Relationship problems and the DSM: Needed improvements and suggested solutions

Relational problems are clinically significant behavioral or psychological syndromes or patterns that occur between or among individuals and that are associated with present distress or disability or with a significant increased risk of suffering death, pain, disability, or an important loss of freedom. Relational problems (e.g., partner relational problems, partner abuse, child maltreatment) are included as Axis I disorders in the DSM-IV as V-codes (i.e., "Other conditions that may be a focus of clinical attention"). However, there are no criteria provided in the DSM-IV for these codes. In this article, we briefly review literature that incontrovertibly documents both relational problems syndromes/patterns and their serious sequelae. We then review a series of studies that provide evidence of content validity and inter-rater agreement for criteria to determine presence versus absence of relational problems. The most studied subset of relational problem criteria, those for partner and child maltreatment, have been shown to have remarkably high levels of reliability when disseminated broadly in the field (κ = .66-.89), at agreement levels never reached by DSM diagnoses for individuals. We conclude by arguing that science, service, families, individuals, and the DSM itself, would be well served to include diagnostic criteria for relational problems and to consider the various options for placement of relational problems/processes in the DSM-V.