Focus: The importance of diagnosis
Vol. 37 No. 1 (2026)
https://doi.org/10.4081/rp.2026.1141

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision: through tradition and change. Critical analysis and clinical implications

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Published: 30 April 2026
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DSM-5, psychiatry, psychiatric nosography, diagnosis

Authors

Fabio Di Fabio
fabio.difabio@uniroma1.it
Policlinico Umberto I, Rome; Department of Neurosciences and Mental Health, Sapienza University of Rome, Italy.
Antonella Moschillo
ASL Roma 5, Tivoli (RM); Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Italy.

Today, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5) is a central point of reference in contemporary psychiatry, not only as a diagnostic manual but also as a device that structures access to care, clinical language, and patient understanding. This article takes a critical look at the main changes, highlighting the continuity with previous editions and the conceptual transformations that have been introduced. The history of the DSM shows that there is tension between the search for diagnostic reliability, the simplification of observable symptoms, and the complexity of the subjective experience. The DSM-5-TR introduces significant updates: the inclusion of prolonged grief disorder, the revision of race and gender language, the expansion of unspecified mood disorders, and the redefinition of intellectual disability and functional neurological symptom disorders, as well as the self-coding of suicidal and self-harming behavior. These changes reflect an orientation toward a psychiatry that is more sensitive to cultural and social contexts, while maintaining priority over standardization and diagnostic replicability. The manual, while not revolutionizing the paradigm, continuously calibrates the boundary between normality and pathology; the text is analyzed with a critical eye, highlighting its limitations and potential, and encouraging a more contemplative use in clinical practice and patient care.

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The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision: through tradition and change. Critical analysis and clinical implications. (2026). Ricerca Psicoanalitica, 37(1). https://doi.org/10.4081/rp.2026.1141
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