Why Is Psychiatry's New Manual So Much Like The Old One?

 The American Psychiatric Association is about to release an updated version of its Diagnostic and Statistical Manual of Mental Disorders. The DSM helps mental health professionals decide who has problems such as depression, anxiety and schizophrenia. Psychiatry's new manual, DSM-5, has been nearly 20 years in the making. During that time, scientists have learned a lot about the brain. Yet despite some tweaks to categories such as autism and mood disorders, DSM-5 is remarkably similar to the version issued in 1994. "There are lots of changes throughout the manual that reflect the research in the last 20 years," says Michael First, a clinical psychiatrist at Columbia University who was involved in creating both DSM-IV and DSM-5. (The APA abandoned Roman numerals for the new manual.) "But because that kind of research hasn't allowed for a paradigm shift, the DSM is not a paradigm shift either," First says.