Description of Relational Processes: Recent Changes in DSM‐5 and Proposals for ICD‐11

• Author: David Reiss,Nadine Kaslow,Marianne Wamboldt
• Date: 01 March 2015
• Published date: 01 March 2015
• DOI: http://doi.org/10.1111/famp.12120

Description of Relational Processes: Recent

Changes in DSM-5 and Proposals for ICD-11

MARIANNE WAMBOLDT*

NADINE KASLOW

†

DAVID REISS

‡

Epidemiologic, prospective, and retrospective research confirms that family relational

variables are significant risk factors for the development of mental and physical health

problems in children as well as adults. In addition, relationships also play a moderating

role in the maintenance, exacerbation, or amelioration of chronic health problems.

Although acknowledgment of the importance of these variables in the pathophysiology of a

number of health conditions is reaching more prominence, the integration of assessments

of family factors as part of standard health care has made little progress. With the arrival

of the Affordable Care Act in the United States, there is a desire for earlier identification of

these risk factors, and the ability to implement prevention programs that reduce risk, and

enhance protective factors. On a global level, there is increased awareness of the health

impact of relational problems, for example, many countries have attempted to implement

programs to decrease domestic violence. More reliable and standardized assessments of key

relational processes will enhance both of these missions, and allow comparison of a variety

of prevention and intervention programs. This article discusses progress over the last dec-

ade in constructing more reliable definitions of relationship processes, how these have been

integrated into the Diagnostic and Statistical Manual 5th edition (DSM-5), and progress

toward implementation into the World Health Organization’s International Classification

of Diseases (ICD-11).

Keywords: Relational Diagnoses; DSM-5; ICD-11

Fam Proc 54:6–16, 2015

WHY A SYSTEMATIC APPROACH TO RELATIONAL DIAGNOSIS?

Basic and translational research explicating the role of key interpersonal relation-

ships in the development, mediation, and moderation of many of our mental disor-

ders has increased substantially over the past two decades (Beach et al., 2006). A few

categories of this research include retrospective risk assessments, such as the Adverse

Childhood Experiences (ACE) Study (Felitti et al., 1998); prospective environmental

studies which yield patterns of psychosocial risk variables associated with psychiatric

disorders (e.g., Copeland, Shanahan, Costello, & Angold, 2009a), and genetically

informed prospective studies (e.g., Caspi, Hariri, Holmes, Uher, & Moffitt, 2010;

Tienari et al., 2004; Uher et al ., 2011) that document both direct effect of family vari-

*Psychiatry, Children’s Hospital Colorado, Aurora, CO.

†

Grady Health System, Atlanta, GA.

‡

Child Study Center, Yale University, New Haven, CT.

Correspondence concerning this article should be addressed to Marianne Wamboldt, Psychiatry, Chil-

dren’s Hospital Colorado, 13123 East 16th Ave., B130, Aurora, CO 80045. E-mail: marianne.wamboldt@

childrenscolorado.org.

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Family Process, Vol. 54, No. 1, 2015 ©2015 Family Process Institute

doi: 10.1111/famp.12120