Diagnostics and Statistical Manual (DSM)
In 1918, the American Medico-Psychological Association (now called American Psychological Association or APA) issued the Statistical Manual for Use of Institutions for the Insane but it wasn’t well received.
In 1928, the APA tried again with another edition but it was too narrowly focused. It looked primarily at neuroses and psychoses.
In WW2, the military created their own system of classification.
The release of ICD-6 contained a section on mental disorders but it needed modification for use in the United States.
In 1952, the APA published the Diagnostic and Statistical Manual of Mental Disorders (DSM-1) based off the ICD-6 and the military classification and contained 60 disorders and was based on theories of abnormal psychology and psychopathology.
However, the DSM was criticized for its reliability and validity because it was based on concepts that were not scientifically tested, and all of the disorders listed were considered to be reactions to events occurring in an individual’s environment. Another problem was there was no distinction between abnormal and normal behaviour.
The DSM-II was published in 1968, and still lacked reliability and validity. It defined 11 major diagnostic criteria with 185 diagnoses for mental disorders with increased attention to childhood mental health.
Controversially, the DSM-II included homosexuality as a disorder until it was removed in 1974.
In the DSM-II, ADHD was called Hyperkinetic disorder of children.
1980 saw the release of the DSM-III which was a complete revolution in the DSM, with the introduction of the five part multiaxial diagnostic system which continues into DSM V.
Neurosis was removed in DSM-III and Racism was considered a disorder but was never added to the DSM.
By DSM-III, the number of diagnoses had grown to 265.
Anxiety disorders were lumped together in previous versions of the DSM were now given their own diagnoses.
The DSM-III added Kanner’s Autism into the DSM and changed Hyperkinetic disorder to ADD as ADD/H as ADD with hyperactivity and ADD/WO as ADD without hyperactivity.
DSM-IIIR was a revision that was released in 1987 as the number of diagnoses had increased to 297.
In this revision, ADHD replaced ADD/H and ADD/WO, but it also meant that an individual without hyperactivity could not be diagnosed as having ADHD.
DSM-IV was the revision released in 1994 and featured more research based criteria and the number of diagnoses had increased to 265.
In this release, ADHD was defined with two sub types: ADHD with Inattentive subtype and ADHD with Hyperactive/Impulsive subtype as well as ADHD combined for people who possessed both.
DSM-IV-TR (Text Revision) was released in 2000, and introduced the concept of differential diagnosis and was heavily research based including the causes of disorders.
Work on the DSM-V release started in 2000 and took 13 years and was eventually released in 2013 as a joint effort between the American Psychiatric Association, the National Institute of Mental Health, the World Health Organisation, and the World Psychiatric Association.
Asperger’s Syndrome was merged into Autism (partly to do with Hans Asperger’s Nazi past coming out after his death and the similarity of Asperger’s Syndrome and Autism) and outdated terminology like mental retardation was replaced with modern terminology such as intellectual disability.
The effect of the joint effort moved the DSM diagnoses closer to the ICD.
Unlike the ICD, the DSM does not provide treatment guidelines.
The next revision of the DSM, which will be titled DSM-V-TR is scheduled to be released in March 2022.
It features a new disorder, Prolonged Grief Disorder, as well as codes for suicidal behaviour available to all clinicians of any discipline without the requirement of any other diagnosis.
Racism and discrimination of mental health is set to feature in this release.
The book can be pre-ordered from Appi, the publishing arm of the APA.