The document provides an overview of the development of the DSM diagnostic system from its origins in the 1920s to the current DSM-5. It discusses the key editions including DSM-I in 1952, DSM-II in 1968, DSM-III in 1980 which introduced a more empirical and reliable approach, and DSM-IV in 1994. It then summarizes the process of developing DSM-5 from 1999 to 2013, which placed greater emphasis on research and dimensional assessments. The document outlines some of the major changes between DSM-IV and DSM-5, including removing the multiaxial system, incorporating dimensional assessments, and revising subtypes and specifiers.

1. INTRODUCTON TO
DSM 5
By
MOSTAFA MAHMOUD ELSABBAN
ASS. Lecturer of Psychiatry
Al Azhar University

2. Preface
Science is the systematic
classification of
experience
George Henry Lewes, The Physical Basis of Mind,

3. Development of DSM
1927
The New York Academy of Medicine
spearheaded a movement to develop a nationally accepted
standard nomenclature of disease.
1933
• A “Standard Classified Nomenclature of Disease” by
AMA.
• 24 major psychiatric categories that were strongly
influenced by the 6th edition of Kraepelin’s (1899).
1928
a conference was organized that included participants from the
government and all the medical specialties, including psychiatry
(represented by the APA).

4. Development of DSM
1940
• The U.S. Army and Navy each developed their own
classification system.
• The Veterans Administration created its own system to
incorporate outpatient presentations of World War II veterans.
NOW WE HAVE 4 DAGNOSTC SYSTEMS IN USA

5. Development of DSM
So the APA chose to develop its own
manual.
1948
ICD 6 DEVELOPED BY WHO, was not entirely
satisfactory to American psychiatrists.

6. Development of DSM
1952
DSM I
Most disorders were “reactions” reflecting the
influence of Adolf Meyer.
1968
DSM II
• The APA contributed to ICD-8 and also published
DSM-II.
• Omission of the term reaction from diagnoses.

7. Development of DSM
1980
DSM III
• The first comprehensive and detailed diagnostic
manual.
• Not relied on psychoanalytic concepts as before.
• The reliability of DSM-III was relatively good,
particularly for schizophrenia and major affective
disorders.
• Multiaxial classification system.
• 5 axes were described:
1. Clinical Syndrome.
2. PD or other specific developmental disorders.
3. GMC.
4. Psychosocial and environmental stressors.
5. Global assessment of functioning in the last year.
Robert Spitzer

9. Development of DSM
1987
1994
2000
DSM III-R
DSM IV
DSM IV- TR
DSM-IV was published in 1994, and its development involved systematic reviews of the literature,
secondary data analyses of previously collected data, and analyses of primary data collected
through 12 field trials.

10. Development of DSM

11. The March to DSM-5
• The process to develop DSM-5 began in 1999, 5 years after the publication of
DSM-IV.
• They met and agreed that the APA and NIMH should work together to expand the
scientific basis for psychiatric diagnosis and classification.
Steven E. Hyman
The director of the
NIMH
Steven M. Mirin
The president of the
APA
David J. Kupfer
The APA Committee on
Psychiatric Diagnosis

12. The March to DSM-5
1. A conference was convened later that year(2000), co-sponsored
by both organizations, to develop research priorities.
2. Participants included experts in epidemiology and genetics,
neuroscience, cognitive and behavioral science, child and adult
development, and disability assessment.
3. To encourage thinking “outside the box,” those closely involved
in the development of DSM-IV were not included.
4. Work groups were created for developmental issues, gaps in the
current diagnostic system, disability and impairment,
neuroscience, nomenclature, and cross-cultural issues

13. The March to DSM-5
2000
Darrel A. Regier, M.D., was recruited
from NIMH in 2000 to serve as director
of the APA’s American Psychiatric
Institute for Research and Education
(APIRE) and to coordinate the
development of DSM-5.
2002
Regier worked with leaders of the WHO and
the WPA to develop a grant from NIMH to
implement a series of research planning
conferences and granted 1.1 million $.

14. The March to DSM-5
2006
The DSM-5 Task Force was created including the
chairs of the 13 diagnostic work groups that were
responsible for reviewing the research and literature
on which to base their recommendations.
The DSM-5 Task Force had 4 guiding principles:
1. Give priority to clinical utility.
2. Use research evidence accumulated since the publication of DSM-IV.
3. Maintain historical continuity with previous editions.
4. Do not establish a priori any limits on changes proposed by work groups.

15. The March to DSM-5
• An initial task for the groups was to address how DSM-IV did or did
not work well or otherwise failed to meet clinicians’ needs.
• In addition, the work groups were asked to do the following:
1. Clarify the boundaries between mental disorders to reduce
confusion of disorders.
2. Consider “cross-cutting” symptoms (those that commonly occur
across different diagnoses)
3. Demonstrate the strength of research for the recommendations on
as many evidence levels as possible
4. Clarify the boundaries between specific mental disorders and
normal psychological functioning.

16. CHANGES FROM DSM IV TR TO DSM 5
DSM-V or DSM-5?
Dimensional Assessment
Removal of the Multiaxial System
Subtypes and Specifiers
Use of Other Specified and Unspecified Mental Disorders

17. DSM-V or DSM-5?
• One goal of was to designate DSM-5 as a “living” document.
• Task force members concluded that the ability to respond in
a rapid and nimble fashion was best captured by the use of
the Arabic numeral rather than the Roman numerals.
• For simplicity, future changes prior to the manual’s next
complete revision can be designated as DSM-5.1, DSM-5.2,
and so forth.

18. Removal of the Multiaxial System
1. Clinical Syndrome.
2. PD or other specific developmental disorders.
3. GMC.
4. Psychosocial and environmental stressors.
5. Global assessment of functioning in the
last year.

19. Dimensional Assessment
• With this categorical system, a person either had a symptom or
did not, and having a certain number of symptoms to make a
diagnosis.
• If this number was not met, the disorder was not diagnosed.
• Dimensional assessments allow clinicians to rate the presence and
the severity of the symptoms (e.g., as very severe, severe, moderate,
or mild).
• This rating can be used to track a patient’s progress with treatment
and can serve as a means to note improvements even when
symptoms remain.

21. Subtypes and Specifiers
• Subtypes define mutually exclusive and jointly exhaustive
phenomenological subgroupings within a diagnosis and are indicated
by the instruction “Specify whether” in the criteria set.
• e.g., in anorexia nervosa, Specify whether restricting type or binge-
eating/purging type.
• Specifiers are not intended to be mutually exclusive and as a
consequence, more than one specifier may be applied to a given
diagnosis and are indicated by the instruction “Specify” or “Specify if”
in the criteria set.
• e.g., in social anxiety disorder, “Specify if: performance only”.

22. DSM-5 includes 3 major sections
Historical material and describes the development of DSM-5,
as well as its organization and use.
The criteria sets for the 19 major diagnostic classes,
plus other mental disorders.
Assessment measures, a cultural formulation, an alternative
DSM- 5 model for PD, and criteria sets for conditions for
further study.
SECTION 1
SECTION 2
SECTION 3

23. DSM 5 TR Diagnostic classes