Key differences from the DSM-IV and DSM-IV-TR versus the DSM-5 are provided in the next section of the manual, while the cautionary consideration for the latest DSM remains mostly unchanged.

The DSM-5 aligns nicely with the ICD-10 and ICD-11.  Codes for diagnosis may be different, but both codes are necessary for the reimbursement by insurance.  My individuals, couples and families pay out of pocket, either due to a limitation on their insurance (no mental health services covered or otherwise) or a desire to remain anonymous or outside the insurance system.  Privacy and to some extent confidentiality is waived by utilizing insurance to cover costs for services rendered.  Some individuals do decide to request billing for services rendered as medical costs deductible on taxes only.  These out of pocket expenses maintain confidentiality with regard to the diagnostics related to our work, while enabling a reduction in tax liability when tethered to additional out of pocket expense through the calendar year.

The DSM-5 attempts to shift from the mere categorization of diagnosis

The DSM-5 attempts to shift from the mere categorization of diagnosis to a more dimensional approach (P. 12-13), and retains a developmental and “lifespan” approach to the order of the manual’s topics or sections.  Considerations on cultural aspects of human behavior and gender differences refer to issues “that result from biological sex”( – individual’s reproductive organs – ) “as well as an individual’s self-representation that includes the psychological, behavioral, and social consequences of one’s perceived gender” (p. 15).  The term “Not Otherwise Specified” or NOS was previously utilized when a diagnosis did not fully meet the typical criteria provided for the disorder; this has been replaced by the term “Other Specified or Unspecified Disorders” as the terminology clinicians utilize today.


The cautionary statement included within the DSM-5 on page 25 refers to how the use of the manual is for “clinicians, public health professionals, and research investigators” rather than the needs of courts and legal professionals whom also use the manual (p. 25).