Future of the DSM: Revisiting Functioning and Social Determinants of Mental Health-View Presentation

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The American Psychiatric Association's Division of Research is spearheading the development of the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Recognizing rapid scientific advances and critical feedback on the DSM-5, the steering committee aims to evolve psychiatric nosology by integrating neuroscience, biomarkers, social determinants of health, culture, development, functioning, and quality of life into a living, continuously updated document.<br /><br />Four subcommittees address key domains: DSM structure and dimensions; functioning and quality of life; biomarkers and biological factors; and social determinants of mental health, including intersectionality. The Functioning and Quality of Life subcommittee highlights the importance of assessing these factors as integral to diagnosis, recommending standardized instruments like the 12-item WHO Disability Assessment Schedule (WHO-DAS) and Work and Social Adjustment Scale (WSAS), alongside person-centered approaches. Challenges include brief yet valid measures usable across cultures and settings.<br /><br />The Social Determinants subcommittee emphasizes addressing modifiable social factors (e.g., income, housing, discrimination) crucial for secondary and tertiary prevention, linking social needs with clinical care. Intersectionality’s role in understanding individual patient contexts is also underscored. The group stresses needing practical, scalable assessments and the importance of systemic and community partnerships.<br /><br />Panel discussions tackled issues such as measurement challenges over time, the interface between DSM and ICD classification systems, incorporation into clinical workflows and insurance frameworks, and the complexities of integrating social determinants without pathologizing patients. The initiative seeks wide stakeholder input, prioritizing feasibility, cultural sensitivity, and clinical utility. The DSM’s future edition is planned to be a nimble, data-driven tool reflecting contemporary science and patient-centered care principles, with ongoing revisions informed by continuous feedback.

Keywords

DSM revision

American Psychiatric Association

psychiatric nosology

neuroscience integration

biomarkers

social determinants of health

cultural sensitivity

quality of life assessment

WHO Disability Assessment Schedule

Work and Social Adjustment Scale

intersectionality

clinical workflow integration

continuous updates