The Impact of the DSM-5’s Dimensional Classification System on Social Security Disability Insurance and Supplement Security Income Rolls

The publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is expected in May 2013. Preliminary information from DSM work groups indicates that there will be substantial changes in the criteria for some diagnoses, reorganization of old and introduction of new diagnoses, and inclusion of dimensional severity ratings for most diagnoses. These changes may represent a critical challenge to disability evaluation for several reasons. First, some argue that base rates of mental disorders will concomitantly increase because individuals with less severe disorders can receive a diagnosis. Second, the reorganization of disorders, such as the neurocognitive disorders, will change the meaning and perception of functioning that we might attach to a diagnosis. Third, the proposed addition of dimensional severity ratings will provide information that was not included before and how that information is used can impact the disability determination process. The current study examines various mental disorders representative of nine broad categories based on the Social Security Administration’s “Disability Evaluation Under Social Security”. In order to address the question of the impact of DSM-5 on SSA’s disability determination, a systematic literature review was performed. The specific changes in diagnostic criteria reveals that some disorders will have limited impact on base rates whereas others may significantly impact prevalence rates as well as conceptualizations of some disorders. Furthermore, dimensional severity ratings can provide important information regarding the extent of an individual’s functional impairment and, in some cases, can significantly predict morbidity score better than the categorical diagnosis alone.