The document provides an overview of the history and development of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It discusses the key changes between editions, from the initial DSM-I in 1952 to the current DSM-5 from 2013. Major revisions in DSM-5 include eliminating the multi-axial system, replacing many disorder names, combining and reorganizing certain diagnoses, and emphasizing dimensional assessments and cultural factors in diagnosis. The goal is to improve clinical utility, reliability and cultural sensitivity in defining and classifying mental disorders.

1. DSM-V
(Diagnostic and Statistical Manual of
Mental Disorders)

2. Definition of Mental Disorders
A mental disorder is a syndrome characterized by clinically significant
disturbance in an individual’s cognition, emotion regulation, or
behavior that reflects a dysfunction in the psychological, biological, or
developmental processes underlying mental functioning.
There is usually significant distress or disability in social or
occupational activities.

3. The Purposes of DSM-V
1. To define clinical entities, so that clinicians have the same
understanding of what a diagnostic term means
2. To determine treatment

4. Historical view
• The 1840s, when the United States Bureau of the Census attempted
for the first time to count the numbers of patients confined in mental
hospitals.
• 1849 meeting of the Association of Medical Superintendents of
American Institutions for the Insane (the forerunner of the
present American Psychiatric Association) in which he called for a
uniform system of naming, classifying and recording cases of mental
illness.
•
Diagnostic categories included mania, melancholia and hysteria

5. DSM-I (1952)
• Used the term “reaction,” reflecting Adolph Meyer’s psychobiological
view that mental disorders represented reactions of the personality
to psychological, social and biological factors

6. DSM-II (1968)
• “Reaction” terminology dropped
• Users encouraged to record
multiple psychiatric diagnoses
(in order of importance)
and associated physical conditions
• Coincided with ICD-8
(first time ICD included mental disorders)

7. DSM-II (cont.)
• The main problem with DSM-II was the lack of an objective and
reliable system for describing psychopathology and determining
diagnoses.

8. DSM-III (1980)
Emphasis was placed on increasing reliability and clinical utility by using
field tested criteria but not focused on etiology
Represents a “dramatic departure” from previous DSM’s

9. Innovations of DSM-III
1. Provided a definition of the term “mental disorder”
2. Presented diagnostic criteria for each disorder
3. Introduced the multiaxial diagnostic format
4. Redefined a number of major disorders (e.g., elimination of
“neurosis”)
5. Added new diagnostic categories (e.g., personality disorders)
6. Presented a systematic description of each disorder
8. Provided a glossary of technical terms
9. Published reliability data from field trials

10. DSM-IV (1994)
• Inclusion of a clinical significance criterion
• New disorders introduced
(e.g., Acute Stress Disorder, PTSD
Bipolar II Disorder, Asperger’s Disorder),
• others deleted
(e.g., Cluttering,
Passive-Aggressive Personality Disorder).

11. DSM IV-TR (2000)
• The text sections giving an extra information on each diagnosis were
updated as were some of the diagnostic codes to maintain
consistency with the ICD. The DSM –IV-TR was organized into a five
part axial system. The first axis was incorporated to clinical disorders.
The second axis covered the personality disorders and intellectual
disabilities. The third axis asks for information concerning relevant
general medical conditions from which the person is currently
suffering. Axis IV asks about special psychosocial and environmental
problems the person is suffering such as school and housing. Axis V
requires the diagnosticians to make a global assessment of
functioning that is to rate the persons psychological, social and
occupational functioning overall on a scale 1 to 100.

12. DSM-5 (2013)
“5” instead of “V” Anticipates change e.g. DSM 5.1 … 5.2
Development started with 1999 meeting
• Task force recruited in 2006
• Work Groups to consider

13. Primary goal of DSM 5 task force in creating
the New Manual
• Increasing the cultural sensitivity
• Increases the awareness of neurobiology that’s underlying in mental
disorders
• Appraise the social and contextual factors to associated with the
psychiatric symptoms.

14. APPROVED
APA Assembly (November 2012)
Board of Trustees (December 2012)

15. DSM-5 Structure
• Section I: Basics
• Section II: Diagnostic Criteria and Codes
• Section III: Emerging Measures and Models
• Appendix

16. Section I: Basics
• Introduction
• Use of the Manual
• Cautionary Statement for Forensic Use

17. Section I: Basics: Introduction
• DSM-5 has better reliability than DSM-IV.
• Research to validate diagnoses continues.
• The boundaries between many disorder categories are fluid over the
life course.
• Symptoms assigned to one disorder may occur in many other
disorders.
• DSM-5 accommodates dimensional approaches to mental disorders.

18. Basics: Introduction (cont…)
• Many mental disorders are on a spectrum with related disorders
that have shared symptoms.
• Disorder categories in earlier DSMs were overly narrow, resulting
in the widespread use of Not Otherwise Specified (NOS)
diagnoses.
• DSM-5 removes the NOS diagnosis. It adds
Unspecified Disorder (for use when there is insufficient
information to be more specific)

19. • For example, suppose a client has significant depressive symptoms
but does not meet all the criteria for a major depressive episode.
• The diagnosis would be “Other specified depressive disorder,
depressive episode with insufficient symptoms.”

