The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) (American Psychiatric Association [APA], 2000) is used for clinical, research, and educational purposes. The focus of the manual is on diagnostic codes that are used in medical record keeping and communication of information to governmental agencies, private insurers, and the World Health Organization (APA, 2000). The relative infancy of this classification system warrants skepticism, yet empirical support for diagnostic reliability and validity has evolved significantly since its inception.

The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I) (1952) was recognized as the manual of mental health categorization. It was developed as a variant of the “Mental Disorders” section of the sixth edition of the World Health Organization's (WHO, 1949) ...

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