considered normal consequences of aging but now understood to represent mental disorders, including the need to identify specific brain structure abnormalities, biomarkers, and the many contributing biological, psychosocial, and environmental factors of mental illness in late life and to understand their roles in the elderly to better diagnose and monitor disease progression.

Written for clinicians and researchers alike, this thought-provoking compendium contributes critical information that helps enhance our understanding of the causes of mental disorders, develop effective preventive and treatment interventions, and inform future editions of DSM and ICD.

In the ongoing quest to improve our psychiatric diagnostic system, we are now searching for new approaches to understanding the etiological and pathophysiological mechanisms that can improve the validity of our diagnoses and the consequent power of our preventive and treatment interventions -- venturing beyond the current DSM paradigm and DSM-IV framework.

This thought-provoking volume -- produced as a partnership between the American Psychiatric Association, the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse -- represents a far-reaching attempt to stimulate research and discussion in the field in preparation for the eventual start of the DSM-V process, still several years hence. The book - Explores a variety of basic nomenclature issues, including the desirability of rating the quality and quantity of information available to support the different disorders in the DSM in order to indicate the disparity of empirical support across the diagnostic system.

- Offers a neuroscience research agenda to guide development of a pathophysiologically based classification for DSM-V, which reviews genetic, brain imaging, postmortem, and animal model research and includes strategic insights for a new research agenda.

- Presents highlights of recent progress in developmental neuroscience, genetics, psychology, psychopathology, and epidemiology, using a bioecological perspective to focus on the first two decades of life, when rapid changes in behavior, emotion and cognition occur.

- Discusses how to address two important gaps in the current DSM-IV: (1) the categorical method of diagnosing personality disorders and their relationship with Axis I disorders, and (2) the limited provision for the diagnosis of relational disorders -- suggesting a research agenda for personality disorders that considers replacing the current categorical approach with a dimensional classification of personality.

- Reevaluates the relationship between mental disorders and disability, asserting that research into disability and impairment would benefit from the diagnosis of mental disorders be uncoupled from a requirement for impairment or disability to foster a more vigorous research agenda on the etiologies, courses, and treatment of mental disorders as well as disabilities and to avert unintended consequences of delayed diagnosis and treatment.

- Examines the importance of culture in psychopathology and the main cultural variables at play in the diagnostic process, stating that training present and future professionals in the need to include cultural factors in the diagnostic process is a logical step in any attempt to develop comprehensive research programs in psychology, psychiatry, and related disciplines.

This fascinating work, with contributions from an international group of research investigators, reaches into the core of psychiatry, providing invaluable background and insights for all psychology and psychiatry professionals -- food for thought and further research that will be relevant for years to come.

Inviting the help of colleagues worldwide, the concise Diagnostic Issues in Substance Use Disorders is part of the new series Advancing the Research Agenda for DSM-V. Its 19 chapters by an international group of experts are designed to stimulate questions that will help guide research related to the development of the next editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Classification of Diseases (ICD-11), with the goal of ensuring that the major substance use diagnoses represent the same condition in both references. They cover 10 major issues in three main sections: - Overarching issues relevant for the development of international diagnostic systems -- statistical modeling techniques and whether DSM-V should use categorical and/or dimensional diagnostic approaches; methods review, emphasizing new hybrid techniques for developing and testing diagnostic concepts; the need for separate clinical and research-oriented diagnostic criteria, incorporating both categorical and dimensional attributes; neurobiological changes characterizing substance dependence; the importance of cultural attributes in developing definitions of substance use disorders; and the history of the development of diagnostic systems and how to optimize the "crosswalk" between DSM and ICD.- Research questions more specific to the substance use disorders section of DSM -- comorbidity between substance use disorders and other psychiatric conditions, the relatively unique clinical course of substance-induced mental disorders and appropriate treatment approaches; the precision of the criteria and threshold for a diagnosis and how to improve them; the subtypes of substance use disorder, including how they have been derived and the extent to which they relate to neurobiological processes; the seemingly high prevalence of alcohol dependence in young people; suggested research questions to evaluate the application of diagnostic criteria to adolescents; and the specific psychoactive substances cannabis and nicotine.- Whether substance use disorders should be included in a broader section termed "addictive disorders" -- impulse-control disorders (especially pathological gambling and the advantages and disadvantages of adding it to the current substance use disorders section), identifying research opportunities regarding their assessment and neurocognitive and physiological bases, discussing the specifics of the research agenda and how it might be implemented, and presenting questions generated by the research agenda developmental process.

This informative compendium distills the findings of a wealth of recent research and concludes with recommendations for exploiting research opportunities that promise to inform decisions regarding DSM-V and other classification systems. As such, it will prove invaluable for clinicians and researchers everywhere.

DSM-IV and ICD-10 both diagnose personality disorders categorically, yet studies indicate that many patients meet criteria for an excessive number of diagnoses, raising the question of whether personality disorders are discrete conditions or rather distinctions along dimensions of general personality functioning. This collection of papers renews long-standing proposals for a dimensional model of personality disorder, describing alternative models, addressing questions about their clinical application and utility, and suggesting that future research seek to integrate such models within a common hierarchical structure.

With contributions by preeminent researchers in the field, "Dimensional Models of Personality Disorders" is drawn from a conference series convened by APA, WHO, and NIH in order to plan for the fifth edition of the DSM. The Nomenclature Work Group concluded that consideration should be given to basing part or all of DSM-V on dimensions rather than categories, and recommended that a dimensional model for personality disorders should serve as a basis for exploring dimensional approaches in other areas. Accordingly, the volume opens with a presentation of 18 proposals for dimensional models and proceeds with provocative contributions on a number of related issues ranging from hard science to clinical practice. Among the topics addressed are Behavioral and molecular genetic research supporting an etiologically informed dimensional classification of personality disorders The as-yet tenuous associations between dimensional trait measures of personality as contained in the models of Cloninger, Depue, and Siever-Davis, and specific neurobiological measures, as examined inneurotransmitter research Potential links between childhood and adolescent temperament and personality dimensions and adult personality psychopathology Studies examining the covariation of personality dimensions across cultures The continuity of Axis I and Axis II disorders and a proposed hierarchical structure of mental disorders that integrates the psychopathology of Axis I disorders with specific personality traits The dual challenges of coverage and cutoffs that must be addressed if dimensional models are to be considered viable alternatives to the existing categorical diagnostic system

Although the editors acknowledge that concerns are certain to be raised regarding conversion to a dimensional classification& mdash;such as the disruption to clinical practice by a radical shift in diagnosing personality disorder& mdash;these papers make a strong case for opening the field to alternative ways of enhancing clinical utility and improving the validity of basic classification concepts. Together, they offer stimulating insight into how we approach personality disorders, with the hope of encouraging a new model of diagnosis for DSM-V.