Book excerpt: This book reflects the discontent of many mental health professionals with the Diagnostic and Statistical Manual-IV (DSM-IV), which has come to provide the foundation for managed care's fragmented, symptomatic treatment approaches. Some of the criticisms that the contributors note are (a) the excessive reliance of the DSM on the medical model; (b) an excessive focus on reliability at the expense of validity and a predominance of the categorical, rather than the dimensional, approach to diagnosis; (c) arbitrary cut-off points for disorders; (d) a significant problem with comorbidity; and (e) a steady proliferation of labels for the personality disorders. The contributors explore this and other criticisms of the DSM system and propose new ways of looking at diagnosis and treatment. This thought-provoking volume proposes the ultimate goal of finding a diagnostic process that can be meaningfully related to what clinicians do in their actual work with patients.