After having a leadership role in the development of the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) and its revision (DSM-III-R; American Psychiatric Association, 1987), I now comment as an outsider-insider on the development of DSM-IV. Many features of the DSM-IV process, such as systematic literature reviews and focused field trials, represent significant advances that will increase the role of empirical findings in the decision-making process in this latest edition of the DSM. However, it is likely that when final decisions are made about DSM-IV, the decisions will still be based primarily on expert consensus, rather than on data, as was the case with DSM-III and DSM-III-R.