Valeria Medina, NeuronUP neuropsychologist, presents the most important changes in the DSM update and how to apply the manual’s new criteria in clinical practice with NeuronUP.
The DSM update toward a Diagnostic and Scientific Manual of Mental Disorders goes beyond symptoms to assess the patient’s actual functioning and quality of life. This new approach proposes a more flexible, up-to-date model with greater clinical utility, incorporating new axes to define diagnoses. NeuronUP facilitates this transition through ecologically valid activities that ensure rehabilitation is tailored to the person’s real-life context.
Introduction
For years, the DSM has been a global reference for understanding and classifying mental disorders. Its main strength has been providing a common language that facilitates communication among professionals and research, and each edition has sought to include new classifications and refine those that require adjustment. However, it has also received significant criticism, particularly for its rigidity, its symptom-centered approach, and its difficulty capturing patients’ real-world complexity.
The American Psychiatric Association (APA) has promoted a transformation proposal that goes beyond adding new diagnoses. Rather than simply expanding the existing “catalog,” it proposes a reorganization of the manual focused on a more flexible, up-to-date model with greater utility in daily clinical practice.
One of the first proposed changes is to rename the Diagnostic and Statistical Manual of Mental Disorders as the Diagnostic and Scientific Manual of Mental Disorders. This adjustment seeks to more accurately reflect its scientific nature and global scope, aligning it with current advances in research.
In addition to this conceptual redefinition, new axes are being incorporated to define how patients are diagnosed. Some of the most relevant changes are presented below.
Key points of the DSM update: What changes in the Diagnostic and Scientific Manual?
1. The influence of socioeconomic, cultural, and environmental determinants on mental health
In this regard, socioeconomic, cultural, and environmental factors are incorporated alongside developmental variables, medical comorbidities, level of functioning, and patient-perceived quality of life (Öngür et al., 2026). This change responds to accumulated evidence on the impact of living conditions on the onset, course, and recovery of mental disorders. These factors do not act in isolation; rather, they interact with biology and individual experience, shaping the expression of symptoms (Wainberg et al., 2026).
Consistent with this perspective, quality of life and functioning are also explicitly included in the clinical assessment. The impact of a disorder is not limited to the presence of symptoms; it is also reflected in daily life and subjective well-being. The relationship between symptoms, functioning, and quality of life is bidirectional, reinforcing the need to assess them together in clinical practice (Drexler et al., 2026).
Thus, the focus expands from the disorder to the person in context, rather than considering only what happens in the clinical setting, promoting a more comprehensive understanding of the patient.
Following this integration of different levels of analysis, another relevant change is the progressive incorporation of biological variables into the diagnostic process.
2. The role of biomarkers and biological factors
The structured integration of biological data into diagnosis is introduced as a possibility. Techniques such as neuroimaging, genetics, cognitive measures, physiological data, and information from digital devices are included (Öngür et al., 2026).
It is worth remembering that the DSM has traditionally been a symptom-based system, not because of a lack of interest in biology, but because sufficiently validated biomarkers were not available for clinical use. However, advances in areas such as genetics, neuroimaging, and digital phenotypes are creating new opportunities.
Some inflammatory markers or patterns of brain activity are beginning to be associated with disorder subtypes or differential treatment responses, which could have relevant clinical implications in the future (Cuthbert et al., 2026). The purpose of this change is to facilitate the progressive incorporation of these biomarkers as the evidence becomes established, promoting more precise data that complement clinical assessment.
Alongside this openness to biological factors, the manual also proposes changes in how diagnosis itself is understood.
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3. Diagnosis with levels of specificity
Another change in the manual is the incorporation of a dimensional model with levels of severity, in which diagnosis remains central but is based on a more flexible conceptualization.
Rather than always requiring a specific label, it allows professionals to work with different levels of precision depending on the information available (Öngür et al., 2026). This proposal reflects the reality of day-to-day clinical practice, since, in the initial phases, it is not possible to establish a definitive diagnosis with complete certainty. The model allows broader categories to be recorded and more specific diagnoses to be developed as more information becomes available.
In addition, severity is incorporated as an independent dimension, allowing clinicians to distinguish between patients with the same diagnosis but different levels of impairment—something the traditional categorical model did not adequately capture. This approach reduces the need to fit the patient into a rigid category and facilitates a formulation better suited to clinical reality, while preserving the usefulness of diagnosis for decision-making.
Finally, this evolution toward more flexible models is complemented by recognition of features that cut across different disorders.
