What do you know about the Diagnostic and Statistical Manual of Mental Disorders (DSM)?

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What do you know about the Diagnostic and Statistical Manual of Mental Disorders (DSM)?

Early systems for classification

The classification of mental disorder started two millennium ago. In the starting different systems of classification were made containing few or many disorders but all those systems were made by different individuals or organizations. Most of these systems were based only on statistical information of different disorders.

Before 1840 there was no proper system for the classification of psychological disorders. First national level work in United Stated was done in the same year which came in the form of “1840 census” which included a single category of mental illness “idiocy/insanity”. In 1844 American Medico-Psychological Association (APA) first published a predecessor of DSM which was a statistical classification of institutionalized mental patients. Its purpose to categorize the types of patients cared for in the hospitals. Seven categories of mental disorders were made by the 1880 census (melancholia, dementia, mania, dipsomania, monomania, paresis, and epilepsy).

In 1917, American Medico-Psychological Association (changed its name to American Psychiatric Association in 1921) and the National Commission on Mental Hygiene published the Statistical Manual for the Use of Institutions for the Insane which manual went through 10 editions until 1942. But still, these all were based on statistical information German psychiatrist Emil Kraepelin founded a new system of classification of disorders which was based on symptoms and classification of diseases. He categorized hundreds of mental disorders by grouping diseases together based on their classification. U.S. Army and the Veterans Administration also made a system for after World War II which in which the psychological problems with soldiers and veterans were given.

In 1949 the sixth edition of International Classification of Diseases (ICD) by World Health Organization (WHO) included a section for mental disorders for the first time which contained 10 categories for psychoses and psychoneuroses and seven categories for disorders of character, behaviour, and intelligence.

Development of Diagnostic and Statistical Manual of Mental Disorders (DSM)

Diagnostic and Statistical Manual of Mental Disorders (DSM)-I

The first version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 by APA. It contained the same codes used in ICD-6 for mental disorders. It was mostly influenced by the works of Adolf Meyer. The term “reaction” was used for most of the disorders. DSM-I had 130 pages and 106 disorders including (some personality disorders, neurosis, nervousness, and homosexuality).

Diagnostic and Statistical Manual of Mental Disorders (DSM)-II

DSM-II was published in 1968 and was consisted of 134 pages and 182 disorders. The term reaction was removed from it. Homosexuality was also removed from DSM-II due to some reasons including the research of Evelyn Hooker (1956) and the protests from the gay population. It was an improved edition of DSM-1 and also contained new information from ICD-8. Some new disorders were also included e.g. Psychosis with childbirth, Involutional melancholia, sexual orientation disturbances, and Depersonalization syndrome. Both DSM-I and DSM-II had some major problems related to the criteria, reliability, validity, and statistical data.

Diagnostic and Statistical Manual of Mental Disorders (DSM)-III

Published in 1980, DSM-III consisted of 494 pages and 265 disorders. Among the major changes were to include disorders like Pre-menstrual dysphoric disorder, Masochistic personality disorder PTSD, Borderline Personality disorder, and Ego-dystonic Homosexuality.  Criteria’s some personality disorders were also changes. Multiaxial System of diagnosis was first time used in DSM-III.

Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R

Published in 1987, DSM-IIIR was a revised edition of DSM-III. 32 new disorders were included in this edition while some others were removed. Pre-menstrual dysphoric disorders and masochistic personality disorders were removed from DSM-IIIR while Sexual orientation disturbance and Ego-dystonic Homosexuality was merged into “sexual disorder not otherwise specified”

Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV

Published in 1994, The DSM-IV was 886 pages long and covered 297. It used the same terminology of ICD-10. While some disorders were deleted and some were moved to an appendix, the important edition was to include a clinical significance criterion to almost half of all the categories. A most important feature of the DSM-IV was the use of the process of psychiatric nosology which is also used for DSM5.

Diagnostic and Statistical Manual of Mental Disorders (DSM)-IVTR

DSM-IV-TR was published in 2000 and it covered 297 disorders. In this edition most of the diagnostic criteria for disorders was unchanged. Text sections were updated which provided more information about the disorders. The most important feature in the DSM-IV-TR was the use of 5 axis system of diagnosis which also focused on general medical conditions, psychosocial and environmental problems, and Global Assessment of Functioning.

Diagnostic and Statistical Manual of Mental Disorders (DSM)-5

Published on May 18, 2013, DSM-5 contains 947 pages. It is very different from the DSM-IV-TR because of its new terminology and the removal of the multiaxial system of diagnosis. Among the other major changes is the removal of the subtypes of schizophrenia, removal of A2 criteria for PTSD etc. Mood disorders are classified into two categories of depressive disorders and bipolar and related disorders. Some new disorders are added to the category of Neurodevelopmental disorders. Some new categories are made which include Trauma- and stressor-related disorder, Obsessive-compulsive and related disorders, Disruptive, impulse-control, and conduct disorders. The change of terminology includes the use of intellectual disability (mental retardation), gender dysphoria (gender identity disorder), depersonalization/derealization disorder (Depersonalization disorder), and somatic symptom and related disorders (somatoform disorders) etc.


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