Commentary "Field trial sites will refl ect the heterogeneity of settings in which DSM is actually used, including clinicians and patients from general medicine, psychiatric, and specialty psychiatric clinics." Moving Toward DSM-5: The Field Trials The ongoing revision of APA's Diagnostic and Statistical Manual of Mental Disorders (DSM) began in 1999 and has a projected completion date of 2013. The longer production time for the 5th edition (DSM-5) is one of many changes from earlier DSM

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... n processes. For example, special efforts were taken to avoid elitism and confl icts of interest in the selection of members for the work groups charged with revisiting each major diagnostic category. DSM-5 will also differ from previous versions by its inclusion of dimensional measures (1, 2), meant to be sensitive to differences between patients and to changes within patients. Some dimensional measures are crosscutting to capture information provided by the patient that is not specifi c to any diagnosis but more generally useful for assessing mental health. While the work groups conferred in privacy, their proposals have been widely disseminated through publications, presentations at professional meetings, and web postings. The fi rst draft of their diagnostic proposals was recently posted, and the resulting public comments are now being considered by the work groups for further revision of the proposed criteria. The next steps for the criteria are fi eld trials. These DSM-5 fi eld trials have features that may be of interest to potential users. A fi eld trial is an evaluation of a product in the context in which it will be used. The DSM-5 diagnostic criteria are the product to be used as a basis for clinical decision making and research to benefi t patients with mental disorders. As was true for DSM-IV, the process for constructing DSM-5 relies on the currently available scientifi c and clinical evidence for the diagnostic features of mental disorders. As occurred for DSM-III and DSM-IV, fi eld trials are now needed to assess the clinical utility of the criteria and their reliability when used by different clinicians, but now additional focus is on their test-retest reliability over time in the same patient (precision) and on criterion validity, the extent to which the application of the criteria matches expert consensus diagnosis (accuracy). Earlier fi eld trials were often conducted by the same groups that developed the proposed criteria. Emphasis was on reliability within observers of the same interview. Thus, major sources of diagnostic error, such as variability in the use of the criteria by different interviewers of the same patient and day-to-day inconsistency of response by the patient, were not available for the calculation of reliability. Moreover, reliability was sometimes estimated with patients selected because they demonstrated particular symptoms of interest and by highly invested clinicians. Now, because a central group has designed the fi eld tests for all work group diagnoses that involve new or controversial changes, there will be uniformity in the approach to fi eld trials. Results will be analyzed centrally and then delivered to the work groups to guide revisions. Field trial sites will refl ect the heterogeneity of settings in which DSM is actually used, including clinicians and patients from general medicine, psychiatric, and specialty psychiatric clinics. Formal Field Trials in Large Clinical Settings Formal fi eld trials will involve the testing of between two and fi ve specifi c diagnoses at any one site. The diagnoses tested at a site will depend on their relative frequency there. For example, major depressive disorder and complex somatic symptom disorder