adolescents and adults that are appropriate for varying developmental states are added. subtypes of gender identity disorder based on sexual orientation were deleted. among other wording changes, criterion a and criterion b (cross-gender identification, and aversion toward one's gender) were combined. along with these changes comes the creation of a separate gender dysphoria in children as well as one for adults and adolescents. the grouping has been moved out of the sexual disorders category and into its own. the name change was made in part due to stigmatization of the term "disorder" and the relatively common use of "gender dysphoria" in the gid literature and among specialists in the area. the creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing and ability to express it in the event that they have insight. disruptive, impulse-control, and conduct disorders some of these disorders were formerly part of the chapter on early diagnosis, oppositional defiant disorder; conduct disorder; and disruptive behavior disorder not otherwise specified became other specified and unspecified disruptive disorder, impulse-control disorder, and conduct disorders. intermittent explosive disorder, pyromania, and kleptomania moved to this chapter from the dsm-iv chapter "impulse-control disorders not otherwise specified". antisocial personality disorder is listed here and in the chapter on personality disorders (but adhd is listed under neurodevelopmental disorders). symptoms for oppositional defiant disorder are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. the conduct disorder exclusion is deleted. the criteria were also changed with a note on frequency requirements and a measure of severity. criteria for conduct disorder are unchanged for the most part from dsm-iv. a specifier was added for people with limited "prosocial emotion", showing callous and unemotional traits. people over the disorder's minimum age of 6 may be diagnosed with intermittent explosive disorder without outbursts of physical aggression. criteria were added for frequency and to specify "impulsive and/or anger based in nature, and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences". substance-related and addictive disorders gambling disorder and tobacco use disorder are new. substance abuse and substance dependence from dsm-iv-tr have been combined into single substance use disorders specific to each substance of abuse within a new "addictions and related disorders" category. "recurrent legal problems" was deleted and "craving or a strong desire or urge to use a substance" was added to the criteria. the threshold of the number of criteria that must be met was changed and severity from mild to severe is based on the number of criteria endorsed. criteria for cannabis and caffeine withdrawal were added. new specifiers were added for early and sustained remission along with new specifiers for "in a controlled environment" and "on maintenance therapy". there are no more polysubstance diagnoses in dsm-5; the substance(s) must be specified. neurocognitive disorders dementia and amnestic disorder became major or mild neurocognitive disorder (major ncd, or mild ncd). dsm-5 has a new list of neurocognitive domains. "new separate criteria are now presented" for major or mild ncd due to various conditions. substance/medication-induced ncd and unspecified ncd are new diagnoses. personality disorders personality disorder (pd) previously belonged to a different axis than almost all other disorders, but is now in one axis with all mental and other medical diagnoses. however, the same ten types of personality disorder are retained. there is a call for the dsm-5 to provide relevant clinical information that is empirically based to conceptualize personality as well as psychopathology in personalities. the issue(s) of heterogeneity of a pd is problematic as well. for example, when determining the criteria for a pd it is possible for two individuals with the same diagnosis to have completely different symptoms that would not necessarily overlap. there is also concern as to which model is better for the dsm - the diagnostic model favored by psychiatrists or the dimensional model that is favored by psychologists. the diagnostic approach/model is one that follows the diagnostic approach of traditional medicine, is more convenient to use in clinical settings, however, it does not capture the intricacies of normal or abnormal personality. the dimensional approach/model is better at showing varied degrees of personality; it places emphasis on the continuum between normal and abnormal, and abnormal as something beyond a threshold whether in unipolar or bipolar cases. paraphilic disorders new specifiers "in a controlled environment" and "in remission" were added to criteria for all paraphilic disorders. a distinction is made between paraphilic behaviors, or paraphilias, and paraphilic disorders. all criteria sets were changed to add the word disorder to all of the paraphilias, for example, pedophilic disorder is listed instead of pedophilia. there is no change in the basic diagnostic structure since dsm-iii-r; however, people now must meet both qualitative (criterion a) and negative consequences (criterion b) criteria to be diagnosed with a paraphilic disorder. otherwise they have a paraphilia (and no diagnosis). section iii: emerging measures and models it includes dimensional measures for the assessment of symptoms, criteria for the cultural formulation of disorders and an alternative proposal for the conceptualization of personality disorders, as well as a description of the currently studied clinical conditions. it presents selected tools and research techniques focused on diagnosis, taking into account the sociocultural context, and also presents a hybrid-dimensional-categorical model of personality disorders. specific personalities (antisocial, borderline, avoidant, narcissistic, obsessive-compulsive, schizotypal) and non-specific disorders were distinguished. conditions for further study these conditions and criteria are set forth to encourage future research and are not meant for clinical use. attenuated psychosis syndrome depressive episodes with short-duration hypomania persistent complex bereavement disorder caffeine use disorder internet gaming disorder neurobehavioral disorder associated with prenatal alcohol exposure suicidal behavior disorder non-suicidal self-injury development in 1999, a dsm-5 research planning conference, sponsored jointly by apa and the national institute of mental health (nimh), was held to set the research priorities. research planning work groups produced "white papers" on the research needed to inform and shape the dsm-5 and the resulting work and recommendations were reported in an apa monograph and peer-reviewed literature. there