Introduction to the special section on DSM-5 and forensic psychiatry.

The American Psychiatric Association’s (APA) 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), marks the first substantial revision of the psychiatric diagnostic classification system since the publication of DSM-III in 1980. In recent decades, significant advances in behavioral science, neuropsychiatry, molecular genetics, neuroimaging, and other fields of research have added new and important information to the understanding of mental disorders. The DSM-5 Task Force comprised work groups of clinicians, researchers, statisticians, and others who aspired to improve the validity of mental disorder diagnoses by incorporating information from empirical studies published over the past two decades into the diagnostic schema. In this Special Section of The Journal, changes in the DSM-5 of particular importance to forensic psychiatrists are examined and discussed. The authors will present and discuss information relevant to the development of DSM-5, including its use in forensic practice, changes in the classification of specific disorders and the assessment of functioning, the end of the categorical multiaxial diagnostic system, and how transitioning to a dimensional diagnostic model may affect diagnosis and the determination of impairment. Some of these changes have been the source of criticism and conflict within the field of psychiatry. Classification is the core of any science, and therefore debate and controversy inevitably accompany the process of change. The desire to advance a science is only one of the many influences that play a role in the development of any classification system. Consequently, the roll-out of DSM-5 has revived older political, social, and scientific debates and criticism of the APA’s official classification of mental disorders and, in addition, has created new areas of controversy. The implications of the changes in DSM-5 of psychiatric diagnostic classifications and methodology for the practice of forensic psychiatry merit keen scrutiny. Forensic psychiatrists should be prepared to address both the uses and the limitations of psychiatric diagnoses in forensic practice. Psychiatric testimony, including opinions regarding psychiatric diagnoses, enters administrative, bureaucratic, and legal systems for a variety of reasons, ranging from testimony during the sentencing phase in capital murder trials to assessment of eligibility for disability benefits. Psychiatric disorders are often threshold requirements to meet specific legal sanctions or administrative determinations. Mental disorders generally serve these threshold functions because they are believed to be meaningfully associated with diminished abilities or functional impairments. Even when not required, psychiatric diagnoses may be sought or requested because they lend credibility to legal arguments or administrative claims. Cheryl D. Wills and Liza H. Gold are editors of this special section on DSM-5 and Forensic Psychiatry.