Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard assessment handbook used by mental health clinicians in the United States and in many other countries to classify and diagnose mental disorders.

It is also used in education, research, and other purposes by government agencies, health insurance [Page 388]and pharmaceutical companies, and universities. The DSM is published by the American Psychiatric Association, and has developed alongside other classification systems of mental disorders, such as sections of the World Health Organization's International Statistical Classification of Diseases and Related Health

Problems (ICD).

The DSM was first published in 1952 and has undergone several revisions since then: DSM-II in 1968; DSM-III in 1980 and 1987; and DSM-IV in 1994 and 2000. The earliest versions were small and limited, with minimal consideration of women's mental health, but each consecutive edition gradually paid more attention to the topic. Notably, DSM-III, published in the 1980s, furnished information about the prevalence and prognosis of disorders among men and women, as well as several diagnoses specific to women, mostly in the section on Psychosexual Disorders.

The latest edition, DSM-IV (2000), is much more informative and based on a comprehensive review of research literature at that time. It lists data about sex differences in prevalence, symptoms, and course of disorders under a section titled, “Specific Culture, Age, and Gender Features,” and provides some commentary on possible causal mechanisms. In addition, DSM-IV recognizes a number of disorders that are unique or have specific diagnostic criteria to women, particularly relating to childbearing, under the section “Sexual and Gender Identity Disorders.” An example is the inclusion of “Postpartum Onset” in DSM-IV to describe major depression experienced within four weeks of childbirth.

A controversial change in DSM-IV was the reclassification of premenstrual dysphoric disorder (PMDD), which was previously known as late luteal phase dysphoric disorder. PMDD is characterized by severe psychological and emotional symptoms associated with the latter phase of the menstrual cycle. DSM III labeled the condition as an “Unspecified Mental Disorder”; it was reclassified in DSM-IV as a “disorder requiring further study.” This change was largely in response to objections by some psychiatrists and women's groups which were concerned that labeling PMDD as a psychiatric disorder may stigmatize women. In their view, menstruation is a normal body process and, therefore, any associated psychological changes also should be interpreted as normal. In contrast to this feminist response, some psychologists and psychiatrists, including women, have argued that PMDD should now be classified as a separate disorder in the DSM, based on considerable research supporting its existence and burden.

Similarly, during the development of the DSM, feminist practitioners have objected to inclusion of other disorders such as paraphilic rapism and masochistic personality disorder. These efforts by the women's movement exemplify the important influence they have on the mental health profession, and also highlight their underlying concerns, particularly the social construction of mental illness.