1) DSM-5 is primarily intended to be a manual to be used by clinicians, and revisions must
be feasible for routine clinical practice; 2)  recommendations for revisions should be guided
by research evidence; 3) where possible, co ntinuity should be maintained with previous
editions of DSM; and 4) no a priori constraints should be placed on the degree of change
between DSM-IV and DSM-5. 
Building on the initial lite rature reviews, work groups identified key issues within
their diagnostic areas. Work  groups also examined broa der methodological concerns,
such as the presence of contra dictory findings within the literature; development of a re-
fined definition of mental disorder; cross-cutting issues relevant to all disorders; and the
revision of disorders categorized in DSM-IV as “not otherwise specified.” Inclusion of a
proposal for revision in Section II was informed by consideration of its advantages and
disadvantages for public health and clinical ut ility, the strength of the evidence, and the
magnitude of the change. New diagnoses and d isorder subtypes and specifiers were sub-
ject to additional stipulations, such as demons tration of reliability (i.e., the degree to which
two clinicians could independently arrive at the same diagnosis for a given patient). Dis-
orders with low clinical utility and weak valid ity were considered for deletion. Placement
of conditions in “Conditions for Further Study” in Section III was contingent on the
amount of empirical evidence generated on the diagnosis, diagnostic reliability or valid-
ity, presence of clear clinical need, an d potential benefit in advancing research.
DSM-5 Field Trials
The use of field trials to empirically demonstrat e reliability was a noteworthy improvement in-
troduced in DSM-III. The design and implemen tation strategy of the DSM-5 Field Trials rep-