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Brief history of Diagnostic and Statistical Manual of Mental Disorders

Posted on:3/24/2006
Users should be reminded that the manual is, to an extent, a historical document. The science used to create categories, taxonomies, and diagnoses is based on statistical models.

Users should be reminded that the manual is, to an extent, a historical document. The science used to create categories, taxonomies, and diagnoses is based on statistical models. These systems are thus subject to the limitations of the methods used to create them. Deconstructive critics assert that DSM invents illnesses and behaviors. Detractors of DSM argue that patients frequently fail to fit into any particular category or fall into several, that time limits and numbers of clinical characteristics required for a categorisation are arbitrary and that attention directed towards finding a suitable DSM category for a patient would be better spent discussing possible life-history events that precipitated a mental disturbance or monitoring treatment. Since effective treatment is the aim of the psychiatric profession they would argue that it makes more sense to regard ailments on the basis of how they should be treated rather than on deciding what clinically irrelevant differences place them in one category and not another. This would allow for the modular treatment of different sets of symptoms, for instance prescribing antidepressants for a deficit of serotonin and tranquillisers to deal with acute anxiety.

1) The first edition (DSM-I) was published in 1952, and had about 60 different disorders.
2) DSM-II was published in 1968.
   Both of these editions were strongly influenced by the psychodynamic approach, which provides no sharp distinction between normal and abnormal. All disorders are considered reactions to environmental events, with mental disorders existing on a continuum of behavior. In this sense, everyone is more or less abnormal. The people with more severe abnormalities have more severe difficulties with functioning.
3) The classificatory structure of early editions of the DSM was rooted in a distinction between two poles of mental disorder, psychosis and neurosis. A psychosis is a severe mental disorder characterized by a disconnection from reality. Psychoses typically involve hallucinations, delusions, and illogical thinking. A neurosis, however, is a milder mental disorder characterized by distortions of reality, but not a complete break with reality. Neuroses typically involve anxiety and depression.
4) Among the most noted examples of controversial diagnoses is the classifying in the DSM-II of homosexuality as a mental disorder, a classification that was removed by vote of the APA in 1973 after three years of various gay activists groups demonstrating at APA meetings (see also homosexuality and psychology).
5) In 1980, with DSM-III, the psychodynamic view was abandoned and the biomedical model became the primary approach, introducing a clear distinction between normal and abnormal. The DSM became atheoretical since it had no preferred etiology for mental disorders.
6) In 1987 the DSM-III-R appeared as a revision of DSM-III. Many criteria were changed.
7) In 1994, it evolved into DSM-IV. This work is currently in its fourth edition.
8) The most recent version is the 'Text Revision' of the DSM-IV, also known as the DSM-IV-TR, published in 2000. The vast majority of the criteria for the diagoses were not changed from DSM-IV. The text in between the criteria was updated.
9) DSM-V, is tentatively scheduled for publication in 2012, with initial planning having begun in 1999. The APA Division of Research expects to begin forming DSM development workgroups in 2007.


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