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84-633: The Diagnostic and Statistical Manual of Mental Disorders ( DSM ; latest edition: DSM-5-TR , published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is an internationally accepted manual on the diagnosis and treatment of mental disorders, though it may be used in conjunction with other documents. Other commonly used principal guides of psychiatry include

168-430: A 21-day hunger strike, protesting at a perceived unjustified biomedical focus and challenging APA to provide evidence of the widespread claim that mental disorders are due to chemical imbalances in the brain. APA published a position statement in response and the two organizations exchanged views on the evidence. The APA's DSM came under criticism from autism specialists Tony Attwood and Simon Baron-Cohen for proposing

252-437: A category reflected a particular underlying pathology (an approach described as " neo-Kraepelinian "). The psychodynamic view was marginalised, although still influential, in favor of a regulatory or legislative model that emphasised observable symptoms. A new "multiaxial" system attempted to yield a picture more amenable to a statistical population census, rather than a simple diagnosis . Spitzer argued "mental disorders are

336-399: A close approximation to the prototype is said to have that disorder. DSM-IV states, "there is no assumption each category of mental disorder is a completely discrete entity with absolute boundaries" but isolated, low-grade, and non-criterion (unlisted for a given disorder) symptoms are not given importance. Qualifiers are sometimes used: for example, to specify mild, moderate, or severe forms of

420-979: A congress of the International Statistical Institute (ISI) in Chicago. (The ISI had commissioned him to create it in 1891). A number of countries adopted the ISI's system. In 1898, the American Public Health Association (APHA) recommended that United States registrars also adopt the system. In 1900, an ISI conference in Paris reformed the Bertillion Classification, and created the International List of Causes of Death (ILCD) . Another conference would be held every ten years, and

504-828: A continuation of the Statistical Manual for the Use of Hospitals of Mental Diseases. Each item was given an ICD-6 equivalent code, where applicable. The DSM-I centers on three classes of symptoms: psychotic, neurotic, and behavioral.  Within each class of mental disorder, classifying information is provided to differentiate conditions with similar symptoms.  Under each broad class of disorder (e.g. "Psychoneurotic Disorders" or "Personality Disorders"), all possible diagnoses are listed, generally from least to most severe. The 1952 DSM version also includes sections detailing how to record patients' disorders along with their demographic details.  The form includes information like

588-545: A disorder. For nearly half the disorders, symptoms must be sufficient to cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning", although DSM-IV-TR removed the distress criterion from tic disorders and several of the paraphilias due to their egosyntonic nature. Each category of disorder has a numeric code taken from the ICD coding system , used for health service (including insurance) administrative purposes. The DSM-IV

672-507: A distinction between neurosis and psychosis (roughly, anxiety/depression broadly in touch with reality, as opposed to hallucinations or delusions disconnected from reality). Sociological and biological knowledge was incorporated, under a model that did not emphasize a clear boundary between normality and abnormality. The idea that personality disorders did not involve emotional distress was discarded. A study published in Science in 1973,

756-515: A far wider mandate under the influence and control of Spitzer and his chosen committee members. One added goal was to improve the uniformity and validity of psychiatric diagnosis in the wake of a number of critiques, including the famous Rosenhan experiment . There was also felt a need to standardize diagnostic practices within the United States and with other countries, after research showed that psychiatric diagnoses differed between Europe and

840-626: A new edition of the ILCD would be released. Five were ultimately issued. Non-fatal conditions were not included. In 1903, New York's Bellevue Hospital published "The Bellevue Hospital nomenclature of diseases and conditions", which included a section on "Diseases of the Mind". Revisions were released in 1909 and 1911. It was produced with the assistance of the AMA and Bureau of the Census. In 1917, together with

924-559: A patient's area of residence, admission status, discharge date/condition, and severity of disorder. See Figure 1. for the form that psychiatrists were asked to utilize for recording preliminary diagnostic information. Furthermore, the APA listed homosexuality in the DSM as a sociopathic personality disturbance. Homosexuality: A Psychoanalytic Study of Male Homosexuals , a large-scale 1962 study of homosexuality by Irving Bieber and other authors,

