For more than seventy years, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has served as one of the most influential texts in psychology and psychiatry. Though often described as a clinical reference guide, the DSM functions in practice as a powerful social, legal, and institutional instrument. Its categories shape who receives accommodations in school, who qualifies for healthcare and housing supports, whose experiences are considered legitimate, and whose distress is rendered intelligible to systems of authority.
To be included in the DSM is not merely to be diagnosed, it is to be recognized. That recognition carries consequences, both protective and harmful. While the DSM can open doors to services and legal protections, it can also reinforce deficit-based narratives and narrow conceptions of normality. For disabled and neurodivergent individuals, this dual role creates an ongoing tension: the same manual that enables access can also constrain identity.
As psychology confronts growing calls for equity, inclusion, and accountability, the DSM remains deeply relevant; not because it is flawless, but because it continues to mediate the relationship between individuals and the systems that govern their lives. Understanding how it has changed over the last decade is essential to understanding how psychology itself is adapting, or failing to adapt, to a more diverse and visible population.
The publication of the DSM-5 in 2013 represented a notable shift in diagnostic philosophy. Earlier editions had relied heavily on categorical distinctions that often failed to capture complexity or overlap. DSM-5 moved cautiously toward dimensional and spectrum-based approaches, particularly in neurodevelopmental and trauma-related diagnoses.
Nearly ten years later, the DSM-5-TR (Text Revision), released in 2022, refined this framework rather than reinventing it. Updates included revised diagnostic language, clarification of criteria, corrected prevalence data, and expanded attention to cultural and contextual factors. Importantly, the DSM-5-TR acknowledged that diagnostic language itself can perpetuate harm, revising terminology that had been criticized as stigmatizing or outdated.
While critics note that the DSM-5-TR stopped short of structural reform, its changes nonetheless reflect a profession under pressure; responding to emerging research, sustained advocacy, and broader social movements that challenge traditional notions of pathology, objectivity, and expertise.
One of the most consequential changes introduced in DSM-5 was the consolidation of multiple diagnoses; such as Asperger’s disorder and pervasive developmental disorder, into a single autism spectrum disorder (ASD) diagnosis. This shift reflected growing scientific consensus that autism is best understood as a spectrum of neurodevelopmental variation rather than a collection of discrete, hierarchical categories.
While the spectrum model improved conceptual clarity, it also introduced new challenges. Many individuals who previously qualified for services under earlier diagnoses found themselves excluded due to revised criteria or shifting interpretations of support needs. This underscores a critical reality: changes intended to improve accuracy can have unintended consequences when systems treat diagnostic thresholds as eligibility cutoffs rather than descriptive tools.
Attention-deficit/hyperactivity disorder (ADHD) criteria were similarly revised to better capture adult presentations, acknowledging that neurodevelopmental conditions persist across the lifespan. These updates signal a broader recognition that disability does not disappear with age; and that systems designed exclusively around childhood intervention are insufficient.
DSM-5 formally separated trauma- and stressor-related disorders from anxiety disorders, recognizing trauma as a distinct category with unique neurobiological and psychological effects. PTSD criteria were expanded to include diverse symptom clusters, including dissociation, negative alterations in cognition, and emotional numbing.
However, the continued exclusion of complex PTSD (C-PTSD) from the DSM, despite its recognition in the ICD-11, highlights ongoing institutional hesitation. Many clinicians and advocates argue that this omission leaves survivors of chronic, developmental, and relational trauma without an accurate diagnostic framework. The debate illustrates a broader ethical tension between clinical caution and responsiveness to lived experience.
Revisions to gender-related diagnoses represent one of the clearest examples of advocacy-driven change within the DSM. The replacement of gender identity disorder with gender dysphoria shifted the focus away from identity itself and toward the distress that may arise from social incongruence, stigma, and discrimination.
While this change reduced overt pathologization, it did not fully resolve the underlying dilemma: access to gender-affirming care often remains contingent upon diagnosis. This dynamic mirrors broader disability justice concerns, where medical validation becomes a prerequisite for autonomy. The DSM’s evolution in this area reflects progress, but also the limits of reform within medicalized systems.
