A participant's observations: Preparing DSM-IV

Objective: To provide an overview of the process of creating the DSM-IV from a participant's perspective. Method: Narrative review. Results: In its attempt to address the perceived weaknesses of both the content and development of the DSM-III and DSM-III-R, the DSM-IV development was based on commissioned reviews for sets of diagnoses, especially designed field trials and a transparent decision-making process. Conclusions: Nosology is an ambitious and complicated enterprise. Classification systems must evolve as new empirical evidence is presented. Many of the obstacles faced by the DSM-IV work groups, therefore, may be moot for those formulating DSM-V. The DSM-IV development process was carefully planned, and the profession is indebted to the American Psychiatric Association (APA) for its initiative and effort in producing this system.