- Last edited on July 8, 2020
History of the DSM
Primer
The DSM, or the Diagnostic and Statistical Manual of Mental Disorders has a long and storied history in the history of psychiatry. As the cornerstone of psychiatry and guide for millions of clinicians and healthcare providers, it has been the most significant advance in the diagnosis and treatment of mental disorders. However, in the midst of its success, criticisms of its role have also developed.
[The] DSM[-IV] does none of its jobs perfectly and its awkward fit certainly creates a variety of problems. Some clinicians refuse to learn DSM and stick to their own personal prototypes of disorders. Many epidemiological researchers ignore the requirement for clinical significance before making a psychiatric diagnosis and therefore report ridiculously high rates of mental illness in the general population. Some students take the DSM descriptions too literally and lose the patient as they evaluate the criteria. Lawyers often find loopholes because the language of DSM is frustratingly below legal requirements for precision. And so on.
But the unifying and synthesizing whole of DSM-IV is still worth much more than would be the accumulated sum of its individual parts. However imperfect, the DSM's special value is as a common denominator that avoids a Babel and is good enough (if admittedly not best) at each of its jobs.
– Allen Frances, MD, Chair of the DSM-IV Task Force
The Cycle of Classification: DSM I through DSM-5
Blashfield, R. K., Keeley, J. W., Flanagan, E. H., & Miles, S. R. (2014). The cycle of classification: DSM-I through DSM-5. Annual review of clinical psychology, 10, 25-51.Pre-DSM Era
DSM-I
DSM-II
Even though the DSM II was published in 1968 (!) the following excerpt is sage advice even (and especially) today.
A Tip From the DSM-II...
The diagnostician, however, should not lose sight of the rule of parsimony and diagnose more conditions than are necessary to account for the clinical picture. The opportunity to make multiple diagnoses does not lessen the physician's responsibility to make a careful differential diagnosis.DSM-III
DSM-IV
DSM-5
Interrater Reliability
Quotes
The DSM-5 on Boundaries Between Disorders
Although some mental disorders may have well-defined boundaries around symptom clusters, scientific evidence now places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors, and possibly shared neural substrates (perhaps most strongly established for a subset of anxiety disorders by neuroimaging and animal models). In short, we have come to recognize that the boundaries between disorders are more porous than originally perceived.– (DSM-5, Introduction, page 5)
The DSM-5 on Checklist Diagnoses
The case formulation for any given patient must involve a careful clinical history and concise summary of the social, psychological, and biological factors that may have contributed to developing a given mental disorder. Hence, it is not sufficient to simply check off the symptoms in the diagnostic criteria to make a mental disorder diagnosis.– (DSM-5, Use of the Manual, page 19)
– Freedman, R., Lewis, D. A., Michels, R., Pine, D. S., Schultz, S. K., Tamminga, C. A., ... & Shrout, P. E. (2013). The initial field trials of DSM-5: new blooms and old thorns.
Readings
ICD-10 and ICD-11
In non-North American circles (i.e. - outside of Canada and the United States), countries use the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, also known as the ICD-10.
The diagnostic criteria for the ICD-10 varies from the DSM-5 for a variety of mental disorders. See Tyrer, P. (2014). A comparison of DSM and ICD classifications of mental disorder. Advances in psychiatric treatment, 20(4), 280-285.
Future
Future of Psychiatry
Beyond the Kraepelinian dichotomy
Research Domain Criteria (RDoC)
RDoC is a research framework proposed by the National Institute for Mental Health (NIMH) for new ways of studying mental disorders. It integrates many levels of information (from genomics to self-report) to better understand basic dimensions of functioning underlying the full range of human behaviour from normal to abnormal.
— Allen Frances, DSM-IV Task Force Chairman, 2015
— Thomas Insel, National Institute of Mental Health Director, 2013
Resources
- A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice (Kawa and Giordano Philosophy, Ethics, and Humanities in Medicine 2012)