 function, from cognition to emotion to behavioral control, and that these circuit abnormalities do not respect the narrow symptoms checklists within the DSM.

The first DSM had many important strengths, but I would argue that part of what went wrong with it was a fairly arbitrary decision: the promulgation of a large number of disorders, despite the early state of the science, and the conceptualization of each disorder as a distinct category. That decision eschewed the possibility that some diagnoses are better represented in terms of quantifiable dimensions, much like the diagnoses of hypertension and diabetes, which are based on measurements on numerical scales.

These fundamental missteps would not have proven so problematic but for the human tendency to treat anything with a name as if it is real. Thus, a scientifically pioneering diagnostic system that should have been treated as a set of testable hypotheses was instead virtually set in stone. DSM categories play a controlling role in clinical communication, insurance reimbursement, regulatory approval of new treatments, grant reviews, and editorial policies of journals. As I have argued elsewhere, the excessive reliance on DSM categories, which are poor mirrors of nature, has limited the scope and thus the utility of scientific questions that could be asked. We now face a knotty problem: how to facilitate science so that DSM-6 does not emerge a decade or two from now a trivially revised descendant of DSM-III, but without disrupting the substantial clinical and administrative uses to which the DSM system is put.

I believe that the most plausible mechanism for repairing this plane while it is still flying is to give new attention to overarching families of disorders, sometimes called meta-structure. In previous editions of the DSM, the chapters were almost an afterthought compared with the individual disorders. It should be possible, without changing the criteria for specific diagnoses, to create chapters of disorders that co-occur at very high rates and that appear to share genetic risk factors based on family, twin, and molecular genetic studies.

This will not be possible for the entire DSM-5, but it would be possible for certain neurodevelopmental disorders, anxiety disorders, the obsessive-compulsive disorder spectrum, so-called externalizing or disruptive disorders (such as antisocial personality disorder and substance use disorders), and others. Scientists could then be invited by funding agencies and journals to be agnostic to the internal divisions within each large cluster, to ignore the over-narrow diagnostic categories. The resulting data could then yield a very different classification by the time the DSM-6 arrives
function, from cognition to emotion to behavioral control, and that these circuit abnormalities do not respect the narrow-minded symptom checklists within the DSM. 

 The first DSM had many important military capability, but I would argue that part of what went ill-timed with it was a reasonably arbitrary decision: the promulgation of a large number of disorders, despite the early department of state of the science, and the conceptualization of each disorder as a discrete category. That decision eschewed the possibility that some diagnoses are well represented in terms of quantifiable dimensions, a lot like the diagnoses of hypertension and diabetes, which are establish on measurements on numeric scales. 

 These fundamental missteps would not have proven so debatable but for the human tendency to treat anything with a name as if it is real. Thus, a scientifically pioneering diagnostic system that should have been treated as a set of testable hypotheses was instead virtually set in stone. DSM categories play a controlling role in clinical communication, policy reimbursement, regulatory approval of modern treatment, grant reviews, and editorial policies of journal. As I have argue elsewhere, the excessive reliance on DSM categories, which are poor mirror of nature, has limited the scope and thus the utility of scientific questions that could be asked. We immediately face a knotty problem: how to facilitate skill so that DSM-6 does not emerge a ten or two from now a trivially revised descendant of DSM - III, but without disrupting the substantial clinical and administrative uses to which the DSM system is place. 

 I believe that the most plausible mechanism for repairing this airplane while it is still fly is to give new care to overarching families of disorders, sometimes called meta - structure. In former editions of the DSM, the chapters were almost an afterthought compare with the individual disorders. It should be potential, without changing the criteria for specific diagnoses, to produce chapters of disorder that co - occur at very gamey rates and that appear to share genetic risk factor based on family, duplicate, and molecular genetic studies. 

 This will not be possible for the entire DSM-5, but it would be possible for certain neurodevelopmental disorders, anxiety disorder, the obsessive - compulsive disorder spectrum, so - called externalizing or disruptive disorders (such as antisocial personality disorder and substance habit disorder), and others. Scientists could then be invited by funding agencies and journals to be agnostic to the internal division within each large cluster, to ignore the all over - narrow diagnostic class. The resulting data could then yield a very unlike classification by the time the DSM-6 arrives
 fujction, from cognition to emotion to behccioral contrkl, and tfat these circuit abnormalitmes eo nou respect the narrod symptomd checklusts qithin the DSM.

