Misplaced Pages

#438561

61-633: 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

122-437: 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

183-399: 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

244-979: 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

305-828: 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

366-545: 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

427-507: 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,

488-515: 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

549-626: 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

610-559: 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,

671-690: 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

SECTION 10

#1732772291439

732-407: 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

793-529: 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

854-453: 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

915-517: 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

976-399: 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,

1037-415: 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

1098-444: 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

1159-725: 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

1220-667: 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

1281-632: 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

SECTION 20

#1732772291439

1342-736: 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

1403-435: 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

1464-548: 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

1525-477: 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

1586-495: 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

1647-508: 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

1708-491: 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

1769-508: 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

1830-613: 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

1891-783: 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

Diagnostic and Statistical Manual of Mental Disorders - Misplaced Pages Continue

1952-633: 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

2013-747: 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

2074-494: 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

2135-593: 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

2196-819: The Wikimedia System Administrators, please include the details below. Request from 172.68.168.133 via cp1102 cp1102, Varnish XID 543321788 Upstream caches: cp1102 int Error: 429, Too Many Requests at Thu, 28 Nov 2024 05:38:11 GMT DSM-IV-TR codes 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

2257-622: 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

2318-454: 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

2379-430: 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

2440-432: 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

2501-627: 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

Diagnostic and Statistical Manual of Mental Disorders - Misplaced Pages Continue

2562-736: 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

2623-596: 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

2684-570: 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

2745-633: 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

2806-548: 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

2867-415: 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

2928-408: 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

2989-550: 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

3050-414: 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

3111-414: 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

SECTION 50

#1732772291439

3172-468: 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

3233-460: 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

3294-437: 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

3355-528: 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 Too Many Requests If you report this error to

3416-459: 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

3477-416: 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

3538-416: 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

3599-422: 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

3660-693: 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

3721-422: 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

SECTION 60

#1732772291439
#438561