Why Global Integration Is Essential for the Future of DSM

Why Global Integration Is Essential for the Future of DSM

As the American Psychiatric Association begins early planning for the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM),1 John J. Miller, MD, editor-in-chief of Psychiatric Times, is raising a fundamental question for psychiatrists as the field looks ahead to the next iteration: Should the DSM remain a US-centered diagnostic manual or evolve into a truly global classification system?

“It makes sense to me to work with the World Health Organization (WHO) and actually integrate or transition DSM into the next iteration of the [International Classification of Diseases] ICD, which will be the ICD-12,” Miller commented in a recent video interview with Psychiatric Times. The video marks the third in a series reflecting on the APA’s announcements outlining the future of the DSM.

How the APA Is Rethinking the Structure of the Future DSM

One recommendation from the DSM workgroup that Miller strongly endorsed was the proposal to add a section on “contextual factors.” This section would include socioeconomic factors, cultural factors, and environmental factors, reflecting a broader understanding of how mental illness presents and is treated in real-world clinical settings.

Miller highlighted the paper, “The Future of DSM: A Report from the Structure and Dimensions Subcommittee,” which is 1 of the 5 that were released from the APA regarding plans for a new addition.^2-6 Interesting, he noted of the 14 authors, most are from the United States but 2 bring in international diversity, representing Canada and the Netherlands. “This makes sense because the American Psychiatric Association is obviously a United States organization,” he said, “but this fact will come into play when I talk about my own opinion, my own thoughts and reflections about how the DSM-5TR should evolve into its next version.”

Why DSM–ICD Alignment Is Emerging as a Central Issue
Miller also drew attention to a growing disconnect between the DSM and the ICD. DSM-5-TR , which was released in 2022, currently uses ICD-10 codes. Coincidentally, the WHO released ICD-11 in 2022. “The timing was unfortunate,” Miller said, noting that a commentary in the Journal of the American Medical Association estimated the United States may not transition to ICD-11 until at least 2027.

The disconnect between the 2 manuals highlights structural differences between a US-based diagnostic manual and a global classification system used across medical specialties worldwide.

Miller noted the importance of ICD-11, which he explained was developed by experts “from 55 countries around the world, from 300 different specialists,” and contains “well over 15,000 different diagnoses.” Miller emphasized that the ICD already serves as the global diagnostic standard for all other medical conditions.

For psychiatry, integration could carry both practical and symbolic weight. “The advantage of this is we’re moving from a United States-based manual to a world-based manual,” Miller explained, adding that integration into ICD-12 could help reduce stigma. “It’s another step in the direction of destigmatizing mental illness.”

Dr Miller is Medical Director, Brain Health, Exeter, New Hampshire; Editor in Chief, Psychiatric Times; Voluntary Consulting Psychiatrist at Seacoast Mental Health Center, Exeter/Portsmouth, NH; Consulting Psychiatrist, Insight Meditation Society, Barre, Massachusetts.

What do you want to see addressed in the next version of DSM? Send your video short reactions to PTEditor@mmhgroup.com.

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References

1. Duerr HA. A New and Improved DSM? The American Psychiatric Association Shares Strategy and Roadmap. Psychiatric Times. January 28, 2026. Accessed February 5, 2026. https://www.psychiatrictimes.com/view/a-new-and-improved-dsm-the-american-psychiatric-association-shares-strategy-and-roadmap

2. Oquendo MA, Abi-Dargham A, Alpert JE et al. Initial strategy for the future of the DSM. Am J Psychiatry. 2026 Jan 28:appiajp20250878.

3. Ongur D, Abi-Dargham A, Clarke DE, et al. The future of the DSM: Areport from the structure and dimensions subcommittee. Am J Psychiatry. 2026 Jan 28:appiajp20250876.

4. Wainberg ML, Alpert JE, Benton TD, et al. The future of DSM: A strategic vision for incorporating socioeconomic, cultural, and environmental determinants and intersectionality. Am J Psychiatry. 2026 Jan 28:appiajp20250875.

5. Drexler K, Alpert JE, Benton TD, et al. The future of DSM: Are functioning and quality of life essential elements of a complete psychiatric diagnosis? Am J Psychiatry. 2026 Jan 28:appiajp20250874.

6. Cuthbert B, Ajilore O, Alpert JE, et al. The future of DSM: Role of candidate biomarkers and biological factors. Am J Psychiatry. 2026 Jan 28:appiajp20250877.