The Diagnostic Classification System for Mental Disorders:
How Do Disorders Get Put In (or Taken Out of) the DSM?
by Jennie Dilworth, Ph.D
Keywords: DSM-5, classification system, mental illness
The DSM, or Diagnostic and Statistical Manual of Mental Disorders, is the equivalent of the Physician’s Desk Reference for mental illness. Psychiatrists and other mental health professionals use the DSM to diagnose mental illness, and it is the preferred classification system used in the United States. The DSM includes symptom checklists to help clinicians correctly label or classify a patient’s symptoms, much as a doctor uses the Physician’s Desk Reference to make the correct diagnosis of physical illness. The DSM is not the only classification system for mental disorders, nor is it used in all other nations. The World Health Organization[1] developed its own classification system, and you can access it here.
The first edition of the DSM was published in 1952. It has since been revised, with the latest edition (DSM-5) being published in 2013. The publication dates of previous versions of the DSM are shown below:
DSM 1: 1952
DSM 2: 1968
DSM 3: 1980
DSM 3-R: 1987
DSM 4: 1994
DSM 4-TR: 2000
DSM 5: 2013
According to the American Psychiatric Association (which publishes the DSM), the DSM-5 “is the product of 10 years of effort by hundreds of international experts.”[2] Why are revisions necessary, and what happens each time the DSM is revised?
With each revision, there may be slight modifications to symptomatology for certain disorders, disorders may be renamed or moved to other sections, and disorders may be added or removed from the manual. For example, homosexuality was classified as a disorder until the 3-R revision was published in 1987. Similarly, “gender identity disorder” has been removed from the latest edition although it was replaced with “gender dysphoria.”
Examples of newly-added disorders in the 5th edition include “premenstrual dysphoric disorder,” “hoarding disorder” and “gambling disorder.” On the other hand, the sub-types of schizophrenia (e.g., paranoid, catatonic, etc.) were removed. An example of a major change that has raised concerns about classifying autism involved the removal of Asperger’s Syndrome as a separate disorder from Autism Spectrum Disorder. On the APA website, you can download guides that address why these changes were made to the latest version of the DSM (click here to access).
Experts in psychological classification often disagree with changes to the DSM. A summary of major changes (and controversies surrounding those changes) are included in this free guide. [3] The authors of the guide share criticisms leveled at the DSM-5 that its revisions may be intended to benefit mental health professionals and drug companies by driving more business their way. Pretty controversial, huh?
What is the role of research in determining what changes to include in future editions of the DSM? Each new revision of the DSM is preceded by extensive research and the inclusion of opinions of international experts. [4] According to the American Psychiatric Association, the latest revision included international conferences with contributions from almost 400 scientists, and a task force of 160 clinicians and researchers who reviewed published research.
In closing, I would like to point out that cultural values often determine what is considered “normal” and “abnormal” behavior. The DSM even has a section about the role of culture in psychiatric diagnoses. You can view the DSM as not only a guide for clinicians in diagnosing mental illness but also as a reflection of modern-day American societal values.
[1] World Health Organization. (1987). The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. Retrieved on Nov 6, 2020 from: https://www.who.int/classifications/icd/en/bluebook.pdf
[2] American Psychiatric Association. (2020). About DSM 5: Development of DSM-5. Retrieved on November 6, 2020, from https://www.psychiatry.org/psychiatrists/practice/dsm/about-dsm.
[3] Wu, J. Q., Boettcher, H., Durand, V. M., & Barlow, D. H. (2013). A guide to DSM-5. Retrieved on November 6, 2020, from http://kopinska.apps01.yorku.ca/1010MN/dsm5_update.pdf.
[4] American Psychiatric Association. (n.d.). DSM-5 frequently asked questions. Retrieved on November 6, 2020, from https://www.psychiatry.org/psychiatrists/practice/dsm/feedback-and-questions/frequently-asked-questions.
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