Diagnostic and Statistical Manual of Mental Disorders

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 among 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].
    
    • DSM-5 Update Supplements are published at regular intervals to "reflect coding updates, changes, or corrections, and other information necessary for compensation in mental health practice."[1]
    • As updates are made, they are uploaded as PDFs to http://dsm.psychiatryonline.org.