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There are several steps involved when personnel at the American Psychiatric Association (APA) review proposals for additions or changes to DSM-5-TR.  Here is a summary of the review process.

Interested parties, usually mental health professionals, develop the proposal following the outline provided by the APA. They submit the proposal to the APA using the web portal for that purpose.

APA Research staff screen the proposals for completeness and appropriateness. They refer acceptable proposals to the DSM-5-TR Steering Committee.

The Steering Committee makes an initial assessment as to whether the evidence in support of the proposal appears likely to meet the criteria for approval. The Steering Committee may invite experts in relevant areas to comment on the proposal.  If approved at this level, the Steering Committee refers the proposal to a Review Committee.

The Review Committee consists of individuals who are knowledgeable regarding the topic being proposed. The Review Committee undertakes whatever investigation is required, such as review of additional literature and consultation with experts in relevant areas. The Review Committee sends their conclusions and recommendations back to the Steering Committee.

If the Steering Committee determines that there is considerable evidence in support of the proposal, the next step is to post the proposal for public comment. Alternatively, the Steering Committee may refer the proposal back to the Review Committee for further modification.

The proposal will be posted for public comment for at least 30 days. Notice will be given to the mental health community and organizations likely to have a specific interest in the proposal will be notified.

If the public comments are largely supportive of the proposal, the Steering Committee will make a final determination regarding whether to recommend approval of the proposal. If it recommends approval, it will forward the proposal, along with an explanation for the recommendation and a summary of the public comments, for review by the Assembly of the APA.

The Steering Committee will also send its recommendation and the supporting information to the Board of Trustees of the APA. To decide to forward a proposal to the Assembly and the Board of Trustees, the Steering Committee must determine that the proposal has met the criteria for approval.

If the proposal is approved by the Assembly and the Board of Trustees of the APA, the Review Committee that considered the proposal will be asked to develop whatever text changes are needed in the DSM to reflect the approved changes.

Finally, the Steering Committee forwards the approved changes for inclusion in an updated version of the DSM.