The DSM Needs to Undergo a Revolutionary Overhaul: Here’s Why That Matters
The Diagnostic and Statistical Manual of Mental Disorders (DSM) — currently in its fifth edition, text revision (DSM-5-TR) — is often described as the bible of mental health. It is used to define diagnoses, legitimise distress, support access to care, guide treatment decisions, and enable communication across clinicians, researchers, insurers, and institutions.
The DSM was first published in 1952, in the aftermath of World War II. It was developed primarily by psychiatrists and shaped by military psychiatry and early psychoanalytic theory. Its original purpose was pragmatic: to create a shared classification system so that mental distress could be named, tracked, and treated within emerging medical and institutional frameworks.
In many ways, it has been essential. Without shared diagnostic language, access to care, funding, and advocacy would be far more difficult. The DSM helped formalise mental health as legitimate and worthy of attention.
But it has now reached a tipping point.
Despite multiple revisions over the past seven decades, the DSM remains grounded in colonial, Western, biomedical assumptions. As a result, it is increasingly out of alignment with contemporary cultural realities, trauma science, lived experience, and what we now know about healing. In some cases, the way it frames mental health may be doing further harm rather than supporting recovery.
Below are some of the key ways this is happening.
1. It Pathologises Individuals While Minimising Systemic Harm
The DSM locates dysfunction inside the individual, even when suffering is clearly shaped by social, economic, relational, and political forces.
For example, chronic anxiety or depression may be diagnosed without adequate consideration of:
poverty or housing insecurity
racism, misogyny, homophobia, transphobia, or ableism
unsafe workplaces or coercive relationships
ongoing exposure to violence or marginalisation
When these realities are treated as background context rather than central causes, the individual becomes framed as the “problem” — rather than the conditions they are surviving within. This not only limits the effectiveness of treatment, it can be invalidating and re-traumatising.
2. It Medicalises Neurodivergence as Disorder Rather Than Difference
Differences in neurofunctioning — such as autism, ADHD, and other forms of cognitive diversity — are still framed through a deficit-based lens.
While many people benefit from support and accommodations, the DSM largely positions neurodivergence as impairment to be corrected rather than variation to be understood, integrated, and supported. Treatment approaches informed by this framing often teach people to mask and conform to neuronormative environments, reinforcing shame and internalised inadequacy, and encouraging unsustainable ways of functioning that frequently lead to burnout.
3. It Is Built on a Colonial Framework of Health and Healing
The DSM is grounded in Western, individualistic, biomedical models of mental health. Much of the research that defines “evidence-based treatment” has been produced by relatively privileged, white, cisgender populations, studying similarly positioned samples.
As a result, diagnosis, categorisation, and symptom reduction are prioritised over relational, communal, spiritual, and embodied forms of healing. Many ways of suffering, coping, relating, and healing are simply not represented in what is considered valid evidence.
Indigenous, non-Western, and community-based understandings of wellbeing are largely absent — or treated as “alternative” rather than legitimate knowledge systems. This erasure matters, particularly for communities whose distress has been shaped by colonisation, displacement, and intergenerational trauma.
4. It Privileges a Narrow, Normative Model of Sex and Relationships
The DSM continues to centre a culturally narrow idea of what constitutes “normal” sexual functioning.
This often includes:
prioritising penetrative, couple-based sex
pathologising desire differences rather than contextualising them
framing sexual difficulties in isolation from trauma, power, identity, or relational dynamics
As a result, many people — particularly women, LGBTQIA+ individuals, disabled people, sex workers, and those in non-monogamous or kink-inclusive relationships — are rendered invisible, excluded, or actively pathologised. This persists despite decades of research demonstrating the extraordinary diversity of human sexuality. Rather than supporting healing, this framework perpetuates shame and fear around sex — which is fundamentally counter-therapeutic.
5. It Maintains a Binary and Outdated View of Gender
Although the language has shifted slightly, the DSM still rests on binary assumptions about sex and gender that do not reflect lived reality.
Trans and gender-diverse people are often required to engage with diagnostic frameworks that implicitly frame their identity as a problem to be managed, rather than a valid expression shaped by social, biological, and cultural complexity. This can act as a significant barrier to care and contribute to further harm.
The DSM continues to reinforce biological binaries of “male” and “female,” rather than recognising the wide range of experiences relating to gender, bodies, genitals, sex, and sexual functioning.
6. It Fails to Adequately Integrate Contemporary Trauma Science
Perhaps most critically, the DSM does not adequately reflect what we now understand about trauma and its links to mental and sexual health symptoms.
In reality, many of the conditions listed as “disorders” could be more accurately understood as adaptations to trauma.
Trauma adaptations can manifest as:
depression
anxiety
manic or dysregulated states
substance use
painful sex
erectile difficulties
dissociation or psychosis
personality-related patterns
In other words — many of the categories within the DSM.
This reframing is fundamentally important. When symptoms are understood as adaptations rather than individual dysfunction, the entire approach to treatment changes. Addressing underlying causes rather than surface symptoms leads to more effective and compassionate care — and better outcomes.
7. It Focuses on Symptoms, Not Causes
At its core, the DSM is a classification system — not a healing framework.
It tells us what is happening, but rarely why. Without attention to meaning, context, and function, treatment risks becoming about symptom management rather than resolution of the roots of distress.
We Can — and Must — Do Better
As healthcare practitioners, researchers, educators, and systems, we need to raise the standard.
We need frameworks that:
centre trauma, context, and systems
recognise diversity rather than pathologise it
integrate lived experience alongside research and clinical expertise
prioritise healing, not just diagnosis
The DSM may still serve an administrative and advocacy function — but it cannot remain the dominant lens through which we understand human suffering.
The future of mental health care — and the wellbeing of our fellow humans — depends on our willingness to move beyond outdated models and build approaches that truly reflect the complexity, resilience, and dignity of the people we serve.