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1008-690: A revision of the DSM, which was published in 1968. DSM-II was similar to DSM-I, listed 182 disorders, and was 134 pages long. The term "reaction" was dropped, but the term " neurosis " was retained. Both the DSM-I and the DSM-II reflected the predominant psychodynamic psychiatry, although both manuals also included biological perspectives and concepts from Kraepelin 's system of classification. Symptoms were not specified in detail for specific disorders. Many were seen as reflections of broad underlying conflicts or maladaptive reactions to life problems that were rooted in

1092-407: A significant increased risk of suffering death, pain, disability, or an important loss of freedom". It also notes that "although this manual provides a classification of mental disorders it must be admitted that no definition adequately specifies precise boundaries for the concept of 'mental disorder." The DSM-IV is a categorical classification system. The categories are prototypes, and a patient with

1176-529: A subset of medical disorders", but the task force decided on this statement for the DSM: "Each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome." Personality disorders were placed on axis II along with "mental retardation". The first draft of DSM-III was ready within a year. It introduced many new categories of disorder, while deleting or changing others. A number of unpublished documents discussing and justifying

1260-453: 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 multi-center field trials relating diagnoses to clinical practice. A major change from previous versions was the inclusion of a clinical-significance criterion to almost half of all

1344-517: A version of Medical 203 specifically for use in the United States, to standardize the diverse and confused usage of different documents. In 1950, the APA committee undertook a review and consultation. It circulated an adaptation of Medical 203, the Standard ' s nomenclature, and the VA system's modifications of the Standard to approximately 10% of APA members. 46% of members replied, with 93% approving

1428-482: Is a round medallion with a purported likeness of Benjamin Rush 's profile and 13 stars over his head to represent the 13 founders of the organization. The outer ring contains the words "American Psychiatric Association 1844." Rush's name and an MD are below the picture. An association history of the seal states: The choice of Rush (1746–1813) for the seal reflects his place in history. .... Rush's practice of psychiatry

1512-405: Is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 38,000 members who are involved in psychiatric practice, research, and academia representing a diverse population of patients in more than 100 countries. The association publishes various journals and pamphlets, as well as

1596-399: Is there any credible evidence that any version of the manual has greatly increased its reliability beyond the previous version. There are important methodological problems that limit the generalizability of most reliability studies. Each reliability study is constrained by the training and supervision of the interviewers, their motivation and commitment to diagnostic accuracy, their prior skill,

1680-415: Is uniformly high. Reliability appears to be only satisfactory for three categories: mental deficiency, organic brain syndrome (but not its subtypes), and alcoholism. The level of reliability is no better than fair for psychosis and schizophrenia and is poor for the remaining categories". As described by Ronald Bayer, a psychiatrist and gay rights activist, specific protests by gay rights activists against

1764-444: Is used by researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies , the legal system, and policymakers. Some mental health professionals use the manual to determine and help communicate a patient's diagnosis after an evaluation. Hospitals, clinics, and insurance companies in the United States may require a DSM diagnosis for all patients with mental disorders. Health-care researchers use

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1848-685: The Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM codifies psychiatric conditions and is used mostly in the United States as a guide for diagnosing mental disorders. The organization has its headquarters in Washington, D.C. At a meeting in 1844 in Philadelphia , thirteen superintendents and organizers of insane asylums and hospitals formed the Association of Medical Superintendents of American Institutions for

1932-542: The American Board of Internal Medicine , the APA proposes five recommendations for physicians and patients. The list was compiled by members of the Council on Research and Quality Care. The APA places a primary focus on antipsychotic medications due to a rapid increase in sales, from $ 9.6 billion in 2004 to $ 18.5 billion in 2011. In his book Anatomy of an Epidemic (2010), Robert Whitaker described

2016-725: The International Classification of Diseases (ICD), Chinese Classification of Mental Disorders (CCMD), and the Psychodynamic Diagnostic Manual . However, not all providers rely on the DSM-5 as a guide, since the ICD's mental disorder diagnoses are used around the world, and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. It

2100-954: The National Association of Counties (NACo). APAF partners with industry organizations to collaborate on mental health research and development through its Corporate Alliance. Current and recent members of the alliance include: Donors to the foundation in 2019 include the Austen Riggs Center , BB&T , Cenveo , McLean Hospital , Menninger Foundation , NeuroStar , Newport Academy , NewYork-Presbyterian Hospital , Sheppard Pratt , and Silver Hill Hospital . APA position statements, clinical practice guidelines, and descriptions of its core diagnostic manual (the DSM) are published. APA publishes several journals focused on different areas of psychiatry, for example, academic, clinical practice, or news. In coordination with

