The presentation of the new version of the DSM-5 during the annual meeting of the American Psychiatric Association, in San Francisco, California, in May of 2013 was preceded by a strong controversy, where not only the scientific community intervened but also the printed and digital media. Through these media, the general public also witnessed an unprecedented situation in the development of psychiatry: just as participation of the scientific community had been paradigmatic in the DSM-IV, for the DSM-5 an attempt was made for the diffusion of the broadest spectrum, taking advantage of the resources offered by the globalization in information technology subjects. Not only common people were being informed, but they also had the opportunity to express their points of view through social media, web sites of specialized publications and of digital newspapers or magazines.

Despite the aforementioned, not all information was disclosed and many points remained in the shadows that put into question the way in which the process of creating the manual was carried out. In addition to the positive aspects of the fifth version of the DSM, diverse opinions regarding the limitations of the instrument, roughly illustrated, were being made public.

The process of reviewing and updating the manual began 1 year after the appearance of the DSM-IVR. From 1999 to 2007, the necessary material was collected and the research was designed that would support the new version. Thirteen teams were formed with a total of more than 400 psychiatrists. Twenty diagnostic groups and six study groups in which 1,200 psychiatrists from six subspecialties and 4,000 doctors from six medical specialties took part. The total cost of the project rose to $25 million dollars.

A pilot test was conducted in 2010 and the proposals of the teams were reviewed.

In the following year proposals related to the criteria, the proposed diagnostic spectra, and the dimensional measures were revised. In 2012, the final draft of the text was prepared and following several revisions, was approved in May 2013 [3].

It would seem that the “rivalry” initiated with the ICD-6 is close to ending. Part of the effort in drafting the DSM-5 was the purpose of finding lines of greater convergence with the future ICD-11 [9], through a rating that holds a certain parallelism and allows an eventual mid-term unification, which goes far beyond the numerical codes. However, not all experts are optimistic about this [10].

The approach has been sought for DSM-5, where research—and the results—are taken into a greater scope, makes it presumably that in this field it has a wider use. This situation could create the low use of the DSM in clinical practice. The correlation between the use of DSM and ICD will be discussed in the Disadvantages section.

The technological advances, which have largely contributed to the emergence, development, and acceleration of globalization, and the effect these developments have had on individuals, society, and culture in general, have also been taken into account in the DSM-5 [11]. The pace of life, which has increased as the twenty-first century advances, is also etiological of pathologies. New disorders caused by these two fronts are opening a space in the new nosological classifications, although this situation has not been without difficulties [12].

Earlier versions of the DSM in Spanish were translations made in Europe, which had more than a few drawbacks derived from the semantic adaptations and the translation of the codes, and the comparison with those of the ICD, in particular the DSM-IV and the ICD-10 [13]. This time, the DSM-5 in Spanish depends directly on the APA, which hired professional translators for both the breviary of the diagnostic criteria of the DSM-5 as well as for the whole manual.

The trend in the versions of the DSM has been to organize groups of criteria which better include the psychopathological characteristics of individuals suffering a mental illness. Some diagnostic criteria contents in the DSM-IVR were, however, too large or were difficult to recall; for example, those of the major depressive disorders [14]. Efforts were made in this sense for the DSM-5, although with only relative success.

It is very positive that the updating of mental disorders has had an inclusive and participatory design [15] as an extension of the impulse on previous work in the DSM precursors. In this sense, the DSM-5 is no worse than the DSM-IV [16].

The presence of field tests, developed in a clinical and academic environment, led by a good number of randomly selected professionals, is one of the predictable guarantees of the manual. In addition, the 11 medical centers chosen to make the protocols in the United States and Canada [17] give reassurance about the results the enormity of this work.

However, there is a concern that cannot be proven: the result of the work of these teams who conducted the field trials depended not so much on their efforts and their personal and professional qualities as the design of the protocols and the previous work on the proposed diagnostic criteria that were proposed: If there were levity in these circumstances, the risks of false positives and negatives would be multiplied (mainly the false positives) and the field trials would shed more distortions than certainties.

Unfortunately, there are indications in this sense: the dates of submission of the findings were postponed more than once, the availability of electronic data is limited, an environment of limited information was experienced, as well as secrecy, concealment, and dissimulation which do not allow sharing the enthusiasm with which the DSM-5 had been received. Some of the issues that are at the basis of this skepticism are described below.

Visit http://​www.​DSM5.​org/​Research/​Pages/​DSM-5FieldTrials.​aspx; when trying to access “To read the studies in AJP in Advance, click on their titles: DSM-5 Field Trials in the United States and Canada, Part I: Study Design, Sampling Strategy, Implementation; DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses and Analytic Approaches; DSM-5 Field Trials in the United States and Canada, Part III: Development and Reliability Testing of a Cross-Cutting Symptom Assessment for DSM-5”, the result is: http://​www.​ajp.​psychiatryonline​.​org/​error404.​aspx?​aspxerrorpath=​/​Errors/​404.​aspx.

One phenomenon that has attracted the most attention is the presence of Allen Frances at the head of the diehard critics of the DSM-5. Phrases like “Many of the changes included in the DSM-5 are clearly unreliable and scientifically flawed”; “Some of the decisions included in the DSM-5 are not only not supported by scientific evidence but even defy common sense”, in addition to the presentation of a list of the ten errors which—in his opinion—the new manual has [18]. See Table 6.3.

Pressure from the media was the reason that some of the changes proposed by the teams and some new “pathologies” were not taken into account in the final draft. There is no certainty as to the scientific support that the DSM-5 experts had, not even to include or discard them [18]. See Table 6.4.