The major accomplishment of the fourth edition of the American Psychiatric Association's diagnostic manual was not in the development of surprising new content but rather in the careful, cautious, and systematic method with which it was constructed. The authors of the forthcoming fifth edition may have reversed the priorities, instead emphasizing radical changes without first conducting careful, systematic, thorough, or objective reviews of the scientific literature. Of particular concern are the proposals to cut half of the diagnoses from the manual, to abandon diagnostic criterion sets, and to include a dimensional model that lacks empirical support, fails to be integrated with normal personality functioning, and will lack official recognition.