Table 1

Typology of roles of claims about societal impact (CSI) in changes in psychiatric nosology

CategoryRoleExamples
1CSI that dictate a change in language/terminology
  • ‘Mental retardation’ has been renamed ‘intellectual development disorder’.

  • ‘Gender identity disorder’ had been renamed ‘gender dysphoria’.

2CSI that add to claims about scientific evidence
  • Premenstrual dysphoric disorder's rationale noted that inclusion would help facilitate research and the development of treatments.

  • Hoarding disorder's rationale noted that inclusion would increase public awareness, improve identification of cases and stimulate research and treatment development.

  • Disruptive mood dysregulation disorder's rationale noted that inclusion would allow these severely impaired youth to have a ‘home’ in the DSM, enabling them to receive intensive attention and services, and fostering future research.

  • Neurobehavioral disorder associated with prenatal alcohol disorder's rationale noted that inclusion would help individuals with these impairments to have access to appropriate mental health services, which may help prevent delinquency, school failure and drug and alcohol abuse.

  • Caffeine use disorder's rationale noted that inclusion would increase awareness among healthcare providers and the general population that some caffeine users want to stop but cannot, which might lead to development of treatment and intervention strategies, and to more people seeking treatment.

3CSI that substitute for claims about scientific evidence
4CSI that are in tension with/subtract from scientific evidence
  • Asperger's collapse into autism spectrum disorder and concerns about loss of identity for persons with the condition.

  • Antisocial personality disorder and concerns that removing the 18 years old clause (to match all other personality disorders) would have undesirable forensic implications.

  • DSM, Diagnostic and statistical manual of mental disorders.