The Diagnostic and Statistical Manual published by the American Psychiatric Association

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a handbook for mental health professionals that lists different categories of mental disorder and the criteria for diagnosing them, according to the publishing organization the American Psychiatric Association. It is used worldwide by clinicians and researchers as well as insurance companies, pharmaceutical companies and policy makers. It has attracted controversy and criticism as well as praise. Image File history File links DSM-IV.jpg File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links DSM-IV.jpg File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... A mental health professional is a person who offers services for the purpose of improving an individuals mental health and/or researches in the field of mental health. ... The Scream, the famous painting commonly thought of as depicting the experience of mental illness. ... Due to the epidemic of medical errors, readers are cautioned to be aware that the American Psychiatric Association isnt immune to this. ...

The DSM has gone through five revisions since it was first published in 1952. The last major revision was the DSM-IV published in 1994, although a "text revision" was produced in 2000. The DSM-V is currently in consultation, planning and preparation, due for publication in approximately 2011.^[1] The mental disorders section of the International Statistical Classification of Diseases and Related Health Problems (ICD) is another commonly-used guide, and the two classifications use the same diagnostic codes. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The Diagnostic and Statistical Manual published by the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR is a manual published by the American Psychiatric Association and includes all currently recognized mental health disorders. ...

History

The Diagnostic and Statistical Manual of Mental Disorders was first published in 1952, by the American Psychiatric Association. It was developed from an earlier classification system adopted in 1918 to meet the need of the federal Bureau of the Census for uniform statistics from psychiatric hospitals; from categorization systems in use by the United States military; and from a survey of the views of 10% of APA members.^[2] The manual was 130 pages long and contained 106 categories of mental disorder. The DSM-II was published in 1968, listed 182 disorders, and was 134 pages long. These manuals reflected the predominant psychodynamic psychiatry.^[3] Symptoms were not specified in detail for specific disorders, but were seen as reflections of broad underlying conflicts or maladaptive reactions to life problems, rooted in a distinction between neurosis and psychosis (roughly, anxiety/depression broadly in touch with reality, or hallucinations/delusions appearing disconnected from reality). Sociological and biological knowledge was also incorporated, in a model that did not emphasize a clear boundary between normality and abnormality.^[4] 1952 (MCMLII) was a Leap year starting on Tuesday (link will take you to calendar). ... Due to the epidemic of medical errors, readers are cautioned to be aware that the American Psychiatric Association isnt immune to this. ... 1918 (MCMXVIII) was a common year starting on Tuesday of the Gregorian calendar (see link for calendar) or a common year starting on Wednesday of the Julian calendar. ... The United States Census Bureau (officially Bureau of the Census) is a part of the United States Department of Commerce. ... The Military of the United States, officially known as the United States Armed Forces, is structured into five branches consisting of the: United States Army United States Marine Corps United States Navy United States Air Force United States Coast Guard The U.S. Public Health Service and NOAA also have... In modern psychology, the term neurosis, also known as psychoneurosis or neurotic disorder, is a general term that refers to any mental imbalance that causes distress, but (unlike a psychosis or personality disorder) does not prevent rational thought or an individuals ability to function in daily life. ... Psychosis is a generic psychiatric term for a mental state often described as involving a loss of contact with reality. Stedmans Medical Dictionary defines psychosis as a severe mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration... A hallucination is a false sensory perception in the absence of an external stimulus, as distinct from an illusion, which is a misperception of an external stimulus. ... A delusion is commonly defined as a false belief, and is used in everyday language to describe a belief that is either false, fanciful or derived from deception. ...

