DEFINITION

• The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA).
  • The DSM’s purpose is to provide objective, reliable criteria for identifying and differentiating mental disorders, thereby facilitating clear communication among clinicians, researchers, and others.
  • DSM-5 was published in 2013.[1] In March 2022, the APA released a text revision (DSM-5-TR) that incorporated selective diagnostic, coding and text revisions rather than a full new edition. The APA describes DSM-5-TR as a targeted update reflecting accumulated evidence since DSM-5 and as part of an iterative ("living document")[1] approach to revisions and coding updates.[2]
  • Like prior editions, DSM-5-TR remains primarily symptom- and syndrome-based: disorders are defined by clusters of observable signs and symptoms rather than by definitive biomarkers or fully established etiologic mechanisms. This approach favors diagnostic reliability (consistent application of criteria across clinicians) while validity (whether categories map on to discrete natural disease entities) remains a separate and ongoing scientific challenge.
  • As updates are made, they are uploaded as PDFs to http://dsm.psychiatryonline.org.
• 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.
• Historical context
  • 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[3].
  • By the 1970s, a lack of reliability and standardization in psychiatric diagnosis were seen as contributing to several problems confronting the field, including[4]: Lack of research progress, attacks on the validity of the profession by the antipsychiatry movement, and decreased funding for psychiatric care by private and public payers.
  • The first modern version of the DSM was DSM-III, published in 1980. It introduced explicit criteria with field testing, an approach intended to improve diagnostic reliability and to make psychiatric research more reproducible. Subsequent editions have built on clinical and epidemiologic research to add or drop disorders, and to adjust criteria for existing disorders.