ment. Need for treatment is a complex clinic al decision that takes into consideration
symptom severity, symptom salience (e.g., the pr esence of suicidal ideation), the patient’s
distress (mental pain) associated with the sy mptom(s), disability related to the patient’s
symptoms, risks and benefits of available trea tments, and other factors (e.g., psychiatric
symptoms complicating other illness). Clinicians may thus encounter individuals whose
symptoms do not meet full crit eria for a mental disorder bu t who demonstrate a clear need
for treatment or care. The fact that some in dividuals do not show all symptoms indicative
of a diagnosis should not be used to justify limiting their access to appropriate care.
Approaches to validating diagnostic criteria  for discrete categorical mental disorders
have included the following types of evidence: antecedent validators (similar genetic mark-
ers, family traits, temperament, and environmen tal exposure), concurrent validators (simi-
lar neural substrates, biomarkers, emotional and cognitive processing, and symptom
similarity), and predictive validators (simila r clinical course and treatment response). In
DSM-5, we recognize that the current diagnostic criteria for any single disorder will not nec-
essarily identify a homogeneous group of patients who can be characterized reliably with all
of these validators. Available evidence shows that these va lidators cross existing diagnostic
boundaries but tend to congregate more frequently within  and across adjacent DSM-5 chap-
ter groups. Until incontrovertible etiological or pathophysiological mechanisms are identi-
fied to fully validate specific disorders or disorder spectra, the most important standard for
the DSM-5 disorder criteria will be their clin ical utility for the assessment of clinical course
and treatment response of individuals groupe d by a given set of diagnostic criteria.