In 1974, the decision to create a new revision of the DSM was taken, and Robert Spitzer was selected as chairman of the task force. The initial impetus was to make the DSM nomenclature consistent with the International Statistical Classification of Diseases and Related Health Problems (ICD), published by the World Health Organization. The revision took on a far wider mandate under the influence and control of Spitzer and his chosen committee members.^[5] One goal was to improve the reliability of psychiatric diagnosis. The practices of mental health professionals, especially in different countries, was not uniform. The establishment of specific criteria was also an attempt to facilitate mental health research. The multiaxial system attempts to yield a more complete picture of the patient, rather than just a simple diagnosis. The criteria and classification system of the DSM-III was based on a process of consultation and committee meetings. An attempt was made to base categorization on description rather than assumptions of etiology, and the psychodynamic view was abandoned, perhaps in favor of a biomedical model, with a clear distinction between normal and abnormal. 1974 (MCMLXXIV) was a common year starting on Tuesday. ... Dr. Robert L. Spitzer is a Professor of Psychiatry at Columbia University. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. ... In general, a diagnosis (plural diagnoses) has two distinct dictionary definitions. ... Etiology (alternately aetiology, aitiology) is the study of causation. ... Psychodynamic psychotherapy is a type of psychotherapy, usually meeting about once or twice a week. ... www. ...

The criteria adopted for many of the mental disorders were expanded from the Research Diagnostic Criteria (RDC) and Feighner Criteria which had been developed for psychiatry research in the 1970s. Other criteria were established by consensus in committee meetings, as determined by Spitzer. The approach is generally seen as "Neo-Kraepelinian", after the work of the psychiatrist Emil Kraepelin. Spitzer argued that “mental disorders are a subset of medical disorders” but the task force decided on the DSM statement: “each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome”. The first draft of the DSM-III was prepared within a year. Many new categories of disorder were introduced. Field trials sponsored by the U.S. National Institute of Mental Health (NIMH) were conducted between 1977 and 1979 to test the reliability of the new diagnoses. A controversy emerged regarding deletion of the concept of neurosis, a mainstream of psychoanalytic theory and therapy but seen as vague and unscientific by the DSM task force. Faced with enormous political opposition, such that the DSM-III was in serious danger of not being approved by the APA Board of Trustees unless “neurosis” was included in some capacity, a political compromise reinserted the term in parentheses after the word “disorder” in some cases. In 1980, the DSM-III was published, at 494 pages long and listing 265 diagnostic categories. The DSM-III rapidly came into widespread international use by multiple stakeholders and has been termed a revolution or transformation in psychiatry.^[3][4] The Feighner Criteria is the informal name given to a diagnostic criteria for use in psychiatry research. ... Emil Kraepelin (February 15, 1856–October 7, 1926) was a German psychiatrist who attempted to create a synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of common patterns of symptoms, rather than by simple similarity of major symptoms in the... The National Institute of Mental Health (NIMH) is one of 27 components of the National Institutes of Health (NIH), the United States federal governments principal biomedical and behavioral research agency. ... Also: 1977 (album) by Ash. ... Also: 1979 by Smashing Pumpkins. ... Year 1980 (MCMLXXX) was a leap year starting on Tuesday (link displays the 1980 Gregorian calendar). ...

In 1987 the DSM-III-R was published as a revision of DSM-III, under the direction of Spitzer. Categories were renamed, reorganized, and significant changes in criteria were made. Six new categories were deleted while others were added. Controversial diagnoses such as pre-menstrual dysphoric disorder and Masochistic Personality Disorder were considered and discarded. Altogether, DSM-III-R contained 292 diagnoses and was 567 pages long. Year 1987 (MCMLXXXVII) was a common year starting on Thursday (link displays 1987 Gregorian calendar). ...

In 1994, DSM-IV was published, listing 297 disorders in 886 pages. The task force was chaired by Allen Frances. A steering committee of 27 people was introduced, including four psychologists. The steering committee created 13 work groups of 5–16 members. Each work group had approximately 20 advisers. The work groups conducted a three step process. First, each group conducted an extensive literature review of their diagnoses. Then they requested data from researchers, conducting analyses to determine which criteria required change, with instructions to be conservative. Finally, they conducted multicenter field trials relating diagnoses to clinical practice.^[6][7] Year 1994 (MCMXCIV) was a common year starting on Saturday (link will display full 1994 Gregorian calendar). ...

A "Text Revision" of the DSM-IV, known as the DSM-IV-TR, was published in 2000. The diagnostic categories and the vast majority of the specific criteria for diagnosis were unchanged.^[8]. The text sections giving extra information on each diagnosis were updated, as were some of the diagnostic codes in order to maintain consistency with the ICD. 2000 (MM) was a leap year starting on Saturday of the Gregorian calendar. ...