4. Transdiagnostic features
This change reflects the recognition that many problems seen in clinical practice do not belong exclusively to a single diagnosis. Symptoms such as anxiety, anhedonia, or cognitive difficulties cut across different disorders and do not always fit clearly into a specific category (Oquendo et al., 2026).
Traditionally, these elements were not considered within diagnoses or could be regarded as secondary. However, the new model proposes recording them explicitly, making it possible to describe the patient’s clinical profile more precisely.
This approach is consistent with evidence showing that psychopathology is not organized into separate compartments. Most patients present combinations of symptoms that vary over time, making a more flexible and dynamic model necessary (Öngür et al., 2026).
How can the DSM’s new criteria be applied in clinical practice with NeuronUP?
Beyond the changes proposed in the DSM, it is useful to see how these new directions align with intervention models that have already been applied in clinical practice. NeuronUP has spent years working from a perspective that is now also beginning to take hold at the diagnostic level. Since its inception, the platform has advocated for a person-centered perspective that is data-driven, flexible, and connected to the patient’s real life.
1. Adaptation to the user’s environment and context
One of the pillars of this approach is adapting to the user’s environment and context. NeuronUP designs ecologically valid activities in multiple formats, making it possible to transfer cognitive training to functional, everyday situations. In this way, intervention is not limited to the clinical setting but facilitates the generalization of gains to daily life.
2. Working progressively and tailoring intervention to each user
This is complemented by the ability to work progressively and tailor intervention to the patient’s level. The platform allows professionals to modulate task difficulty and adjust cognitive load, organizing intervention into phases that evolve alongside the person. Thus, intervention depends not only on a diagnosis but also on each user’s current stage and needs.
3. Focus on cognitive functions
Another relevant aspect is the focus on cognitive functions. Rather than focusing solely on diagnostic labels, NeuronUP allows professionals to target processes such as attention, memory, and executive functions specifically. This facilitates more precise intervention tailored to individual profiles, even within the same diagnosis. Even when two people have the same diagnosis, their profiles may differ considerably, so treatment must be adjusted to each person’s needs.
4. Use of objective data
In addition, NeuronUP naturally integrates the use of objective data. By recording performance, professionals can track the user’s progress and make clinical decisions based on quantifiable information. This ongoing monitoring provides a more complete and precise view that complements traditional clinical observation.
To better visualize this connection, below is a summary of how the manual’s changes discussed in this article relate to NeuronUP’s intervention features.
| Change in the manual | NeuronUP principles and features |
|---|---|
| Integration of contextual factors (socioeconomic, cultural, environmental, functioning, and quality of life) | NeuronUP designs ecologically valid activities in multiple formats, allowing intervention to be adapted to the user’s real-life context. This facilitates transfer to daily life and more precise personalization. |
| Dimensional model with levels of severity | The platform allows professionals to work with different levels of cognitive load and adjust task difficulty, as well as structure intervention in progressive phases according to the patient’s progress. |
| Less emphasis on diagnostic labels and greater focus on clinical profiles, including transdiagnostic features | NeuronUP works by cognitive function (attention, memory, executive functions…), adapting to individual differences rather than focusing only on diagnosis. |
| Openness to biomarkers and objective data | NeuronUP incorporates quantitative performance data (in addition to assessment), allowing professionals to monitor the user’s progress and make clinical decisions based on objective information, beyond observation and qualitative aspects. |
All of this reflects an approach to neuropsychological intervention that prioritizes personalization, functionality, and the use of data. It is an approach that not only responds to the current needs of clinical practice but also anticipates the direction in which the mental health field is moving.
Rather than adapting to these changes, NeuronUP has been moving in the same direction for some time, toward a more flexible, integrated neuropsychology centered on the patient’s real-world experience.
Conclusion
The evolution of the DSM reflects a profound change in how mental health is understood. This new model broadens the focus beyond symptoms and diagnostic labels by incorporating context, level of functioning, and individual differences among patients.
For neuropsychology, this approach is particularly relevant because its practice is based precisely on assessing cognitive functioning and its impact on daily life. This change reinforces the need to go beyond diagnosis and focus on how cognitive difficulties affect each person’s independence, performance, and quality of life. It also promotes more individualized intervention, prioritizing the patient’s specific cognitive profile and progress over time, integrating objective data, and continuously adjusting therapeutic strategies.
Tools such as NeuronUP not only adapt to this evolution but also reflect a way of working that already incorporated many of these principles. The current trend simply reinforces the importance of moving toward person-centered intervention models based on real-world functioning and supported by objective information.