The nnrst SDM hcd many importanj strengths, tut I would arcud chat part of what went wrong with it was a galrly arbitrary decpsyon: fhe promulgation of a large number of dismrders, despitr the early state of the sfienfe, and the conceptkalization if ewxh disorder xs a distinct category. That decision eschewed the posribilnty that sone diwcnoses are uetter represented in termv of qusntifiable dimcnsiois, mych like the diagnosev of hypertension wnd diabedea, which are based ob meavurekentr on nujeciczl scapes.

Vhese fundajental missreps would not have pwiven so problsmatic btt for the human tendency to treat anytvinf with a name as if it us real. Thus, a scientlfically [ioneering diagnostic system that should have beet treetdd cw a sdr lf testable hypotheses was instead virtually fst ik stone. DSM catenories play a conttoplogg role in clknical cojmunication, insurajce reiiburswment, regtlatpry approval of new treatmebts, grant renieww, and editorial popicies of juurnsls. Ax I have argued elsewhexe, the excessive geliance kv DSM categories, whpch dre poor mirrors of nature, has limived tke scope and thus ehe utilitj of scientific questiond thaj coulg be asked. We now face a knotty problem: how to facilitaje vcivnce so tkat DSK-6 does not emqrge a decade pr two yrom nuw a trivizlly retised descenqant of DSM-IIH, but without disruptyng rhe wubstangkal clinical amd administrative uwes to which the DXM rgstem is put.

I bzuueve that the mpst plwudiule mqwhanism for sepakrivb thir plane whiod it is still flying is do gjve new attention yo overarcying famylies of disotders, sometimes capled kete-strucyurg. In previous editions of the DAM, the chwptcrs were almoft ak afjerthought eompared with the individual disorders. Iv should be possible, wirhout changing the erlteria for s'ecifis diagnosas, to create chapterw of disorders thst co-occur at very hifh ratas anf that appear to share genetic risk factors based on family, twin, and molexular jegetic studiss.

Thos winl uot be [ossmbue for the entirv DSM-5, but it would be possible fur certahn neurodevelopmental disorderx, xnxiety disoraers, the obsessive-compulaive disprder spectrum, so-called externakizing or disruptive disprders (sych aa antisociel personality disorcer anb subsrance uwe dlsorders), and oghets. Scientishs cpumd then be invited by funding agwncies ajd journals to bx agnostic tl the pnternaj divisions withjn ezfh latge cluster, to ignore the ovrr-narrow diagnostic batqgories. The rewllting data cpuld jkvn yield a vecy different classification by the time the DSM-6 arrives
function, from cognition to emotion to behavioral that circuit abnormalities not respect the DSM. first DSM had important strengths, but would argue that part of what wrong with it was a fairly arbitrary decision: the promulgation of a large of disorders, despite the early state of the science, and the conceptualization of disorder a category. decision eschewed the possibility that some diagnoses are better represented in terms of quantifiable dimensions, much the diagnoses of hypertension and diabetes, which are on measurements on numerical These fundamental missteps would not proven problematic but the tendency treat anything with name as if it is real. Thus, a scientifically pioneering diagnostic system that should have been treated a set hypotheses was virtually in DSM categories play role in clinical communication, insurance reimbursement, new treatments, grant reviews, and editorial policies of As I argued elsewhere, the excessive reliance on categories, which are poor mirrors of nature, has the scope and thus the utility of scientific questions that could be asked. We now knotty problem: how to science so that does emerge decade two from a trivially revised descendant of DSM-III, but without disrupting the substantial and administrative uses to which the DSM system is put. that most plausible mechanism repairing this plane while is flying is to give to families called In editions of the DSM, chapters were almost an afterthought with the individual disorders. changing the criteria for specific diagnoses, to create of disorders that co-occur at very high and that appear to share genetic risk factors based on family, twin, molecular genetic will not be possible for the entire DSM-5, it would be possible certain neurodevelopmental disorders, anxiety disorders, the obsessive-compulsive disorder spectrum, externalizing disruptive disorders as antisocial personality and substance use and others. Scientists be invited funding and agnostic to the internal divisions within large to ignore the over-narrow diagnostic The could then yield a very different classification by the time the DSM-6 arrives
 function, from cognition to emOtion to behAviorAl cOntRoL, and That These circuit abNOrmaLities do not respect the nArrow SyMPtomS ChEckliSts withIN tHE dSM.

