Diagnostic and Statistical Manual of Mental Disorders
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- 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.
- 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.
- By the 1970s, a lack of reliability and standardization in psychiatric diagnosis were seen as contributing to several problems confronting the field, including:
- 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.
- Hence the use of a "5" rather than a "V," allowing for a version 5.1, 5.2, etc.
- As updates are made, they are uploaded as PDFs to http://dsm.psychiatryonline.org.