3. Introduction to DSM
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was created
in 1952 by theAmerican PsychiatricAssociation so that mental health professionals
in the United States would have a common language to use when diagnosing
individuals with mental disorders.
It is the handbook used by health care professionals as the authoritative guide
to the diagnosis of mental disorders.
DSM contains descriptions, symptoms, and other criteria for diagnosing mental
disorders.
Used by clinicians and researchers to diagnose and classify mental disorders,
the criteria are concise and explicit, intended to facilitate an objective assessment of
symptom presentations in a variety of clinical settings—inpatient, outpatient,
partial hospital, consultation-liaison, clinical, private practice, and primary care.
4. Revision of DSM
TheAPAprepared for the revision of DSM for nearly a decade, with an unprecedented
process of research evaluation that included a series of white papers and 13 scientific
conferences supported by the National Institutes of Health.
This preparation brought together almost 400 international scientists and produced a
series of monographs and peer-reviewed journal articles.
1952
1968
1980
1987
1994
DSM-I
DSM-II DSM-III-R
DSM-III
DSM-IV-TR
DSM-IV 2000 DSM-5
2013
5. Diagnostic and Statistical Manual of Mental Disorders (DSM)
Edition Publication
Date
Number of
Pages
Number of
Diagnoses
Number of
Disorders
DSM-I 1952 132,130 128 106,60
DSM-II 1968 119,134 193 182
DSM-III 1980 494 228 265
DSM-III-R 1987 567 253 292
DSM-IV 1994 886 383 297,410
DSM-IV-TR 2000 943 383
DSM-5 2013 947 541 312
6. DSM-I (1952)
The first edition of DSM (1952) was titled 'Diagnostic and Statistical Manual
of Mental Disorders'. It did not carry any number attached to its title.
DSM-I was created after World War II, and was partially a reaction to the return
of military veterans from the war. Many veterans showed non-psychotic but non-
physical disorders, and a number of military medical officers from World War II
turned their attention to the treatment of these disorders.
(Baker & Pickren, 2007; Pickren & Schneider, 2005).
The DSM-I contained 128 categories. Organizationally, it had a hierarchical system
in which the initial node in the hierarchy was differentiating organic brain syndromes
from “functional” disorders which were subdivided into psychotic versus neurotic
versus character disorders.
DSM contained a glossary of descriptions of the diagnostic categories and was the
first official manual of mental disorders to focus on clinical use.
7. DSM-II (1968)
DSM II listed 182 disorders, and was 134 pages long. It was quite similar to the DSM-I.
The term "reaction" was dropped, but the term "neurosis" was retained.
In the 1960s, there were many challenges to the concept of mental illness itself. These
challenges came from sociologists,behavioural psychologists and psychiatrists like
Thomas Szasz, who argued mental illness was a myth used to disguise moral conflicts.
Unlike the DSM-I, many of the new categories added in the DSM-II were categories
of relevance to outpatient mental health efforts. Anxiety disorders, depressive
disorders, personality disorders (PDs), and disorders of childhood/adolescence were
larger subsets than they had been in the DSM-I.
LIMITATIONS:
Fleiss and Spitzer concluded "there are no diagnostic categories for which reliability is
uniformly high. Reliability appears to be only satisfactory for three categories:
mental deficiency, organic brain syndrome, and alcoholism.
8. Sixth printing of the DSM-II (1968)
As described by Ronald Bayer, a psychiatrist and gay rights activist,
specific protests by gay rights activists against theAPAbegan in 1970.
After a vote by theAPAtrustees in 1973, and confirmed by the wider
APAmembership in 1974, the diagnosis was replaced with the category
of "sexual orientation disturbance".
Homosexuality removed as a mental disorder following the protests
at the 1974 annual convention of theAPAin San Francisco.
9. DSM-III (1980)
Work began on DSM–III in 1974, with publication in 1980.
DSM-III heralded a paradigm shift in the history of psychiatric diagnosis, with its
incorporation of empirically-based, a theoretical and agnostic criteria for psychiatric
diagnosis.
Other criteria, and potential new categories of disorder, were established by consensus
during meetings of the committee, as chaired by Spitzer.
DSM–III introduced a number of important innovations, including:
Explicit diagnostic criteria
Amultiaxial diagnostic assessment system.
An approach that attempted to be neutral with respect to the causes of mental
disorders.
It was developed with the additional goal of providing precise definitions of mental
disorders for clinicians and researchers.
10. DSM-III-R (1987)
APA appointed a work group to revise DSM–III, which developed the
revisions and corrections that led to the publication of DSM–III–R in 1987.
Categories were renamed and reorganized, and significant changes in criteria
were made. Six categories were deleted while others were added.
Controversial diagnoses, such as pre-menstrual dysphoric disorder and
masochistic personality disorder, were considered and discarded.
"Ego-dystonic homosexuality" was also removed.