2184-667: The New York State Psychiatric Institute . However, the influence of clinical psychiatrists, themselves often working with psychoanalytic ideas, were still strong. Other criteria, and potential new categories of disorder, were established by debate, argument and consensus during meetings of the committee chaired by Spitzer. A key aim was to base categorization on colloquial English (which would be easier to use by federal administrative offices), rather than by assumption of cause, although its categorical approach still assumed each particular pattern of symptoms in

2268-632: The Rosenhan experiment , received much publicity and was viewed as an attack on the efficacy of psychiatric diagnosis. An influential 1974 paper by Robert Spitzer and Joseph L. Fleiss demonstrated that the second edition of the DSM (DSM-II) was an unreliable diagnostic tool. Spitzer and Fleiss found that different practitioners using the DSM-II rarely agreed when diagnosing patients with similar problems. In reviewing previous studies of eighteen major diagnostic categories, Spitzer and Fleiss concluded that "there are no diagnostic categories for which reliability

2352-581: The Royal College of Physicians and Surgeons of Canada (RCPS[C]), or the American Osteopathic Association (AOA). Applicants for membership must also hold a valid medical license (with the exception of medical students and residents) and provide one reference who is an APA member. APA holds an annual conference attended by an American and international audience. APA is made up of some 76 district associations throughout

2436-736: The Standard), was released. Along with the New York Academy of Medicine , the APA provided the psychiatric nomenclature subsection. It became well adopted in the US within two years. A major revision of the Statistical Manual was made in 1934, to bring it in line with the new Standard. A number of revisions of the Standard were produced, with the last in 1961. World War II saw the large-scale involvement of U.S. psychiatrists in

2520-435: The U.S. House of Representatives , stating that "the most glaring and remarkable errors are found in the statements respecting nosology , prevalence of insanity, blindness, deafness, and dumbness, among the people of this nation", pointing out that in many towns African Americans were all marked as insane, and calling the statistics essentially useless. The Association of Medical Superintendents of American Institutions for

2604-548: The APA began in 1970, when the organization held its convention in San Francisco . The activists disrupted the conference by interrupting speakers and shouting down and ridiculing psychiatrists who viewed homosexuality as a mental disorder. In 1971, gay rights activist Frank Kameny worked with the Gay Liberation Front collective to demonstrate at the APA's convention. At the 1971 conference, Kameny grabbed

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2688-719: The APA issued an apology for its historical role in perpetuating racism. DSM-IV-TR codes This is a list of mental disorders as defined in the DSM-IV , the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders . Published by the American Psychiatry Association (APA), it was released in May 1994, superseding the DSM-III-R (1987). This list also includes updates featured in

2772-692: The American Psychiatric Association and a board of trustees with an executive committee. APA reports that its membership is primarily medical specialists who are qualified, or in the process of becoming qualified, as psychiatrists. The basic eligibility requirement is completion of a residency program in psychiatry accredited by the Residency Review Committee for Psychiatry of the Accreditation Council for Graduate Medical Education (ACGME),

2856-477: The Armed Forces nomenclature [were] introduced into many clinics and hospitals by psychiatrists returning from military duty." The Veterans Administration also adopted a slightly modified version of the standard in 1947. The further developed Joint Armed Forces Nomenclature and Method of Recording Psychiatric Conditions was released in 1949. In 1948, the newly formed World Health Organization took over

2940-495: The DSM and the ICD manuals, which may not systematically match because revisions are not simultaneously coordinated. Though recent editions of the DSM and ICD have become more similar due to collaborative agreements, each one contains information absent from the other. For instance, the two manuals contain overlapping but substantially different lists of recognized culture-bound syndromes . The ICD also tends to focus more on primary-care and low and middle-income countries, as opposed to

3024-508: The DSM to categorize patients for research purposes. The DSM evolved from systems for collecting census and psychiatric hospital statistics, as well as from a United States Army manual. Revisions since its first publication in 1952 have incrementally added to the total number of mental disorders , while removing those no longer considered to be mental disorders. Recent editions of the DSM have received praise for standardizing psychiatric diagnosis grounded in empirical evidence, as opposed to