thE fIrsT Dsm hAd manY imPortant Strengths, bUt I WoUld argue that PArT of what wenT wrOng with it was A faIrly arBiTraRY deciSioN: the pRomulgATion of A large numBeR Of disoRDers, desPITe The eArly state of the sciENcE, And the conceptuAlizatIoN Of EACh dIsoRder as a disTiNct caTEgory. ThAT dECISioN Eschewed the poSsibility thAT soMe diagNoSes ARe bettEr repReSEntEd in terms of QuanTifiable dImensiONs, much lIKe the diAgnoseS of HypErteNSiOn And DiABetES, wHicH Are Based on mEaSuRemenTs on NUMERicaL scAles.

these Fundamental miSstEps wOUld Not haVe proVen sO pRobleMatic bUt for ThE human tendency tO treAt anythinG wiTh A naMe As if iT Is real. thuS, a sCientifIcally pIOneErING DiAgnostic system that ShOULd Have been TreateD As A sET of testaBlE hyPothESEs was InstEAd VirtuallY set in SToNe. dSM cateGoRies plAy A coNtrOllinG Role In clinIcal commUnicaTIon, insurance reIMbursement, regULaTORy APproVal Of new treatmEnts, GRant ReviEWs, And EDitorIal poLiCIeS Of journals. As I have arGuEd elseWhere, The excessive rEliance on Dsm CAtegorieS, whiCH aRE poor mirrors of NaturE, has limiteD The scope And thUs the utiLity of sciENTific queStiOns ThaT coULD bE asked. We now faCE A knoTtY probleM: hoW to faciLitAte SciEncE sO that DSM-6 dOes not emErGe A dEcAde Or two FRom now a tRiViaLlY reVised DEscendAnt of dSM-IiI, BuT WitHout disRUpTINg thE sUbStanTiaL cLinicAl anD AdmInistraTive uses tO whICh thE DsM System iS put.

I believe tHaT the most plAuSibLe mechANIsm for rePairing this plane while it IS still fLyiNg is tO givE new attenTioN to oveRarCHing faMilies Of disOrDerS, SOmetiMES cAllEd Meta-structURE. In PreviOuS ediTions of The DSM, the chapters wERe aLmost an aftertHouGht cOMPaRed WItH The InDIviDUAl disorders. It shOuld be possIbLE, wIthout chanGIng ThE criterIa for spEcifiC DiagnosEs, to creatE chapters Of DisoRDErs That co-occuR at very hIgh rates aND that APpEar to ShaRe geneTiC riSk facTors baSEd oN famiLy, twin, AnD molecUlar gEnEtic studIes.

This will not be possiblE for thE entiRe DsM-5, but it woUld BE poSsible for CertAin neurodeVelOpmEntal DisORders, AnxiETy DisORders, The oBSessive-coMPuLsiVE DiSorder spectRUM, So-cAlled ExtERnalizIng oR disruptive disordERs (such as antisoCial PERsoNalITy diSoRder and substanCe uSe DISorders), aNd Others. ScienTists couLd THen be InviteD by funDing ageNCIeS And jouRnalS to Be agnostiC to ThE InternaL dIvISions wIthiN eAch larGe clusTEr, to IGNore the over-narroW diagNOStic cATegOries. thE resultINg daTa could theN yield a very DifferEnt cLassiFicatioN bY the tiMe tHe dSM-6 arrives
 function, from cognitionto emotion  to b eha vio ra l co ntro l, and that th e se c ircuit abnormalities d o not  r e spec t  t he na rrow sy m pt o m s c he ck lis ts wi thinthe  DSM.
The firstDSM  h ad many impo r ta nt strengt hs,  but I would  ar gue th at  pa r t ofwha t wen t wron g  withit was afa i rly ar b itraryd e ci sion : the promulgatio n  o f  a large numbe r of d is o rd e r s,des pite the e ar ly st a te of t h es c i enc e , and the con ceptualizat i onof eac hdis o rder a s a d is t inc t category.  Tha t decisio n esch e wed the possibi lity t hat  so me d i ag no ses  a r e b e tt err epr esentedin  t ermsof q u a n t ifia ble  dim ensio ns, much like  th e di a gno ses o f hyp erte ns ion a nd dia betes ,which are based  onmeasureme nts  o n n um erica l  scale s.
Th ese fun damenta l  mi ss t e p swould not have pro ve n so  problem atic b u tfo r  the hum an  te nden c y  to t reat an ything w ith an am eas if i tis rea l.  Th us,  a sc i enti ficall y pionee ringd iagnostic syst e m that should ha v e  b e en t rea ted as a se t of test able hy pot h eseswas i ns t ea d  virtually set in s to ne. DS M cat egories playa controll i n g  role in  cli n ic a l communicatio n, in surance re i mburseme nt, r egulator y approva l of new t rea tme nts , g r a nt  reviews, and e dito ri al poli cie s of jo urn als . A s I  h ave argue d elsewh er e,  t he  ex cessi v e relian ce  on  D SMcateg o ries,which  are  p oo r  mi rrors o f  n a t ure,  h as  lim ite dthe s cope and  thus t he utilit y o f  sci en ti fic que stions that c ou ld be aske d.  We  now f a c e a knot ty problem: how to faci l itate s cie nce s o th at DSM-6doe s noteme r ge a d ecadeor tw ofro m now a t ri via ll y revisedd e sce ndant  o f DS M-III,but without disrup t ing  the substant ial  cli n i ca l a n da dmi ni s tra t i ve uses to whic h the DSMsy s te m is put.I b el ieve th at themostp lausibl e mechani sm for re pa irin g thi s plane wh ile it i s still f l yingi sto gi venew at te nti on to  overa r chi ng fa milies  o f diso rders ,sometime s called meta-structure . In p revio useditionsoft heDSM, thechap ters werealm ost  an a fte r thoug ht c o mp are d  with  the individua l  d iso r d er s. It shoul d b e p ossib le, withou t ch anging the criter i a for specific  dia g n ose s,t o cr ea te chapters of  di so r d ers that  c o-occur atvery hig hr atesand th at app ear tos h ar e  genet ic r isk  factorsbas ed on fami ly ,t win, a nd m ol ecular  genet i c st u d ies.

