Diagnostic and Statistical Manual
of Mental Disorders (DSM)
DSM is published by the American Psychiatric Association
and is the classification used most often in diagnosing mental disorders in USA.
Classification of Diseases (ICD) is a commonly-used alternative
The first edition (DSM-I) was published in 1952. DSM-II was
published in 1968. DSM-III in 1980 and DSM-III-R as a revision in 1986.
The current fourth edition, DSM-IV was first published in 1994. A text
revision known as DSM-IV-TR appeared in 2000. Work is being done in order to
publish a new fifths edition in the future.
DSM-I and DSM-II were strongly influenced by the
psychodynamic approach to mental disorders, but 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. When DSM-III was first published in
1980 it embodied a radical, new method for identifying psychiatric illness.
DSM-III was often referred to as the "psychiatric Bible," and it was used to
challenge the pervasive criticism that psychiatric diagnoses were unreliable and
IV-TR, 2000 edition,
systemizes psychiatric diagnosis in five axes:
major mental disorders, developmental disorders and learning
underlying pervasive or personality conditions, as well as
III: any nonpsychiatric medical condition ("somatic
social functioning and impact of symptoms
Global Assessment of Functioning (on a scale from 100 to 0)
Common Axis I
disorders include depression, anxiety disorders, bipolar
disorders, ADHD and schizophrenia. Common Axis II disorders
include borderline personality disorder, schizotypal personality
disorder, antisocial personality disorder, and mild mental
retardation. The contents of the DSM are determined by experts
whose mandate is to create a set of diagnoses that are
replicable and meaningful. The classification system was
originally intended to enhance research into diagnosis and
treatment, but the nomenclature is now widely used by both
clinicians and insurance companies.
& Kutchins (1992) is a critical book of DSM. A reviewer
"Chapters 2 and 3 present the political and
scientific context in which DSM-III developed. The historical progression is
described along with the manner in which the APA (American Psychiatric
Association) was manipulated to produce and endorse this product. The history
includes tracing the development and use of the new statistic, kappa, to shift
the issue of reliability from a serious conceptual, scientific problem to a
relatively innocuous technical issue.
Chapter 4 presents the
step-by-step account of how a small band of research psychiatrists accomplished
such remarkable success in influencing the course of American psychiatry.
Chapters 5 and 6 are the meat of the book. The authors demonstrate that careful
analysis of the data from the field trials used in developing DSM-III indicates
that these trials do not show what it is claimed they show. Rather than
improving the reliability of psychiatric diagnosis, DSM-III either does not show
any better reliability or is worse than DSM-II. The few studies of reliability
that have been done after DSM -III show a high level of unreliability."
Spasser (1998) writes that psychiatric classification is a
profoundly important activity that directs subsequent treatment decisions,
assumptions about etiology, and prognostic considerations. While the ideal
classification scheme would be clear, concise, comprehensively inclusive of, and
hospitable to, the entities under consideration, in practice, all classification
systems reflect trade-offs and embody flawed structures. Accordingly, it is
essential to be fully cognizant of the shortcomings, biases, and tacit
assumptions of extant systems so that classifications can be improved and so
that misrepresentations will not be blindly repeated or reproduced. Modern
psychiatric classification and diagnosis are almost exclusively defined within
the context of the nomenclature and diagnostic categories of the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental
Disorders (DSM). He uses Giddens’s (1984) theory of "structuration" to
explain how at least some of the consequences of relying on the DSM for
classification result in unexamined conditions of its use and unintentionally
reproduced its underlying assumptions. This article uses the DSM to
explicate agency in structuration theory and structuration theory to illuminate
the structure and use of the DSM. Finally, Spasser suggests that several
prominent issues and concerns in psychiatric nosology resonate profoundly with
those that have concerned, and continue to interest, library classificationists.
Dunne & Chute (1999) report on a project aimed at parsing
the rubric criteria of the DSM to extract the clinically detailed signs,
symptoms, findings, and conditions that are present. These are seen as a "latent
terminology" implicit within the DSM which is highly granular and clinically
specific. The article describes the content of these terms that heretofore
existed sub rosa, though it is recognized that during the authorship of the DSM
such terms were constructed deliberately and systematically. Relevant
characteristics of the classification system are briefly reviewed. Summary
results of parsing the defining criteria for the 400 JCD-9 Codes enumerated in
DSM-IV are presented.
"The Diagnostic and Statistical
Manual of Mental Disorders is important, but it is also controversial. While its
publishers claim that the D.S.M. is a scientific classification system based on
sound data, many have doubts. Big business has interests in the D.S.M. Perhaps
the D.S.M. has been distorted by pressures stemming from insurance companies, or
from pharmaceutical companies? Others are concerned that whether a condition is
classified as a mental disorder depends too greatly on social and political
factors. More conceptual worries are also frequent. If classification requires a
theory, and if mental disorders are poorly understood, then a sound
classification system may be presently unobtainable. Possibly even attempting to
construct a classification system that cuts nature at the joints is conceptually
naïve. Maybe types of mental disorder are radically unlike, say, chemical
elements, and simply fail to have a natural structure. Cooper (2005)
offers a sustained philosophical critique of the D.S.M. that addresses these
concerns. The first half of the book asks whether the project of constructing a
classification of mental disorders that reflects natural distinctions makes
sense. I conclude that it does. The second half of the book addresses epistemic
worries. Even supposing a natural classification system to be possible in
principle, there may be reasons to be suspicious of the categories included in
the D.S.M. I examine the extent to which the D.S.M. depends on psychiatric
theory, and look at how it has been shaped by social and financial factors. I
aim to be critical of the D.S.M. without being antagonistic towards it.
Ultimately, however, I am forced to conclude that although the D.S.M. is of
immense practical importance, it is not on track to become the best possible
classification of mental disorders." (Cooper, 2005).
American Psychiatric Association Task Force on DSM-IV.
(1994). Diagnostic and statistical manual of mental disorders 4th ed.;
DSM-IV. Washington, DC: American Psychiatric Association.
Cooper, Rachel (2005).
Classifying Madness: A Philosophical Examination of the Diagnostic and
Statistical Manual of Mental Disorders. Berlin: Springer. (Philosophy
Dunne, D. & Chute, C. G. (1999).
Detailed content and terminological properties of DSM-IV.
Journal of the
American Medical Informatics Association, S, 57-61.
Kirk, S. A. & Kutchins, H. (1992).
The Selling of DSM: The
Rhetoric of Science in Psychiatry. New Brunswick, NJ: Aldine
Kupfer, D. J.; First, M. B. & Regier, D. A. (Eds.). (2002).
A research agenda for DSM-V. Washington, D.C.: American Psychiatric
Psychiatrists make Diagnoses, but not in Circumstances
of Their Own Choosing: Agency and Structure in the DSM. Library
Trends, 47(2), 313-337.
Underwager, R. (1993). [Book review of] The Selling of DSM:
The Rhetoric of Science in Psychiatry.
Issues In Child
Abuse Accusations, 5(2), available at:
Wikipedia. The free encyclopedia. (2006). Diagnostic
and Statistical Manual of Mental Disorders.
See also: Psychiatry