DSM and Politics

Following controversy and protests from gay activists at APA annual conferences from 1970 to 1973, the seventh printing of the DSM-II, in 1974, no longer listed homosexuality as a category of disorder. After talks led by the psychiatrist Robert Spitzer, who had been involved in the DSM-II development committee, a vote by the APA trustees in 1973, confirmed by the wider APA membership in 1974, replaced the diagnosis with a milder category of "sexual orientation disturbance".^[3][9] Dr. Robert L. Spitzer is a Professor of Psychiatry at Columbia University. ...

The current DSM

Categorization

The DSM-IV is a categorical classification system. The categories are prototypes, and a patient with a close approximation to the prototype is said to have that disorder. DSM-IV states that “there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries...” but isolated, low-grade and noncriterion (unlisted for a given disorder) symptoms are not given importance.^[10] Qualifiers are sometimes used, for example mild, moderate or severe forms of a disorder. The DSM-IV also introduced a diagnostic criterion of “clinically significant distress or impairment in social, occupational, or other important areas of functioning", although DSM-IV-TR removed this distress criterion from tic disorders and several of the paraphilias. Each category of disorder has a numeric code taken from the ICD coding system, used for health service (including insurance) administrative purposes.

Multi-axial system

The DSM-IV organizes each psychiatric diagnosis into five levels (axes) relating to different aspects of disorder or disability:

• Axis I: clinical disorders, including major mental disorders, as well as developmental and learning disorders
• Axis II: underlying pervasive or personality conditions, as well as mental retardation
• Axis III: Acute medical conditions and Physical disorders.
• Axis IV: psychosocial and environmental factors contributing to the disorder
• Axis V: Global Assessment of Functioning or Children’s Global Assessment Scale for children under the age of 18. (on a scale from 100 to 0)

Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, and schizophrenia. It has been suggested that this article or section be merged into Diagnostic and Statistical Manual of Mental Disorders#A multiaxial approach. ... The Global Assessment of Functioning, or GAF scale, is a numeric scale (1 through 100) used by mental health clinicians and doctors to rate the social, occupational and psychological functioning of adults. ... The Childrens Global Assessment Scale (CGAS) is a numeric scale (1 through 100) used by mental health clinicians and doctors to rate the general functioning of children under the age of 18. ... Clinical depression (also called major depressive disorder, or unipolar depression when compared to bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... Anxiety disorder is a blanket term covering several different forms of fear, phobia and nervous condition, that come on suddenly and prevent pursuing normal daily routines including: general anxiety disorder social anxiety, sometimes known as social phobia or social anxiety disorder (SAD) specific phobias agoraphobia claustrophobia panic disorder separation anxiety... For other uses, see Bipolar. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ...

Common Axis II disorders include borderline personality disorder, schizotypal personality disorder, antisocial personality disorder, narcissistic personality disorder, and mild mental retardation. Borderline personality disorder (BPD) is defined as a mental illness primarily characterized by emotional dysregulation, extreme black and white thinking, or splitting, and chaotic relationships. ... Schizotypal personality disorder, or simply schizotypal disorder, is a personality disorder that is characterized by a need for social isolation, odd behaviour and thinking, and often unconventional beliefs such as being convinced of having extra sensory abilities. ... Antisocial personality disorder (abbreviated APD or ASPD) is a psychiatric diagnosis in the DSM-IV-TR recognizable by the disordered individuals disregard for social rules and norms, impulsive behavior, and indifference to the rights and feelings of others. ... Narcissistic personality disorder (NPD), a term first used by Heinz Kohut in 1971[1], is a form of pathological narcissism acknowledged in the Diagnostic and Statistical Manual of Mental Disorders in 1980, in the edition known as DSM III-TR. Narcissistic personality disorder is characterized by extreme focus on oneself...