This willnot b e possi b lefor t he  entire DSM- 5, but itwould be po ssible  for  cert ain neu ro develo pme nt al disorde r s, anxiet y dis orders,  t he o bse ssive- comp u l sivediso rd erspectrum, s o- c al le d  ex tern alizi ng  ordisruptiv e  disorde rs( such as  a nti s o cial p e rs o n ality diso rde r and s ubstance u s e di s or d ers),  and o thers.  Scient i sts  c ould th enb e  invitedby fundin g  ag en cies  and jou rn alsto  be  a gnostic to theinternal  divisio n s  withi n e a ch l a rge cl us ter, to igno re th eo ver-nar r o w d iagnost i c c ate gor ies.  Th e re s ulting data could then y ield  a ve r y d iffer ent c la ssificat i on b y the ti m e the DSM-6 a rrives
 function,_from cognition_to emotion to behavioral_control, and_that_these circuit_abnormalities_do not respect_the narrow symptoms_checklists within the DSM.

The_first DSM had_many_important strengths, but I would argue that part of what went wrong with it_was_a fairly_arbitrary_decision:_the promulgation of a large_number of disorders, despite the_early state_of the science, and the conceptualization of each_disorder_as a distinct_category. That decision eschewed the possibility that some diagnoses_are better represented in terms of_quantifiable dimensions, much_like_the_diagnoses of hypertension and_diabetes, which are based on measurements_on numerical scales.

These fundamental missteps would_not have proven so problematic but for_the human tendency to treat anything_with a name as if_it is_real. Thus, a scientifically pioneering_diagnostic system that_should have_been treated as_a set of testable hypotheses was_instead virtually set_in stone. DSM categories play a_controlling_role in clinical_communication,_insurance_reimbursement, regulatory_approval of new_treatments,_grant reviews,_and_editorial policies of journals. As I_have_argued elsewhere, the excessive reliance on DSM_categories, which are poor_mirrors_of nature, has limited_the scope and thus the_utility of scientific questions that could_be asked._We now_face a knotty problem: how to facilitate science so that DSM-6_does not emerge a decade or_two from now a_trivially revised_descendant_of DSM-III, but_without_disrupting the_substantial clinical and administrative uses to which_the DSM_system is put.

I believe that the_most plausible mechanism for_repairing_this plane while it is still_flying is to give new attention_to overarching families of disorders,_sometimes_called_meta-structure. In previous editions of_the DSM, the chapters were almost_an afterthought compared_with the individual disorders. It should be_possible,_without changing the criteria for specific_diagnoses,_to create chapters of disorders that_co-occur_at_very high rates and that_appear to share genetic risk factors_based on family, twin, and molecular genetic studies.

This will_not be possible_for the entire DSM-5, but_it_would_be possible for certain neurodevelopmental disorders, anxiety disorders, the obsessive-compulsive_disorder spectrum,_so-called externalizing or_disruptive disorders (such as antisocial personality disorder and substance use_disorders), and others. Scientists could then be_invited by funding agencies and journals to be agnostic to the_internal divisions within each large cluster, to ignore_the over-narrow diagnostic categories. The resulting data_could then yield a_very_different classification by the time the DSM-6_arrives