Updating the DSM: Reviewing the New APA DSM Recommendations

John J. Miller, MD, editor in chief of Psychiatric Times, discussed the recent American Psychiatric Association (APA) release of 5 publications outlining an initial framework and recommendations for development of the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). He reviewed the historical context of the DSM, noting its first publication in 1951, the release of DSM-5 in 2013 with major revisions from DSM-IV, and the DSM-5-TR in 2022, which currently serves as the working manual and incorporates ICD-10 billing codes. In 2024, the APA Board of Trustees established the Future DSM Strategic Committee in recognition of rapid scientific and clinical changes affecting psychiatry.

Miller explained that the publications proposed 4 domains to serve as a potential organizing template for the next DSM. The first domain, contextual factors, encompassed medical comorbidities, socioeconomic variables, cultural and environmental influences, developmental and functional considerations, and patient-reported quality of life. The second domain focused on biomarkers and biological factors, which were acknowledged as early but increasingly important contributors to diagnosis, monitoring, and understanding the etiology of psychiatric presentations. The third domain addressed diagnoses themselves, including major diagnostic categories, primary diagnoses, severity specifiers, and associated ICD codes. The fourth domain, transdiagnostic features, captured symptoms such as anxiety that could cut across multiple diagnostic categories and co-occur due to diverse etiologies.

Miller reflected that the proposed framework evoked elements of the multiaxial system used in DSM-IV and DSM-IV-TR, which had previously been eliminated in DSM-5. He highlighted parallels between the new contextual factors domain and the former axes addressing medical comorbidities, psychosocial stressors, and global functioning. In particular, he emphasized the value of Axis V and the Global Assessment of Functioning as a longitudinal measure of patient functioning.

Further reflections from Miller on this new DSM discussion are upcoming.

References

1. APA releases roadmap for the future of the DSM. American Psychiatric Association. January 28, 2026. Accessed January 29, 2026. https://www.psychiatry.org/News-room/News-Releases/APA-Releases-Roadmap-for-Future-of-DSM

2. Oquendo MA, Abi-Dargham A, Alpert JE, et al. Initial strategy for the future of DSM. Am J Psychiatry. 2026.