The DSM-5 introduced the Cultural Formulation Interview (CFI) as a structured tool to help clinicians assess cultural identity, explanatory models of distress, and environmental stressors. The DSM-5-TR expanded this emphasis, explicitly acknowledging racism, discrimination, and systemic inequity as contributors to mental health outcomes.
These additions signal an important conceptual shift: distress is not solely an individual pathology, but often a rational response to oppressive conditions. However, integrating cultural awareness into diagnostic practice remains uneven, particularly when systems prioritize efficiency, standardization, and billing over relational care.
Rising diagnostic prevalence, particularly for autism, ADHD, and trauma-related conditions; is frequently framed as evidence of overdiagnosis. This narrative, however, obscures historical exclusion, misdiagnosis, and underrecognition, especially among marginalized communities.
For many individuals, increased diagnosis reflects improved awareness, expanded criteria, and greater willingness to seek support. What is often described as diagnostic inflation may instead represent long-delayed recognition. The challenge lies not in identifying more people, but in ensuring that recognition translates into meaningful support rather than additional surveillance or stigma.
Despite its evolution, the DSM remains constrained by normative assumptions about communication, productivity, and emotional regulation. Diagnostic thresholds often privilege dominant cultural norms, reinforcing deficit-based models that frame difference as dysfunction.
At the same time, the absence of diagnosis frequently results in exclusion from services and protections. For disabled individuals, diagnosis operates as a form of institutional currency; necessary for access, yet costly in its demands. Ethical engagement with the DSM requires holding both truths simultaneously: that diagnosis can harm, and that lack of diagnosis can harm more.
My own experience reflects these tensions clearly. I was first diagnosed in 2002 to qualify for services within the K–12 education system. In 2018, updated documentation was required to access accommodations in community college. Most recently, in 2025, I was again required to obtain diagnostic validation to qualify for subsidized housing; an application that remains pending.
These repeated demands did not reflect changes in my identity or needs, but shifting institutional requirements. They reveal a system that treats lifelong conditions as administratively temporary, forcing disabled individuals to continually prove legitimacy. The labor required to navigate these systems, emotional, financial, and cognitive, is rarely acknowledged, yet it shapes nearly every aspect of disabled life.
For neurodivergent and disabled communities, DSM revisions are not abstract debates. They determine who is deemed worthy of support, whose needs are prioritized, and whose lives are rendered precarious by bureaucratic delay.
The evolution of the DSM over the past decade reflects a field in transition; one increasingly attentive to complexity, context, and lived experience. Yet adaptation alone is not progress. True progress must be measured by outcomes: whether revisions reduce harm, expand access, and affirm the dignity of disabled lives.
For those of us engaged in disability self-advocacy, the DSM is not simply a diagnostic manual, it is a site of struggle. It reveals how power operates through classification, how access is conditioned on compliance, and how recognition is rationed. Advocacy, therefore, cannot stop at inclusion within the manual. It must challenge the systems that rely on it to justify exclusion.
A disability-just future will require moving beyond perpetual revalidation toward trust, from deficit toward difference, and from classification toward accommodation. The DSM can, and must, be part of that transformation, not as an unquestioned authority, but as a tool accountable to the people whose lives it shapes.
In adapting psychology to a growing and diverse population, the ultimate measure of progress is not how precisely we diagnose, but how equitably we support, include, and sustain one another.
Ian Allan
Self-Advocate for The Arc of Northern Virginia
Ian Allan is a self-advocate with a deep commitment to policy literacy, systems change, and disability justice. Through The Arc of Northern Virginia, he works to ensure that people with intellectual and developmental disabilities are not merely served by systems, but are actively shaping them.
As a 501(c)(3) nonprofit organization, The Arc of Northern Virginia relies on private support from individuals, corporations, organizations, and foundations to fund our efforts. Your generous donations help make it possible for us to provide programs, services, and advocacy so that people with IDD can live “A Life Like Yours.”
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