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DSM-5 is not ‘the bible of psychiatry’ but a practical manual for everyday work. Psychiatric diagnosis is primarily a way of communicating. That function is essential but pragmatic—categories of illness can be useful without necessarily being ‘true.’ The DSM system is a rough-and-ready classification that brings some degree of order to chaos. It describes categories of disorder that are poorly understood and that will be replaced with time. Moreover, current diagnoses are syndromes that mask the presence of true diseases. They are symptomatic variants of broader processes or arbitrary cut-off points on a continuum.
