Johns Hopkins Psychiatry Guide

Diagnostic and Statistical Manual of Mental Disorders

Jacob Taylor, M.D., Margaret S. Chisolm, M.D.
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DEFINITION

  • The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA).
    • The current 5th edition (DSM-5) was published in 2013 [1].
    • Its purpose is to provide objective, reliable criteria for identifying and differentiating mental disorders, thereby facilitating clear communication amongst clinicians, researchers, and others.
  • The hallmark of the DSM is its emphasis on diagnostic reliability, perhaps at the expense of validity.
    • Disorders are defined by their appearances (clusters of signs and symptoms) rather than by the mechanisms that are presumed to generate them.
  • The first two versions of the DSM were published in 1951 and 1968, respectively.
    • They relied on paragraph-length general descriptions of mental disorders rather than clearly defined diagnostic criteria.
    • These editions were published at a time when most American psychiatrists believed, following Freud, that virtually all mental disorders arose from unresolved unconscious conflicts.
      • There was therefore little perceived need to reliably distinguish the different manifestations of these conflicts from one another [2].
  • By the 1970s, a lack of reliability and standardization in psychiatric diagnosis were seen as contributing to several problems confronting the field, including [3]:
    • Lack of research progress
    • Attacks on the validity of the profession by the antipsychiatry movement
    • Decreased funding for psychiatric care by private and public payers
  • The first modern version of the DSM was DSM-III, published in 1980.
    • Characterized by clear, observable criteria for differentiating disorders
    • Supported by field trials to identify criteria that are most helpful in making replicable diagnoses
    • Atheoretical, in that propositions regarding etiology were generally not included in criteria
  • Subsequent editions, including the recently published DSM-5, have built on clinical and epidemiologic research to add or drop disorders, and to adjust criteria for existing disorders.
    • The overall organization and sequence in which disorders are enumerated have also changed across editions, and the length of the volume has grown progressively.
    • DSM-5 is conceived of as a "living document" to which frequent updates and revisions are anticipated [1].
      • Hence the use of a "5" rather than a "V," allowing for a version 5.1, 5.2, etc.

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Last updated: November 21, 2014