3108-491: The DSM's focus on secondary psychiatric care in high-income countries. The initial impetus for developing a classification of mental disorders in the United States was the need to collect statistical information. The first official attempt was the 1840 census , which used a single category: " idiocy / insanity ". Three years later, the American Statistical Association made an official protest to

3192-508: The ICD specifically covers mental, behavioral and neurodevelopmental disorders. Moreover, while the DSM is the most popular diagnostic system for mental disorders in the US, the ICD is used more widely in Europe and other parts of the world, giving it a far larger reach than the DSM. An international survey of psychiatrists in sixty-six countries compared the use of the ICD-10 and DSM-IV. It found

3276-613: The Insane ("The Superintendents' Association") was formed in 1844. In 1860, during the international statistical congress held in London, Florence Nightingale made a proposal that was to result in the development of the first international model of systematic collection of hospital data. In 1872, the American Medical Association (AMA) published its Nomenclature of Diseases , which included various "Disorders of

3360-527: The Insane (AMSAII). The group included Thomas Kirkbride , creator of the asylum model which was used throughout the United States. The group was chartered to focus "primarily on the administration of hospitals and how that affected the care of patients", as opposed to conducting research or promoting the profession. In 1893, the organization changed its name to the American Medico-Psychological Association. In 1921,

3444-783: The Intellect". Its use was short-lived however. Edward Jarvis and later Francis Amasa Walker helped expand the census, from two volumes in 1870 to twenty-five volumes in 1880. In 1888, the Census Office published Frederick H. Wines' 582-page volume called Report on the Defective, Dependent, and Delinquent Classes of the Population of the United States, As Returned at the Tenth Census (June 1, 1880) . Wines used seven categories of mental illness, which were also adopted by

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3528-509: The Mind of Barry Goldwater". This led to a ban on the diagnosis of a public figure by psychiatrists who have not performed an examination or been authorized to release information by the patient. This became the Goldwater rule . Supported by various funding sources, the APA and its members have played major roles in examining points of contention in the field and addressing uncertainties about psychiatric illness and its treatment, as well as

3612-533: The National Commission on Mental Hygiene (now Mental Health America ), the American Medico-Psychological Association developed a new guide for mental hospitals called the Statistical Manual for the Use of Institutions for the Insane . This guide included twenty-two diagnoses. It would be revised several times by the Association, and by the tenth edition in 1942, was titled Statistical Manual for

3696-747: The Superintendents: dementia , dipsomania (uncontrollable craving for alcohol), epilepsy , mania , melancholia , monomania , and paresis . In 1892, the Superintendents' Association expanded its membership to include other mental health workers, and renamed to the American Medico-Psychological Association (AMPA). In 1893, a French physician, Jacques Bertillon , introduced the Bertillon Classification of Causes of Death at

3780-494: The United States. The establishment of consistent criteria was an attempt to facilitate the pharmaceutical regulatory process. The criteria adopted for many of the mental disorders were influenced by the Research Diagnostic Criteria (RDC) and Feighner Criteria , which had just been developed by a group of research-orientated psychiatrists based primarily at Washington University School of Medicine and

3864-593: The Use of Hospitals of Mental Diseases . In 1921, the AMPA became the present American Psychiatric Association (APA). The first edition of the DSM notes in its foreword: "In the late twenties, each large teaching center employed a system of its own origination, no one of which met more than the immediate needs of the local institution." In 1933, the AMA's general medical guide the Standard Classified Nomenclature of Disease , (referred to as

3948-631: The association changed that name to the present American Psychiatric Association. The association was incorporated in 1927. The cover of the publication Semi-Centennial Proceedings of the American Medical Psychological Association , which the association distributed in 1894 at its 50th annual meeting in Philadelphia, contained the first depiction of the association's official seal . The seal has undergone several changes since that time. The present seal

4032-622: The basic outline of the Standard and attempting to express present-day concepts of mental disturbance." Under the direction of James Forrestal , a committee headed by psychiatrist Brigadier General William C. Menninger , with the assistance of the Mental Hospital Service, developed a new classification scheme in 1944 and 1945. Issued in War Department Technical Bulletin, Medical, 203 (TB MED 203); Nomenclature and Method of Recording Diagnoses

