Diagnostic and Statistical Manual of Mental Disorders (DSM)

Revisions

The DSM has been revised five times over the past 25 years. In 1952, the American Psychiatric Association (APA) published the DSM-I. It was 130 pages long, defined 106 separate categories of mental disorders, and contained coding systems used by earlier diagnostic manuals, such as the Statistical Manual for Mental Diseases, which was published in 1933. The DSM-I also drew from [Page 299]nomenclature developed by the U.S. Army and the Veterans Administration.

In 1968, the DSM-II was published, and it attempted to improve consistency with the International Classification of Diseases (ICD). The ICD is published by the World Health Organization (WHO) for similar reasons that had motivated the development of the DSM. The ICD provides an international taxonomy that assigns numerical codes to disease conditions. In the United States, the DSM is used in addition to the ICD codes. There were many new mental disorders added to the DSM-II, increasing the total number of separate categories to 182. Neither the DSM-I nor the DSM-II attempted to elaborate on specific psychiatric symptoms or their manifestations. Rather, the DSM-I and DSM-II emphasized the psychological underpinnings of psychiatric disease and were less focused on the itemized symptom clusters that identified the illness. This was an important distinction beginning with the third edition of the DSM, DSM-III.

The DSM-III was published in 1980. It was 494 pages long, and included 265 categories. The DSM-III attempted to transition from an explanatory tome of mental disorders to an objective and descriptive model based on empirical data, not theories and hypotheses. The most significant change was that the manual focused on symptom-based diagnostic criteria. Further developments included a multiaxial diagnostic framework that not only included the primary diagnosis but also supplemented it with relevant clinical information on contributing medical, psychosocial, and functional distinctions.

The DSM-III-R was published in 1987, and it not only refined definitions of many diagnoses but also included exclusionary criteria to be considered in ruling out a disorder.

After much research, the DSM-IV was published in 1994. It had a major focus on empirical research gathered by extensive literature reviews. Almost half of the categories included a clinical aspect, which required specific symptoms that cause impairment in various areas of functioning such as work, school, or social interaction. Many disorders were deleted (i.e., sadistic personality disorder and passive aggressive personality disorder), and other disorders were reorganized. Disorders were also added (e.g., bipolar-II disorder), as well as culture-specific syndromes and disorders, which focus on age-, race-, and gender-specific problems. Other small changes were made to the nomenclature, such as the renaming of multiple personality disorder to dissociative identity disorder.

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