The American Psychiatric Association is revising the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, for the first time in almost 20 years. Since this manual is the gold standard for diagnosing mental illnesses, they are finding it has many implications, including economic, legal, and linguistic ones.

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"We have to be very careful about our choice of language and precise criteria," said Dr. David J. Kupfer, the DSM-5 task force chairman and director of research at Western Psychiatric Institute and Clinic. Slight word changes could translate into making a disorder much more prevalent — or much more rare, he said.

And here is an example of a problematic wording change:

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A minor wording change in the last DSM revision prompted attempts to label repeat sex offenders as people stricken with the mental disorder paraphilia, blurring the line between criminal behavior and mental illness, said Dr. Allen Frances, chairman of the DSM-IV Task Force and one of the most vocal critics of DSM-5.

Here are some wording changes being recommended:

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Even when concepts are not at issue, nomenclature sometimes is. Suggestions include replacing the word "anxiety" with "worry," and scrapping the terms "addiction," "dependence" and "substance abuse" in favor of "substance-use disorder."

Our organization has just published a book on "substance use disorder" (no hyphen for us). I have never liked euphemisms like this. Isn't it really substance abuse?

Interestingly, one new proposal for the DSM-5 will be adding a diagnosis for "binge eating disorder," which relates to obesity.

One of the first thesis project topics I looked at in computer science was writing an application to help folks diagnose using the DSM-3R (at that time). Some anecdotal evidence I found suggested that more than a few people used the keys in the back to arrive at diagnoses (by going in the wrong direction) that would be covered by their patient's insurance.

I'm not sure I understand what you mean by the keys in the back.

Surely the DSM classifications are not without problems. Here is one point of view.

In the DSM-IV-TR, it's Appendix A, Decision Trees for Differential Diagnoses.