8. A History of the DSM
(Abridged)
Tuesday, April 20, 2010
9. • 1917: APA produces
“Statistical Manual for
the Use of Institutions of
the Insane”
• 1943: Medical 203
Emil Kraeplin
• 1949: ICD version 6
• 1840/1880 U.S. Census: covers mental disorders
Categories and counts
• 1952: DSM-I is published
• Late 19th century:
Kraeplin gets “clinical” at • 130 pages
the Tartu University
Clinic in Estonia • 106 mental disorders
Tuesday, April 20, 2010
10. DSM: Evolution
Title Year Pages Disorders
DSM I 1952 130 106
DSM II 1968 134 182
DSM III 1980 494 265
DSM III-R 1987 567 292
DSM IV 1994 886 297
DSM IV-TR 2000 943 365
DSM V 2013 ? ?
Tuesday, April 20, 2010
16. Impact on America
• 26.2 percent of American adults suffer from
a diagnosable mental disorder every year
• 6 percent of American adults suffer from a
serious mental illness
• $57.5B spent in 2006 to treat mental
disorders: equivalent to the amount spent
on cancer and the third-largest category of
expense in American health care today
Tuesday, April 20, 2010
18. Problem 1: Definition
Can we increase certainty in our ontology?
• ICD and DSM name different categories of
• DSM publishes four sourcebooks to detail
their empirical methodology and findings
• Volumes 1 - 3 are literature reviews
• Volume 4 has 40 re-analyses and 12 field
trials
Tuesday, April 20, 2010
19. Problem 2: Diagnosis
Can we recognize health as well as disorder?
• Diagnosis done using symptoms, not causes
• Decision trees and sample cases published
as supplements to the DSM
• Differential Diagnosis supplement highlights
similar disorders
• Structured Clinical Interview for the DSM
• Sill issues: “On being sane in insane places”
Tuesday, April 20, 2010
20. Problem 3: Treatment
Can we heal effectively and at low cost?
• When a new disorder is identified, how is a
new treatment prototyped and developed?
• What are the cost and outcomes of existing
treatments?
• What does the drug development pipeline
look for critical disorders?
• How do non-drug treatment options
interact with treatment via drugs?
Tuesday, April 20, 2010
27. Healthcare
Communities Online
• Could we build a community resource
around the disorders identified in the DSM?
• Empower patients to discuss their disorder
with others
• Allow psychiatrists to debate definitions
Tuesday, April 20, 2010
28. The Benefits of a
Community
• Identify the most effective treatments and
locations for treatment
• Highlight where controversy still hides
• Recall discussions around homosexuality
• Potentially inform future versions of the
DSM
Tuesday, April 20, 2010