australian university criticized the dsm-5 for having poor cultural diversity, stating that recent work done in cognitive sciences and cognitive anthropology is still only accepting western psychology as the norm. dsm-5 includes a section on how to conduct a "cultural formulation interview", which gives information about how a person's cultural identity may be affecting expression of signs and symptoms. the goal is to make more reliable and valid diagnoses for disorders subject to significant cultural variation. financial conflicts of interest and perverse dependencies the financial association of dsm-5 panel members with industry continues to be a concern for financial conflict of interest. of the dsm-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of dsm-iv task force members. although the apa has since instituted a disclosure policy for dsm-5 task force members, many still believe the association has not gone far enough in its efforts to be transparent and to protect against industry influence. in a 2009 point/counterpoint article, lisa cosgrove, phd and harold j. bursztajn, md noted that "the fact that 70% of the task force members have reported direct industry ties—an increase of almost 14% over the percentage of dsm-iv task force members who had industry ties—shows that disclosure policies alone, especially those that rely on an honor system, are not enough and that more specific safeguards are needed". the role of the dsm-5 in protecting the interests of wealthy and politically powerful owners of the means of production in the united states has been criticized as well. placing the blame for predictable and common psychological distress caused by the deleterious effects of economic inequality in the united states on individuals by attributing it to mental pathology has been criticized as hindering change of the root causes of the distress. the dsm-5's expansive criteria that attribute mental pathology to people with distress or impairment from a wide-ranging constellation of experiences has been criticized for pathologizing an unhelpful number of people that a psychiatric diagnosis is not benefical for. medical education the national board of medical examiners (nbme) which is responsible for creating and publishing board exams for medical students around the united states conforms to the use of dsm-5 criteria despite the known problems with an unquestioning checklist approach to diagnosis and treatment based on the dsm that have been outlined by critics. borderline personality disorder controversy in 2003, the treatment and research advancements national association for personality disorders (tara-apd) campaigned to change the name and designation of borderline personality disorder in dsm-5. the paper how advocacy is bringing bpd into the light reported that "the name bpd is confusing, imparts no relevant or descriptive information, and reinforces existing stigma." instead, it proposed the name "emotional regulation disorder" or "emotional dysregulation disorder." there was also discussion about changing borderline personality disorder, an axis ii diagnosis (personality disorders and mental retardation), to an axis i diagnosis (clinical disorders). the tara-apd recommendations do not appear to have affected the american psychiatric association, the publisher of the dsm. as noted above, the dsm-5 does not employ a multi-axial diagnostic scheme, therefore the distinction between axis i and ii disorders no longer exists in the dsm nosology. the name, the diagnostic criteria for, and description of, borderline personality disorder remain largely unchanged from dsm-iv-tr. british psychological society response the british psychological society stated in its june 2011 response to dsm-5 draft versions, that it had "more concerns than plaudits". it criticized proposed diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements... not value-free, but rather reflect current normative social expectations", noting doubts over the reliability, validity, and value of existing criteria, that personality disorders were not normed on the general population, and that "not otherwise specified" categories covered a "huge" 30% of all personality disorders. it also expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences... which demand helping responses, but which do not reflect illnesses so much as normal individual variation". the society suggested as its primary specific recommendation, a change from using "diagnostic frameworks" to a description based on an individual's specific experienced problems, and that mental disorders are better explored as part of a spectrum shared with normality: a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are the most strongly-evidenced causal factors. rather than applying preordained diagnostic categories to clinical populations, we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or 'symptoms' or 'complaints'... we would like to see the base unit of measurement as specific problems (e.g. hearing voices, feelings of anxiety etc.)? these would be more helpful too in terms of epidemiology. while some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their problems are recognised (in both senses of the word) understood, validated, explained (and explicable) and have some relief. clients often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. since – for example – two people with a diagnosis of 'schizophrenia' or 'personality disorder' may possess no two symptoms in common, it is difficult to see what communicative benefit is served by using these diagnoses. we believe that a description of a person's real problems would suffice. moncrieff and others have shown that diagnostic labels are less useful than a description of a person's problems for predicting treatment response, so again diagnoses seem positively unhelpful compared to the alternatives.— british psychological society, june 2011 responsemany of the same criticisms also led to the development of the hierarchical taxonomy of psychopathology, an alternative, dimensional framework for classifying mental disorders. national institute of mental health national institute of mental health director thomas r. insel, md, wrote in an april 29, 2013 blog post about the dsm-5: the goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. while dsm has been described as a "bible" for the field, it is, at best, a dictionary, creating a set of labels and defining each. the strength of each of the editions of dsm has been "reliability" – each edition has ensured that clinicians use the same terms in the same ways. the weakness is its lack of validity ... patients with mental disorders deserve better. insel also discussed an nimh effort to develop a new classification system, research domain criteria (rdoc), currently for research purposes only. insel's post sparked a flurry of reaction, some of which might be termed sensationalistic, with headlines such as "goodbye to the dsm-v", "federal institute for mental health abandons controversial 'bible' of psychiatry", "national institute of mental health abandoning the dsm", and "psychiatry divided as mental health 'bible' denounced". other responses provided a more nuanced analysis of the nimh director's post. in may 2013, insel, on behalf of nimh, issued a joint statement with jeffrey a. lieberman, md, president of the american psychiatric association, that emphasized that dsm-5 "... represents the best information currently available for clinical diagnosis of mental disorders. patients, families, and insurers can be confident that effective treatments are available and that the dsm is the key resource for delivering the best available care. the national institute of mental health (nimh) has not changed its position on dsm-5." insel and lieberman say that dsm-5 and rdoc "represent complementary, not competing, frameworks" for characterizing diseases and disorders. however, epistemologists of psychiatry tend to see the rdoc project as a putative revolutionary system that in the long run will try to replace the dsm, its expected early effect being a liberalization of the research criteria, with an increasing number of research centers adopting the rdoc definitions.