4116-518: The bio-bio-bio model" and accepted "kickbacks and bribes" from pharmaceutical companies leading to the over-use of medication and neglect of other approaches. In 2008 APA was the focus of congressional investigations on how pharmaceutical industry money shapes the practices of nonprofit organizations that purport to be independent. The drug industry accounted in 2006 for about 30 percent of the association's $ 62.5 million in financing, half through drug advertisements in its journals and meeting exhibits, and

4200-454: The categories, which required symptoms causing "clinically significant distress or impairment in social, occupational, or other important areas of functioning". Some personality-disorder diagnoses were deleted or moved to the appendix. The DSM-IV characterizes a mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with

4284-430: The category of "sexual orientation disturbance". The emergence of DSM-III represented a "quantum leap" in terms of the scale and reach of the manual. In 1974, the decision to revise the DSM was made, and psychiatrist Robert Spitzer was selected as chair of the task force. The initial impetus was to make the DSM nomenclature consistent with that of the International Classification of Diseases (ICD). The revision took on

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4368-432: The changes have recently come to light. 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, DSM-III

4452-569: The changes. After some further revisions, the Diagnostic and Statistical Manual of Mental Disorders was approved in 1951 and published in 1952. The structure and conceptual framework were the same as in Medical 203, and many passages of text were identical. The manual was 130 pages long and listed 106 mental disorders. These included several categories of "personality disturbance", generally distinguished from "neurosis" (nervousness, egodystonic ). The foreword to this edition describes itself as being

4536-560: The country. APA operates a non-profit subsidiary called the American Psychiatric Association Foundation (APAF), offering community-based programs and research initiatives intended to better understand and support issues of mental health. Its strategic partners include the Council of State Governments (CSG) Justice Center, Substance Abuse and Mental Health Services Administration (SAMHSA) and

4620-501: The doctors felt they were independents, they rehearsed their speeches and likely would not be invited back if they discussed drug side effects. "Thought leaders" became the experts quoted in the media. As Marcia Angell wrote in The New England Journal of Medicine (2000), "thought leaders" could agree to be listed as an author of ghostwritten articles, and she cites Thomas Bodenheimer and David Rothman who describe

4704-401: The elimination of Asperger's syndrome as a disorder and replacing it with an autism spectrum severity scale. Roy Richard Grinker wrote a controversial editorial for The New York Times expressing support for the proposal. The APA president in 2005, Steven Sharfstein , praised the pharmaceutical industry but argued that American psychiatry had "allowed the biopsychosocial model to become

4788-582: The extent of the drug industry's involvement with doctors. The New York Times published a summary about antipsychotic medications in October 2010. In 2008, for the first time, Senator Charles Grassley asked the APA to disclose how much of its annual budget came from drug industry funds. The APA said that industry contributed 28 percent of its budget ($ 14 million at that time), mainly through paid advertising in APA journals and funds for continuing medical education. The APA receives additional funding from

4872-736: The former was more often used for clinical diagnosis while the latter was more valued for research. This may be because the DSM tends to put more emphasis on clear diagnostic criteria, while the ICD tends to put more emphasis on clinician judgement and avoiding diagnostic criteria unless they are independently validated. That is, the ICD descriptions of psychiatric disorders tend to be more qualitative information, such as general descriptions of what various disorders tend to look like. The DSM focuses more on quantitative and operationalized criteria; e.g., to be diagnosed with X disorder, one must fulfill 5 of 9 criteria for at least 6 months. The DSM-IV-TR (4th ed.) contains specific codes allowing comparisons between

4956-596: The homogeneity of the clinical setting in regard to patient mix and base rates, and the methodological rigor achieved by the investigator ... In 1987, DSM-III-R was published as a revision of the DSM-III, under the direction of Spitzer. Categories were renamed and reorganized, with significant changes in criteria. Six categories were deleted while others were added. Controversial diagnoses, such as Premenstrual Dysphoric Disorder and Masochistic Personality Disorder , were considered and discarded. (Premenstrual Dysphoric Disorder

5040-460: The image of two hemispheres of a human brain . The logo appears next to the words "American Psychiatric Association", with the word "Psychiatric" in bold type; the tagline "Medical leadership for mind, brain and body" appears below the logo. The association will continue to use the seal bearing Rush's profile for ceremonial purposes and for some internal documents. APA is led by the President of