11. DSM-IV (1994)
Numerous changes were made to the classification (e.g., disorders were
added, deleted, and reorganized), to the diagnostic criteria sets, and to
the descriptive text.
A major change was the inclusion of a clinical significance criterion to
almost half of all the categories, which required symptoms cause "clinically
significant distress or impairment in social, occupational, or other impo
rtant areas of functioning".
Some personality disorder diagnoses were deleted or moved to the appendix.
12. Axis I:
Clinical
Syndromes
Described clinical
symptoms that cause
significant impairment.
Disorders were
grouped into different ca
tegories such as
mood disorders,
anxiety disorders, or
eating disorders.
Described long-term
problems in
functioning that were
not considered
discrete axis I
disorders.
These include
such things as
unemployment,
relocation,divorce,
or the death of a
loved one.
Allowed the clinician to
rate the client's overall
level of functioning.
Based on this
assessment, clinicians
could better understand
how the other four axis
interacted and the effect
on the individual's life.
DSM-IV-TR (2000)
The DSM-IV-TR described disorders using five different dimensions.
This multiaxial approach was intended to help clinicians and psychiatrists make comprehensive
evaluations of a client's level of functioning because mental illnesses often impact many different life areas.
Axis II:
Personality
and
Mental Retardation
Axis III:
Medical
Conditions
Axis IV:
Psychosocial and
Environmental
Problems
Axis V:
Global Assessment of
Functioning or Child
Global Assessment of
Functioning
These included physical
and medical conditions
that influence or worsen
Axis 1 andAxis II
disorders.
Some examples include
HIV/AIDS and brain
injuries.
13. DSM-5 (2013)
Dr. Dilip Jeste, the then President of the American Psychiatric Association, released
the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders on May
18, 2013 at the 166 th Annual Meeting of theAPAat San Francisco.
As the process of developing the manual progressed, the Roman numerical 'V' was
replaced by the alpha numerical '5'. This would facilitate subsequent revisions being
numbered as 5.1, 5.2 and so forth.
It is an authoritative volume that defines and classifies mental disorders in order to
improve diagnoses, treatment, and research. It does not claim to be the ultimate or
the final word in classification of mental disorders.
Some examples of categories included in the DSM-5 include anxiety disorders,
bipolar and related disorders, depressive disorders, feeding and eating disorders,
obsessive-compulsive and related disorders, and personality disorders.
14. DSM-5
It is a 947 page manual, divided into three sections and an appendix:
Section
Includes:
Introduction, Instruction on
how to use the manual, and a
chapter on cautionary
of DSM 5.
statement for forensic use axis format and considers
the relevance of age,
gender, and culture.
Covers:
Self-rated cross-cutting
symptom measures for
adults, children, and
adolescents between
age 6 and 17 years.
01 02 03
Section Section
Lists:
Diagnostic criteria and
codes of 22 diagnostic
categories. It has a single
15. Changes in The DSM-5
It eliminated the axis system, instead listing categories of disorders along
with a number of different related disorders.
Asperger's disorder was removed and incorporated under the category of a
utism spectrum disorders.
Disruptive mood dysregulation disorder was added, in part to decrease
over-diagnosis of childhood bipolar disorders.
Several diagnoses were officially added to the manual including binge eating
disorder, hoarding disorder, and premenstrual dysphoric disorder.
It is based on explicit disorder criteria, which taken together constitute a
“nomenclature” of mental disorders, along with an extensive explanatory text
that is fully referenced for the first time in the electronic version of this DSM.
16. Conclusion
DSM serves as the principal authority for psychiatric
diagnoses.
It also provides a common language for researchers to
study the criteria for potential future revisions and to aid in
the development of medications and other interventions.
DSM is an important tool for those who have received
specialized training and possess sufficient experience are
qualified to diagnose and treat mental illnesses.
The strength of each of the editions of DSM has been
"reliability". The weakness is its lack of validity .
While DSM has been described as a "Bible" for the field,
it is, at best, a dictionary, creating a set of labels and
defining each.
17. References:
American Psychiatric Association. Diagnostic and statistical manual of
mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013
Alina Surís et al.(2016) The Evolution of the Classification of Psychiatric
Disorders
Vahia V. N. Diagnostic and statistical manual of mental disorders 5: A quick
glance. Indian J Psychiatry 2013;55:220-3
http://apsychoserver.psych.arizona.edu/JJBAReprints/PSYC621/Blashfield_etal
2014_ARCP.pdf
https://dhss.delaware.gov/dsamh/files/si2013_dsm5foraddictionsmhandcrimi
naljustice.pdf
http://pepsic.bvsalud.org/pdf/psipesq/v8n1/09.pdf
https://tpb.psy.ohio-state.edu/5681/notes/dsm/01.htm
https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm
https://www.verywellmind.com/the-diagnostic-and-statistical-manual-dsm-
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