Diagnostic and Statistical Manual

Psychiatry has always sought after a clear classification system of mental disorders. At issue has been which disorders should be included and how they should be organized. Around the end of World War II, four classification systems were in use: (1) the American Psychiatric Association's (APA) 1932 system, (2) the U.S. Army's system, (3) the U.S. Navy's system, and (4) the Veterans Administration's system.

It was after the realization that a more concise classification system was needed that the APA began working on the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The purpose of the DSM-I was to present a common classification based on a compromise of the psychiatric knowledge of the day, allowing professionals in the mental health field to communicate using a common diagnostic language. In 1952, the DSM-I was published, containing three categories of psychopathology and 106 diagnoses—only one of which could be applied to children—all in 103 pages of text. The terminology and descriptions of mental disorders reflected strongly the psychodynamic model of the day. The DSM-I was the first manual to focus on clinical utility.

The second version of the DSM, DSM-II, was published in 1968. The APA made minor revisions from the DSM-I, adding a few diagnoses, which brought the total to 182, and the manual became 134 pages long. The criticisms of DSM-I and DSM-II, most notably their reliability and validity, were [Page 200]extensive. The lack of detailed diagnostic descriptions left too much room for error. The descriptions given were also not collected from empirical studies but rather came from a small group of academics. Because it is so difficult to place cause on any one mental disorder, the editions were also criticized for use of the medical model. The remarks from very outspoken critics of the DSM caused considerable doubt not only about the DSM but also about psychiatry and psychology as professions.

The APA radically changed its classification system in the next edition of the DSM. Shifting away from the psychodynamic model, the DSM-III, published in 1980, was widely received as having a greater measure of validity because its contents were influenced much more by researchers than by clinicians. This revision consisted of uniform definitions of disorders, with explicit diagnostic criteria. With 494 pages and 265 diagnostic categories, the DSM-III came into widespread international use, leading to the formation of the American Psychiatric Press.

This new revision was not without its challenges as well. With its bulky size, it was not very user-friendly, and there were still some issues of reliability. To make coding more accurate, a revision was produced in 1987 (DSM-III-R). Some categories were added, and some were deleted; others were renamed or reorganized, or criteria were changed; certain controversial diagnoses, such as Masochistic Personality Disorder, were discarded.

In 1994, the DSM-IV was unveiled. This revision was made with a whole new approach: Committees, psychologists, and advisors broke up into groups and conducted extensive literature reviews. They gathered data from researchers and conducted numerous analyses and field trials to improve on the accuracy of the diagnoses and the diagnostic criteria for each disorder listed in the DSM. Even so, in 2000, a text revision was needed to give additional information on each diagnosis and to update the diagnostic codes to match consistently with the International Classification of Diseases.

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