History of the DSM

• In 1918, the American Medico-Psychological Association (presently the American Psychological Association, or APA) issued the Statistical Manual for Use of Institutions for the Insane. It did not catch on.
• In 1928, the American Psychiatric Association issued another edition but it was too narrowly focused. It looked primarily at neuroses and psychoses.
• By World War II, the military had its own nomenclature system.
• The World Health Organization (WHO) issued the International Classification of Diseases-6 (ICD-6); it contained a section on mental disorders but it needed modification for use in the United States.

DSM-I

• The ​APA published the Diagnostic and Statistical Manual of Mental Disorders in 1952; it was based off of the ICD-6 and the military system.
• The first DSM contained about 60 disorders and was based on theories of abnormal psychology and psychopathology.
• Problems: DSM was criticized for its reliability and validity. The major limitation of the DSM was that the concept had not been scientifically tested. Also, all of the disorders listed were considered to be reactions to events occurring in an individual’s environment. Another problem was that there really was no distinction between abnormal and normal behavior. Despite this, it gained acceptance.

DSM-II

• The ​DSM-II was published in 1968 but still had criticism over its validity and reliability. Changes in the DSM-II included eleven major diagnostic categories, with 185 total diagnoses for mental disorders. Additionally, increased attention was given to children and adolescents in the DSM-II. For example the diagnostic category of Behavior Disorders of Childhood-Adolescence was presented for the first time.
• In 1974, the seventh printing of the DSM-II no longer listed homosexuality as a disorder.

DSM-III

• The DSM-III was published in 1980. This dramatically changed the field of psychology.
• The five part multiaxial diagnostic system, still used today, first appeared in DSM-III.
• DSM-III provided specific diagnostic criteria for 265 diagnoses.
• Dr. Robert L. Spitzer was appointed to lead the changes to the DSM in 1974. He was largely involved in creating the discrete diagnostic categories of the DSM-III, as opposed to a dimensional model of diagnosis.
• As with the DSM-II, many significant changes were made in the third edition of the DSM. For example, previously many of the anxiety disorders were lumped together as one diagnosis of Anxiety Neurosis. The DSM-III broke that broad diagnosis down to include many different anxiety disorders such as generalized anxiety disorder (GAD), panic disorder, agoraphobia, and social phobia. In fact, the term “neurosis” was removed from the DSM-III altogether. Furthermore, social issues came into play with the development of the DSM-III. Racism was considered as a mental disorder to be added, but after much deliberation and research was not included. Post-traumatic stress disorder was added to the DSM at this time. Also, the DSM-II category of “sexual orientation disturbance” was changed to “ego-dystonic homosexuality.”

DSM-III-R

• The revision for DSM-III was published in 1987.
• 297 diagnoses

DSM-IV

• The DSM-IV was published in 1994.
• This edition was more research based as far as criteria and diagnoses are concerned.
• 365 diagnoses.

DSM-IV-TR

• The newest revision of the DSM was published in 2000.
• This volume is heavily research based and includes information about the etiologies of the disorder.

DSM-V

• The newest revision, DSM-V, will be available in 2012, with final approved edition expected May 2013.
• Join effort between the American Psychiatric Association, the National Institute of Mental Health, the World Health Organization, and the World Psychiatric Association.
• Efforts began in 2000, and have involved 13 conferences with international involvement.
• Some of the proposed changes include:
  • Modifications of various disorder spectrums, such as including Asberger’s disorder within the autism spectrum;
  • Modiciations of terminology, such as replacing use of “mental retardation” with “intellectual disability”;
  • Improved methods of assessment.
  • Large scale inclusion of new criteria to all aspects, with some proposed removals and integrations.
• To learn more about many of the changes being proposed, click here.