5124-570: The inter-rater reliability is low for many disorders in the DSM-5, including major depressive disorder and generalized anxiety disorder . An alternate, widely used classification publication is the International Classification of Diseases (ICD), produced by the World Health Organization (WHO). The ICD has a broader scope than the DSM, covering overall health as well as mental health; chapter 6 of

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5208-633: The introductory text stated for at least some disorders, "particularly the Personality Disorders, the criteria require much more inference on the part of the observer"[page xxiii]. In 1994, DSM-IV was published, listing 410 disorders in 886 pages. The task force was chaired by Allen Frances and was overseen by a steering committee of twenty-seven people, including four psychologists. The steering committee created thirteen work groups of five to sixteen members, each work group having about twenty advisers in addition. The work groups conducted

5292-548: The maintenance of the ILCD. They greatly expanded it, included non-fatal conditions for the first time, and renamed it the International Statistical Classification of Diseases (ICD). The foreword to the DSM-I states the ICD-6 "categorized mental disorders in rubrics similar to those of the Armed Forces nomenclature." The APA Committee on Nomenclature and Statistics was empowered to develop

5376-415: The medical community and made her a heroine to many gay men and lesbians, but homosexuality remained in the DSM until May 1974. In the 1960s, there were many challenges to the concept of mental illness itself. These challenges came from psychiatrists like Thomas Szasz , who argued mental illness was a myth used to disguise moral conflicts; from sociologists such as Erving Goffman , who said mental illness

5460-408: The microphone and yelled: "Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you." This gay activism occurred in the context of a broader anti-psychiatry movement that had come to the fore in the 1960s and was challenging the legitimacy of psychiatric diagnosis. Anti-psychiatry activists protested at

5544-494: The other half sponsoring fellowships, conferences and industry symposiums at its annual meeting. The APA came under increasing scrutiny and questions about conflicts of interest. The APA president in 2009–10, Alan Schatzberg , was identified as the principal investigator on a federal study into the drug mifepristone for use as an antidepressant being developed by Corcept Therapeutics, a company Schatzberg had created and in which he had several million dollars' equity. In 2021,

5628-457: The partnership that has developed between the APA and pharmaceutical companies since the 1980s. APA has come to depend on pharmaceutical money. The drug companies endowed continuing education and psychiatric "grand rounds" at hospitals. They funded a political action committee in 1982 to lobby Congress. The industry helped to pay for the APA's media training workshops. It was able to turn psychiatrists at top schools into speakers, and although

5712-416: The pharmaceutical industry through its American Psychiatric Association Foundation (APAF), including Boehringer Ingelheim , Janssen Pharmaceuticals , and Takeda Pharmaceutical Company , among others. In the 1964 election, Fact magazine polled American Psychiatric Association members on whether Barry Goldwater was fit to be president and published "The Unconscious of a Conservative: A Special Issue on

5796-550: The production of DSM-IV, and the scientific credibility of contemporary psychiatric classification. A text revision of DSM-IV, titled DSM-IV-TR, was published in 2000. The diagnostic categories were unchanged as were the diagnostic criteria for all but nine diagnoses. The majority of the text was unchanged; however, the text of two disorders, pervasive developmental disorder not otherwise specified and Asperger's disorder, had significant and/or multiple changes made. The definition of pervasive developmental disorder not otherwise specified

5880-475: The relationship of individual mental health concerns to those of the community. Controversies have related to anti-psychiatry and disability rights campaigners, who regularly protest at American Psychiatric Association offices or meetings. In 1970, members of the Gay Liberation Front organization protested the APA conference in San Francisco. In 2003 activists from MindFreedom International staged

5964-414: The reliability of the radically new diagnostic system they had devised, which relied on data from special field trials. However, according to a 1994 article by Stuart A. Kirk : Twenty years after the reliability problem became the central focus of DSM-III, there is still not a single multi-site study showing that DSM (any version) is routinely used with high reliably by regular mental health clinicians. Nor

6048-414: The same APA conventions, with some shared slogans and intellectual foundations as gay activists. Taking into account data from researchers such as Alfred Kinsey and Evelyn Hooker , the seventh printing of the DSM-II, in 1974, no longer listed homosexuality as a category of disorder. After a vote by the APA trustees in 1973, and confirmed by the wider APA membership in 1974, the diagnosis was replaced with

