What is the DSM?


By David Joel Miller.

DSM is  short for Diagnostic and Statistical Manual of Mental Disorders.

What is? Series

What is the DSM?
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The DSM, short for Diagnostic and Statistical Manual of Mental Disorders is a book created and published by the APA (American Psychiatric Association) which seeks to codify the classification of mental, emotional or behavioral diagnosis. Currently the DSM is in its fifth edition (DSM-5.) Each successive edition has seen significant shifts in how we understand and diagnose mental illnesses.

While this volume is published by an American organization it has been widely used thorough out the world. A number of reasons for the creation of the DSM have been suggested but a few large reasons stand out as the most important.

The early lists of diseases were about mortality, morbidity and treatment.

Some of the earliest efforts to categorize diseases had to do with classifying causes of death. Other methods of classification were used on census reports to describe those who were unable to work because of mental retardation or mental illnesses.

It was also useful to doctors to have lists of diseases in order to help direct treatment. That medical model continues to influence mental health treatment. The APA is an organization of those people from a medical specialty who can prescribe medication. The result of reliance on doctors to write the classification system has been medicalization of mental illness. If the main tool you have to treat illness is medications then they get classified by those disorders that will respond to a particular class of medication rather than those that will be best treated by a particular talk therapy.

Your diagnoses should not change with the place you live or who sees you.

One goal in encouraging universal use of the DSM (and the International Classification of Diseases or ICD, more on the ICD in another post) is to increase the likelihood that when clinicians in various countries diagnose someone with a mental illness they are using the same definitions and criteria.

When you do research it is important to be researching the same disorder.

Standardized criteria, sometimes called strict criteria, are important in researching the treatment of mental disorders. Being sure that everyone in the research study has the same illness improves the chances that a treatment that works once with one group might work again on people with similar symptoms.

The DSM has undergone some huge alterations over the years. Early thinking separated mental illness into neuroses, the problems of living, and psychosis, the loss of contact with reality. Often mental retardation was tossed in with mental illness or vice versa.

Every time the list of mental illnesses has been revised the list has gotten longer. There is still a lot of debate over whether we have all the possible mental health issues listed in the DSM. The result of this uncertainty is a chapter in the back of the DSM-5 called “conditions for further study.” Some of these conditions will eventually get listed as disorders and some will disappear again.

The first or original version of the DSM came out in 1952. It is reported to have been influenced by government efforts to test solders during WWII. This was revised into DSM-II in 1968.

DSM-III was introduced in 1980. It introduced a thing called the “multi-axial system.” This was partially a recognition that the boundaries between mental illness, environmental issues, personality disorders and physical illness were not always easy to fix precisely. The multi axial system survived officially until Oct of 2015 when all were, in theory, required to adopt the new DSM-5. In the DSM-5 there is no longer a 5 axis system though we still look for most of the things that used to be placed on these axis.

The DSM-III version was revised to be DSM-III-R in 1987 with lots of stuff changed and moved around.

In 1994 the DSM became DSM-IV, followed in 2000 by a minor text revision to become the DSM-4-TR.

The latest DSM revision was released in 2013 as the DSM-5. This version includes the codes for use with both the ICD-9 and the ICD-10. For those clinicians trained over the last 20 years the DSM-5 was a sort of culture shock as some of the things we thought we knew about mental illness have been redefined. There was and continue to be some professional disagreements about how the DSM-5 classifies certain human problems.

The process of treatment research, especially in the area of brain scans and neuroscience makes it likely that our understanding of the human brain and mental illness will continue to change.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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