Since 1980, the DSM system has gained widespread acceptance and contributed significantly to improved diagnostic agreement. That very success,
however, has given rise to a serious unintended consequence: DSM diagnoses have come, over the last four decades, to be treated as "real entities" in the world, that is, they have been reified.
Just as clinicians need DSM-IV diagnoses to select treatments, to communicate with each other and with patients, and to be reimbursed, scientists must generally
use DSM-IV criteria to obtain a research grant or to have a paper accepted by a journal. Industry must use DSM-IV criteria in the design of clinical trials if they are to gain approval from the Food and Drug Administration for a new treatment.
As a result, clinical and translational researchers have largely based their work on DSM-IV disorders. While initially a great aid to the study of mental illness by ensuring the comparability of research results,
the DSM system has, paradoxically, also become a constraint. DSM diagnostic entities continue to dominate research from epidemiology to clinical trials to the production of transgenic mouse
models despite a large and growing body of data, derived both from clinical sources and from the laboratory, signaling profound
problems in the way that DSM-IV divides up and classifies the complex world of psychopathology. Given that the intellectual roots of DSM-IV are more than four decades old, this development is neither surprising nor does it diminish the historical importance of