Thus, rather than a single change, what we are seeing is a progressive transformation toward a more complete, flexible, and tailored way of understanding and addressing mental health.
References
- Cuthbert, B., Ajilore, O., Alpert, J. E., Clarke, D. E., Compton, W. M., Drexler, K., Fung, K. P., Gogtay, N., Kas, M. J. H., Kumar, A., Malaspina, D., O’Keefe, V. M., Öngür, D., Tamminga, C., Wainberg, M. L., Yonkers, K. A., Yousif, L., Abi-Dargham, A., & Oquendo, M. A. (2026). The Future of DSM: Role of Candidate Biomarkers and Biological Factors. The American journal of psychiatry, appiajp20250877. Advance online publication. https://doi.org/10.1176/appi.ajp.20250877
- Drexler, K., Alpert, J. E., Benton, T. D., Fung, K. P., Gogtay, N., Malaspina, D., O’Keefe, V. M., Oquendo, M. A., Wainberg, M. L., Yonkers, K. A., Yousif, L., & Clarke, D. E. (2026). The Future of DSM: Are Functioning and Quality of Life Essential Elements of a Complete Psychiatric Diagnosis?. The American journal of psychiatry, appiajp20250874. Advance online publication. https://doi.org/10.1176/appi.ajp.20250874
- Öngür, D., Abi-Dargham, A., Clarke, D. E., Compton, W. M., Cuthbert, B., Fung, K. P., Gogtay, N., Kas, M. J. H., Kumar, A., Malaspina, D., O’Keefe, V. M., Oquendo, M. A., Wainberg, M. L., Yonkers, K. A., Yousif, L., & Alpert, J. E. (2026). The Future of DSM: A Report From the Structure and Dimensions Subcommittee. The American journal of psychiatry, appiajp20250876. Advance online publication. https://doi.org/10.1176/appi.ajp.20250876
- Oquendo, M. A., Abi-Dargham, A., Alpert, J. E., Benton, T. D., Clarke, D. E., Compton, W. M., Drexler, K., & Gogtay, N. (2026). Initial strategy for the future of DSM. American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.20250878
- Wainberg, M. L., Alpert, J. E., Benton, T. D., Clarke, D. E., Drexler, K., Fung, K. P., Gogtay, N., Malaspina, D., O’Keefe, V. M., Oquendo, M. A., Yonkers, K. A., & Yousif, L. (2026). The Future of DSM: A Strategic Vision for Incorporating Socioeconomic, Cultural, and Environmental Determinants and Intersectionality. The American journal of psychiatry, appiajp20250875. Advance online publication. https://doi.org/10.1176/appi.ajp.20250875
Frequently asked questions about the DSM update
1. Why is the DSM changing its name to the Diagnostic and Scientific Manual of Mental Disorders?
This adjustment seeks to more accurately reflect its scientific nature and global scope, aligning it with current advances in research. For health professionals, this represents a transition from a purely statistical model to one based on the most recent scientific evidence.
2. How do socioeconomic factors influence the DSM’s new diagnostic model?
The new model explicitly incorporates socioeconomic, cultural, and environmental factors, recognizing that they do not act in isolation but interact with the patient’s biology. This allows neurorehabilitation clinics to conduct a more comprehensive assessment that includes quality of life and functioning in the user’s real-world context.
3. What role do biomarkers play in current clinical assessment?
The manual introduces the possibility of systematically integrating neuroimaging, genetic, and physiological data into the diagnostic process. The objective is to facilitate the progressive incorporation of these biomarkers to obtain more precise data that complement traditional clinical observation.
4. What does the DSM’s dimensional model with levels of severity involve?
Unlike the rigid categorical model, the dimensional approach allows professionals to work with different levels of precision depending on the information available. This is especially useful during the initial phases of clinical care, when professionals can record broad categories and move toward more specific diagnoses as more data are obtained.
5. What are transdiagnostic features, and how do they affect treatment?
They are symptoms or cognitive difficulties, such as anxiety or anhedonia, that cut across different disorders and do not belong to a single category. The new model proposes recording them explicitly to describe the patient’s clinical profile more precisely, which is essential for designing effective rehabilitation plans.
6. How does NeuronUP help professionals adapt to the DSM’s new changes?
NeuronUP aligns with the DSM by focusing on specific cognitive functions and using objective data to monitor the patient’s progress. In addition, its ecologically valid activities facilitate the transfer of gains to daily life, meeting the need to assess the user’s real-world functioning in their environment.
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