6132-468: The selection, processing, assessment, and treatment of soldiers. This moved the focus away from mental institutions and traditional clinical perspectives. The U.S. armed forces initially used the Standard, but found it lacked appropriate categories for many common conditions that troubled troops. The United States Navy made some minor revisions but "the Army established a much more sweeping revision, abandoning

6216-697: The text revision of the DSM-IV, the DSM-IV-TR , released in July 2000. Similar to the DSM-III-R , the DSM-IV-TR was created to bridge the gap between the DSM-IV and the next major release, then named DSM-V (eventually titled DSM-5 ). The DSM-IV-TR contains expanded descriptions of disorders. Wordings were clarified and errors were corrected. The categorizations and the diagnostic criteria were largely unchanged. No new disorders or conditions were introduced, although

6300-460: The theory-bound nosology (the branch of medical science that deals with the classification of diseases ) used in DSM-III. However, it has also generated controversy and criticism , including ongoing questions concerning the reliability and validity of many diagnoses; the use of arbitrary dividing lines between mental illness and " normality "; possible cultural bias ; and the medicalization of human distress. The APA itself has published that

6384-437: Was another example of how society labels and controls non-conformists; from behavioural psychologists who challenged psychiatry's fundamental reliance on unobservable phenomena; and from gay rights activists who criticised the APA's listing of homosexuality as a mental disorder. The APA was closely involved in the next significant revision of the mental disorder section of the ICD (version 8 in 1968). It decided to go ahead with

6468-409: Was based on bleeding, purging, and the use of the tranquilizer chair and gyrator. By 1844 these practices were considered erroneous and abandoned. Rush, however, was the first American to study mental disorder in a systematic manner, and he is considered the father of American Psychiatry. In 2015, the association adopted a new logo that depicts the serpent-entwined Rod of Asclepius superimposed over

6552-528: Was changed back to what it was in DSM-III-R and the text for Asperger's disorder was practically entirely rewritten. Most other changes were to the associated features sections of diagnoses that contained additional information such as lab findings, demographic information, prevalence, and course. Also, some diagnostic codes were changed to maintain consistency with ICD-9-CM. American Psychiatric Association The American Psychiatric Association ( APA )

6636-459: Was in serious danger of not being approved by the APA Board of Trustees unless "neurosis" was included in some form; a political compromise reinserted the term in parentheses after the word "disorder" in some cases. Additionally, the diagnosis of ego-dystonic homosexuality replaced the DSM-II category of "sexual orientation disturbance". The gender identity disorder in children (GIDC) diagnosis

6720-416: Was introduced in the DSM-III; prior to the DSM-III's publication in 1980, there was no diagnostic criteria for gender dysphoria . Finally published in 1980, DSM-III listed 265 diagnostic categories and was 494 pages long. It rapidly came into widespread international use and has been termed a revolution, or transformation, in psychiatry. When DSM-III was published, the developers made extensive claims about

6804-416: Was later reincorporated in the DSM-5, published in 2013). "Ego-dystonic homosexuality" was also removed and was largely subsumed under "sexual disorder not otherwise specified", which could include "persistent and marked distress about one's sexual orientation." Altogether, the DSM-III-R contained 292 diagnoses and was 567 pages long. Further efforts were made for the diagnoses to be purely descriptive, although

6888-422: Was organized into a five-part axial system: The DSM-IV does not 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. The sourcebooks have been said to provide important insights into the character and quality of the decisions that led to

6972-587: Was released shortly after the war in October 1945 under the auspices of the Office of the Surgeon General . It was reprinted in the Journal of Clinical Psychology for civilian use in July 1946 with the new title Nomenclature of Psychiatric Disorders and Reactions . This system came to be known as "Medical 203". This nomenclature eventually was adopted by all the armed forces, and "assorted modifications of

7056-422: Was used to justify inclusion of the disorder as a supposed pathological hidden fear of the opposite sex caused by traumatic parent–child relationships. This view was influential in the medical profession. In 1956, however, the psychologist Evelyn Hooker performed a study comparing the happiness and well-adjusted nature of self-identified homosexual men with heterosexual men and found no difference. Her study stunned

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