were six workgroups, each focusing on a broad topic: nomenclature, neuroscience and genetics, developmental issues and diagnosis, personality and relational disorders, mental disorders and disability, and cross-cultural issues. three additional white papers were also due by 2004 concerning gender issues, diagnostic issues in the geriatric population, and mental disorders in infants and young children. the white papers have been followed by a series of conferences to produce recommendations relating to specific disorders and issues, with attendance limited to 25 invited researchers. on july 23, 2007, the apa announced the task force that would oversee the development of dsm-5. the dsm-5 task force consisted of 27 members, including a chair and vice chair, who collectively represent research scientists from psychiatry and other disciplines, clinical care providers, and consumer and family advocates. scientists working on the revision of the dsm had a broad range of experience and interests. the apa board of trustees required that all task force nominees disclose any competing interests or potentially conflicting relationships with entities that have an interest in psychiatric diagnoses and treatments as a precondition to appointment to the task force. the apa made all task force members' disclosures available during the announcement of the task force. several individuals were ruled ineligible for task force appointments due to their competing interests. the dsm-5 field trials included test-retest reliability which involved different clinicians doing independent evaluations of the same patient—a common approach to the study of diagnostic reliability. about 68% of dsm-5 task-force members and 56% of panel members reported having ties to the pharmaceutical industry, such as holding stock in pharmaceutical companies, serving as consultants to industry, or serving on company boards. revisions and updates beginning with the fifth edition, it is intended that diagnostic guideline revisions will be added incrementally. the dsm-5 is identified with arabic rather than roman numerals, marking a change in how future updates will be created. incremental updates will be identified with decimals (dsm-5.1, dsm-5.2, etc.), until a new edition is written. the change reflects the intent of the apa to respond more quickly when a preponderance of research supports a specific change in the manual. the research base of mental disorders is evolving at different rates for different disorders. criticism general robert spitzer, the head of the dsm-iii task force, publicly criticized the apa for mandating that dsm-5 task force members sign a nondisclosure agreement, effectively conducting the whole process in secret: "when i first heard about this agreement, i just went bonkers. transparency is necessary if the document is to have credibility, and, in time, you're going to have people complaining all over the place that they didn't have the opportunity to challenge anything." allen frances, chair of the dsm-iv task force, expressed a similar concern. david kupfer, chair of the dsm-5 task force, and darrel a. regier, md, mph, vice chair of the task force, whose industry ties are disclosed with those of the task force, countered that "collaborative relationships among government, academia, and industry are vital to the current and future development of pharmacological treatments for mental disorders". they asserted that the development of dsm-5 is the "most inclusive and transparent developmental process in the 60-year history of dsm". the developments to this new version can be viewed on the apa website. during periods of public comment, members of the public could sign up at the dsm-5 website and provide feedback on the various proposed changes. in june 2009, allen frances issued strongly worded criticisms of the processes leading to dsm-5 and the risk of "serious, subtle, ubiquitous" and "dangerous" unintended consequences such as new "false 'epidemics'". he writes that "the work on dsm-v has displayed the most unhappy combination of soaring ambition and weak methodology" and is concerned about the task force's "inexplicably closed and secretive process". his and spitzer's concerns about the contract that the apa drew up for consultants to sign, agreeing not to discuss drafts of the fifth edition beyond the task force and committees, have also been aired and debated. the appointment, in may 2008, of two of the taskforce members, kenneth zucker and ray blanchard, led to an internet petition to remove them. according to msnbc, "the petition accuses zucker of having engaged in 'junk science' and promoting 'hurtful theories' during his career, especially advocating the idea that children who are unambiguously male or female anatomically, but seem confused about their gender identity, can be treated by encouraging gender expression in line with their anatomy." according to the gay city news, "dr. ray blanchard, a psychiatry professor at the university of toronto, is deemed offensive for his theories that some types of transsexuality are paraphilias, or sexual urges. in this model, transsexuality is not an essential aspect of the individual, but a misdirected sexual impulse." blanchard responded, "naturally, it's very disappointing to me there seems to be so much misinformation about me on the internet. my views, they completely reversed my views." zucker "rejects the junk-science charge, saying there 'has to be an empirical basis to modify anything' in the dsm. as for hurting people, 'in my own career, my primary motivation in working with children, adolescents and families is to help them with the distress and suffering they are experiencing, whatever the reasons they are having these struggles. i want to help people feel better about themselves, not hurt them.'" in 2011, psychologist brent robbins co-authored a national letter for the society for humanistic psychology that brought thousands into the public debate about the dsm. approximately 13,000 individuals and mental health professionals signed a petition in support of the letter. thirteen other american psychological association divisions endorsed the petition. in a november 2011 article about the debate in the san francisco chronicle, robbins notes that under the new guidelines, certain responses to grief could be labeled as pathological disorders, instead of being recognized as being normal human experiences. in 2012, a footnote was added to the draft text which explains the distinction between grief and depression. the dsm-5 has been criticized for purportedly saying nothing about the biological underpinnings of mental disorders. a book-long appraisal of the dsm-5, with contributions from philosophers, historians and anthropologists, was published in 2015. a 2015 essay from an