Describing Relationship Problems in DSM–V: Toward Better Guidance for Research and Clinical Practice Steven R. H. Beach University of Georgia Marianne Z. Wamboldt University of Colorado Denver Health Sciences Center and The Children’s Hospital, Denver Nadine J. Kaslow Emory University School of Medicine Richard E. Heyman Stony Brook University David Reiss George Washington University Medical Center The authors provide a description of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV; American Psychiatric Association, 1994) and its limitations, as well as empirical connections between relational processes and mental health. Four types of relational processes are identified, with each type clearly distinguished in terms of its pattern of association with psychopathology. For illustrative purposes, examples are provided along with suggestions of how each might be accommodated in the DSM–V. In view of the importance and complexity of the connections between relational processes and mental health, the authors argue that reliable and standardized assessments of relational processes are needed and suggest 6 possible approaches for providing better coverage of relational pro- cesses and relational disorders in the DSM–V. The article concludes with a discussion of potential concerns about expansion of attention to relational processes in the DSM–V. Keywords: DSM–V, diagnosis, family, relationships, psychopathology The fourth edition of the Diagnostic and Statistical Man- ual of Mental Disorders (DSM–IV) was adopted by the American Psychiatric Association (1994, 2000) to guide reliable diagnosis. Those involved in its development made an explicit effort to use the best available science to inform decisions about nomenclature. This approach continued a revolution in psychiatric assessment begun with the DSM– III (American Psychiatric Association, 1980). Since 1980, reliability has improved as a result of the development of empirically informed criterion sets and the application of structured clinical interviews. The result has been enormous gains in the ease of communication regarding specific prob- lems and in developing science-based recommendations to guide clinical decision making. Why Have Relational Processes Lagged Behind? Relational processes have not been the focus of any successful effort comparable to that undertaken for psychi- atric assessment more generally, but the resulting limita- tions of the DSM–IV in this regard do not stem from a failure to recognize the importance of relational context for disorders. Indeed, the DSM–IV highlights relational pro- cesses in the V codes (e.g., partner relational problem, sibling relational problem, parent– child relational problem), lists categories of psychosocial problems on Axis IV (e.g., problems with primary support group, problems related to social environment), and provides the Global Assessment of Functioning (GAF) scale on Axis V and the Global Assess- ment of Relational Functioning (GARF) scale in Appendix B. In addition, some relational problems have been ad- dressed in supplemental materials, such as the discussion of abuse and neglect and other relational problems in Volume III of the DSM–IV Sourcebook (American Psychiatric As- sociation, 1997). Unfortunately, because the research base from this era (i.e., pre-1994) was considered insufficient to support reliable guidelines for assessment or to tie relational processes to particular diagnostic outcomes, relational pro- cesses were not given the prominence in the DSM–IV hoped Steven R. H. Beach, Department of Psychology, University of Georgia; Marianne Z. Wamboldt, University of Colorado Denver Health Sciences Center and The Children’s Hospital, Denver, Colorado; Nadine J. Kaslow, Department of Psychiatry and Be- havioral Sciences, Emory University School of Medicine; Richard E. Heyman, Department of Psychology, Stony Brook University; David Reiss, The Center for Family Research, The George Wash- ington University Medical Center. We gratefully acknowledge the Fetzer Institute, which has par- tially supported the process of writing this article and is also partially supporting the process of collecting background material for the inclusion of relational processes in the DSM–V. Correspondence concerning this article should be addressed to Steven R. H. Beach, Institute for Behavioral Research, 111 Barrow Hall, University of Georgia, Athens, GA 30602. E-mail: sbeach@ egon.psy.uga.edu Journal of Family Psychology Copyright 2006 by the American Psychological Association 2006, Vol. 20, No. 3, 359 –368 0893-3200/06/$12.00 DOI: 10.1037/0893-3200.20.3.359 359