Cautions

The DSM-IV-TR states that, because it is produced for mental health specialists, its use by people without clinical training can lead to inappropriate application of its contents. Appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents "cannot simply be applied in a cookbook fashion."^[11] The APA notes that diagnostic labels are primarily for use as a "convenient shorthand" among professionals. The DSM advises that laypersons should consult the DSM only to obtain information, not to make diagnoses, and that people who may have a mental disorder should be referred to psychiatric counseling or treatment. Further, people sharing the same diagnosis/label may not have the same etiology (cause) or require the same treatment; the DSM contains no information regarding treatment or cause for this reason. The range of the DSM represents an extensive scope of psychiatric and psychological issues, and it is not exclusive to what one may consider "illnesses." Etiology (alternately aetiology, aitiology) is the study of causation. ...

DSM-IV sourcebooks

The DSM-IV doesn't specifically cite its sources, but there are four volumes of "sourcebooks" intended to be APA's documentation of the guideline development process and supporting evidence, including literature reviews, data analyses and field trials.^{[12] [13] [14] [15]} The Sourcebooks have been said to provide important insights into the character and quality of the decisions that led to the production of DSM-IV, and hence the scientific credibility of contemporary psychiatric classification.^[16][17]

DSM-V planning

The DSM-V is tentatively scheduled for publication in 2011.^[18] In 1999, a DSM–V Research Planning Conference, sponsored jointly by APA and the National Institute of Mental Health (NIMH), was held to set the research priorities. Research Planning Work Groups produced "white papers" on the research needed to inform and shape the DSM-IV,^[19] and the resulting work and recommendations were reported in an APA monograph^[20] and peer-reviewed literature.^[21] There were six workgroups, each focusing on a broad topic: Nomenclature, Neuroscience and Genetics, Developmental Issues and Diagnosis, Personality and Relational Disorders, Mental Disorders and Disability, and Cross-Cultural Issues. Three additional white papers were also due by 2004 concerning gender issues, diagnostic issues in the geriatric population, and mental disorders in infants and young children.^[22] The white papers have been followed by a series of conferences to produce recommendations relating to specific disorders and issues, with attendance limited to 25 invited researchers.^[23] The National Institute of Mental Health (NIMH) is one of 27 components of the National Institutes of Health (NIH), the United States federal governments principal biomedical and behavioral research agency. ...

Criticism

Inasmuch as the DSM is central to the field of psychiatry, the criticisms of the antipsychiatry movement also apply to the DSM. Psychiatry is a branch of medicine dealing with the prevention, assessment, diagnosis, treatment, and rehabilitation of the mind and mental illness. ... Beginning in the 1960s, a movement called anti-psychiatry claimed that psychiatric patients are not ill but are individuals that do not share the same consensus reality as most people in society. ...

For example, the gay rights movement challenged the DSM's classification of homosexuality as a mental illness. In 1974, the American Psychiatric Association membership voted to remove "homosexuality" per se as an illness category from the DSM^[24]. The gay rights movement is a collection of loosely aligned civil rights groups, human rights groups, support groups and political activists seeking acceptance, tolerance and equality for non-heterosexual, (homosexual, bisexual), and transgender people - despite the fact that it is typically referred to as the gay rights movement, members also... Homosexuality refers to sexual interaction and / or romantic attraction between individuals of the same sex. ...

Some people diagnosed with "Gender Identity Disorder" and some people diagnosed with pedophilia also criticize the DSM, citing the APA's decision to remove homosexuality from the DSM as evidence of the APA incorrectly referring to diverse states of being or orientations as mental illnesses. ^[25] It has been suggested that Pro-pedophile activism be merged into this article or section. ...

It should be noted that GID (gender Identity Disorder) and other physical anomaly that are associated with physical characteristics are not to be associated, or construed, as a paraphilia such as is pedrophilia. GID, Transsexuality, and Intersex conditions are not about sexual behavior, but rather are issues of identity and the physical relationship one may have with their identity. As such they are also not specifically related to other Transgender issues.

The potential for conflict of interest has also been raised. Roughly 50% of the authors who previously defined psychiatric disorders have had or have financial relationships with drug companies.^[26] A conflict of interest is a situation in which someone in a position of trust, such as a lawyer, a politician, or an executive or director of a corporation, has competing professional or personal interests. ...

