Relationship problems and the DSM:needed improvements and suggested solutions

HEYMAN, RICHARD E. ; SLEP, AMY M. SMITH ; BEACH, STEVEN R.H. ; WAMBOLDT, MARIANNE Z. ; KASLOW, NADINE J. ; REISS, DAVID (2009) — World Psychiatry

DOI: 10.1002/j.2051-5545.2009.tb00198.x

Synopsis

This World Psychiatry article surveys how relationship problems are represented within the DSM framework and what improvements could enhance clinical usefulness. It considers how relational distress intersects with various diagnostic categories, including mood and anxiety disorders as they unfold in relational contexts, and how interpersonal dysfunction features in personality pathology. The discussion notes that current coding can underrepresent the relational dimension of distress, potentially limiting treatment planning and prognosis. It also points to broader concerns about reliability and validity when relationship functioning is central to a clinical presentation but not treated as a primary diagnostic target. The authors emphasize that relationship functioning is multidimensional, shaped by communication patterns, family systems, and cultural expectations, and that these dynamics may vary across different populations and life stages. Proposed solutions focus on expanding or reframing the DSM’s coverage of relational phenomena and incorporating dimensional assessments of impairment and distress that traverse traditional categories. The article outlines directions such as developing standardized tools to assess relational functioning, refining guidelines to distinguish relational distress from comorbid mental disorders, and providing clearer case formulation and treatment-matching guidance for clinicians. Additional emphasis is placed on cultural and sexual-orientation diversity, cross-population validity, and the integration of relational context into outcome measurement. Implementation considerations include clinician training, research priorities, and the potential benefits of revised diagnostic constructs for early identification, targeted interventions, and improved coordination between mental health care and relationship-focused modalities.

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