Commentary ajp.psychiatryonline.org The Conceptual Development of DSM-V

Over the past 30 years, there has been a continuous testing of multiple hypotheses that are inherent in the Diagnostic and Statistical Manual of Mental Disorders, from the third edition (DSM-III) (1) to the fourth (DSM-IV) (2). Although DSM-III was the first of-ficial classification of APA to embrace these hypotheses, their intellectual origin is more properly attributed to Eli Robins and Samuel Guze’s landmark 1970 article on the estab-lishment of diagnostic validity in psychiatric illness (3) and the subsequent 1972 release of the St. Louis “Feighner diagnostic criteria ” (4). These formed the basis for the 1978 Research Diagnostic Criteria (RDC) (5), which were used in the longitudinal collabora-tive study on the psychobiology of depression supported by the National Institute of Mental Health (NIMH) (6) and ultimately were the prototypical diagnoses adopted in DSM-III in 1980. The expectation of Robins and Guze (3) was that each clinical syndrome described in the Feighner criteria (4), RDC (5), and DSM-III (1) would ultimately be validated by its separation from other disorders, common clinical course, genetic aggregation in fami-lies, and further differentiation by future laboratory tests—which would now includ