A Columbia University team headed by Robert Spitzer, an editor of the DSM, acknowledges a concern about the DSM in their annual report of 2001, “Problems with the current DSM-IV categorical (present vs. absent) approach to the classification of personality disorders have long been recognized by clinicians and researchers.” Among the problems, they list “arbitrary distinction between normal personality, personality traits and personality disorder” and point out the fact that the most commonly diagnosed personality disorder is 301.9, Personality Disorder not Otherwise Specified. ^[27] Columbia University is a private research university in the United States. ... Dr. Robert L. Spitzer is a Professor of Psychiatry at Columbia University. ...

See also

• GAF Scale
• Chinese Classification and Diagnostic Criteria of Mental Disorders

The Global Assessment of Functioning, or GAF scale, is a numeric scale (1 through 100) used by mental health clinicians and doctors to rate the social, occupational and psychological functioning of adults. ... The Chinese Classification and Diagnostic Criteria of Mental Disorders (CCDCMD), published by the Chinese Psychiatric Association, is the handbook used most often in diagnosing mental disorders in China. ...

References

1. ^ DSM-5 Timeline
2. ^ Grob, GN. (1991) Origins of DSM-I: a study in appearance and reality Am J Psychiatry. Apr;148(4):421–31.
3. ^ ^{a b c} Mayes, R. & Horwitz, AV. (2005) DSM-III and the revolution in the classification of mental illness. J Hist Behav Sci 41(3):249–67.
4. ^ ^{a b} Wilson, M. (1993) DSM-III and the transformation of American psychiatry: a history. Am J Psychiatry. 1993 Mar;150(3):399–410.
5. ^ Speigel, A. (2005) The Dictionary of Disorder: How one man revolutionized psychiatry The New Yorker, issue of 2005-01-03.
6. ^ Allen Frances, Avram H. Mack, Ruth Ross, and Michael B. First (2000) The DSM-IV Classification and Psychopharmacology.
7. ^ Schaffer, David (1996) A Participant's Observations: Preparing DSM-IV Can J Psychiatry 1996;41:325–329.
8. ^ APA Summary of Practice-Relevant Changes to the DSM-IV-TR.
9. ^ Spiegel, Alix. (18 January 2002.) "81 Words". In Ira Glass (producer), This American Life. Chicago: Chicago Public Radio.
10. ^ Maser, JD. & Patterson, T. (2002) Spectrum and nosology: implications for DSM-V Psychiatric Clinics of North America, Dec, 25(4)p855-885
11. ^ http://www.psych.org/research/dor/dsm/dsm_faqs/faq81301.cfm
12. ^ DSM-IV Sourcebook Volume 1
13. ^ DSM-IV Sourcebook Volume 2
14. ^ DSM-IV Sourcebook Volume 3
15. ^ DSM-IV Sourcebook Volume 4
16. ^ Poland, JS. (2001) Review of Volume 1 of DSM-IV sourcebook
17. ^ Poland, JS. (2001) Review of vol 2 of DSM-IV sourcebook
18. ^ DSM-V Prelude Project website
19. ^ First, M. (2002) A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers Published in May 2002
20. ^ Kupfer, First & Regier (2002) A Research Agenda for DSM-V
21. ^ Regier, DS., Narrow, WE., First, MB., Marshall, T. (2002) The APA classification of mental disorders: future perspectives. Psychopathology. Mar-Jun;35(2-3):166-70.
22. ^ DSM-5 Research Planning
23. ^ APA DSM-V Research Planning Activities
24. ^ "The diagnostic status of homosexuality in DSM-III: a reformulation of the issues", by R.L. Spitzer, Am J Psychiatry 1981; 138:210-215
25. ^ "GID Reform Advocates" transgender.org
26. ^ Cosgrove, Lisa, Krimsky, Sheldon,Vijayaraghavan, Manisha, Schneider, Lisa,Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry
27. ^ Spitzer, Robert L, M.D., Williams, Janet B.W, D.S.W., First, Michael B, M.D., Gibbon, Miriam, M.S.W., Biometric Research

is the 18th day of the year in the Gregorian calendar. ... For album titles with the same name, see 2002 (album). ...

External links

• DSM-IV-TR Official Site - American Psychiatric Association
• DSM-V Prelude Project - DSM-V Prelude Review Project by American Psychiatric Association

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