ical clarification issues for criteria that ha d not yet accumulated the type or level of evi-
dence deemed sufficient for change by the SRC. This review process was particularly
important for DSM-IV disorders with known deficiencies for whic h proposed remedies
had neither been previously considered in the DSM revision process nor been subjected to
replicated research studies. These selected d isorders were evaluated by four to five exter-
nal reviewers, and the blinded results were  reviewed by CPHC members, who in turn
made recommendations to the APA Boar d of Trustees and the work groups. 
Forensic reviews by the members of the APA Council on Psychiatry and Law were con-
ducted for disorders frequently appearing in forensic environments and ones with high
potential for influencing civil and criminal judgments in courtroom settings. Work groups
also added forensic experts as advisors in pertinent areas to complement expertise pro-
vided by the Council on Psychiatry and Law. 
The work groups themselves were charged with the responsib ility to review the entire re-
search literature surrounding a diagnostic area, including old, revised, and new diagnostic cri-
teria, in an intensive 6-year re view process to assess the pros and cons of making either small
iterative changes or major conceptual changes to  address the inevitable reification that occurs
with diagnostic conceptual approaches that pe rsist over several decades. Such changes in-
cluded the merger of previously separate diagno stic areas into more dimensional spectra, such
as that which occurred with autism spectrum disorder, substance use disorders, sexual dys-
functions, and somatic symptom and related di sorders. Other changes included correcting
flaws that had become apparent over time in th e choice of operational criteria for some disor-
ders. These types of changes po sed particular challenges to the SRC and CPHC review pro-