20. Section I: Basics: Use of the Manual
• Clinical Case Formulation
• Making diagnoses requires clinical judgment, not just checking off
the symptoms in the criteria.
• The client’s cultural and social context must be considered.

21. Section I: Basics: Cautionary Statement for
Forensic Use of DSM-5
• The diagnosis of a mental disorder does not imply that the person
meets legal criteria for the presence of a mental disorder or a specific
legal standard for competence, criminal responsibility, disability, etc.
• Having a diagnosis does not imply that the person is (or was) unable
to control his or her behavior at a particular time.

22. Section-II (Diagnostic Criteria and Codes)
Highlights of Specific Disorder Revisions

23. Major DSM-5 Changes
• The term “General medical condition” has been replaced throughout
DSM-5 with “Another medical condition”
• Diagnoses are no longer placed on the multi-axial system of Axes I-V
• The Global Assessment of Functioning Scale (GAF) has been
eliminated and now used the WHODAS2.0

24. Disorders Usually First Diagnosed in Infancy,
Childhood, or Adolescence
• This category has been eliminated
• Disorders formerly in the section have been distributed in other
sections
• Neurodevelopmental Disorders is a new section that contains many of
the diagnoses from this old section

25. Intellectual Disability
• Mental Retardation diagnosis has been replaced with Intellectual
Disability
• Both cognitive capacity (IQ) and adaptive functioning are assessed
with severity based on adaptive functioning rather than IQ

26. Communication Disorders is a category in Neurodevelopmental
Disorders that includes:
1. Language Disorder (combines Expressive and Mixed Receptive-
Expressive Disorder)
2. Speech Sound Disorder (replaces Phonological Disorder)
3. Childhood Onset Fluency Disorder (formerly Stuttering)
4. Social Pragmatic Disorder (New)

27. Additional Neurodevelopmental Disorder
Diagnoses
• Attention Deficit/Hyperactivity Disorder
• Specific Learning Disorder
• Motor Disorders (includes Developmental Coordination Disorder,
Stereotypic Movement Disorder, Tourette’s Disorder, and other vocal
and motor tics, & unspecified disorders)

28. Schizophrenia Spectrum and other Psychotic
Disorders
• Elimination of paranoid, undifferentiated, disorganized, and residual
subtypes
• Delusional Disorder – can now include bizarre delusion(s)
• Schizoaffective Disorder – major mood episode must be present for a
majority of the total duration of disorder

29. Bipolar and Related Disorders
• Criteria for mania and hypomania now include changes in activity and
energy as well as mood changes

30. Depressive Disorders
• Disruptive Mood Dysregulation Disorder – for children under age 18
who have persistent irritability and frequent extreme out of control
behavior (to address concerns about potential over diagnosis of
Bipolar Disorder)
• Persistent Depressive Disorder (replaces Dysthymic Disorder)
• Bereavement no longer excluded from depression diagnosis

31. Anxiety Disorders
• PTSD moved to new section called Trauma and Stressor Related
Disorders
• OCD moved to new section called Obsessive-Compulsive and Related
Disorders
• Social Anxiety Disorder (replaces Social Phobia)
• Panic Disorder with Agoraphobia – now 2 diagnoses, no longer one
diagnosis
• Separation Anxiety Disorder – moved from the old First Diagnosed in
Infancy…section

32. Obsessive-Compulsive and Related Disorders
• Obsessive-Compulsive Disorder – moved from Anxiety Disorder
section
• New Diagnosis: Hoarding Disorder
• Body Dysmorphic Disorder – moved from old Somatoform Disorder
section
• Trichotillomania
• Skin-picking Disorder
• Substance-induced OCD and OCD due to another medical condition

33. Trauma and Stressor-Related Disorders
• Reactive Attachment Disorder – moved from the old First Diagnosed
in Infancy…section
• Disinhibited Social Engagement Disorder
• PTSD – moved from Anxiety Disorders section
• Acute Stress Disorder – moved from Anxiety Disorder Section
• Adjustment Disorders – old section of Adjustment Disorders
eliminated

34. Dissociative Disorders
• Depersonalization/DE realization Disorder – concepts of
depersonalization and DE realization combined to replace former
Depersonalization Disorder

35. Somatic Symptom and Related Disorders
• Formerly called Somatoform Disorders
• Somatic Symptom Disorder (replaces Somatization Disorder)
• Illness Anxiety Disorder (replaces Hypochondirasis)
• Conversion Disorder – also called Functional Neurological Symptom
Disorder
• Factitious Disorder: Imposed on self or Imposed on other colloquially
known as Munchausen’s Syndrome and Munchausen’s by proxy)

36. Feeding and Eating Disorders
• Adult diagnoses of Anorexia Nervosa and Bulimia Nervosa are
essentially unchanged
• New Diagnosis: Binge Eating Disorder
• New Diagnosis: Avoidant/Restrictive Food Intake Disorder
• Pica and Rumination Disorder - moved from former First Diagnosed in
Infancy…section

37. Disruptive, Impulse-Control, and Conduct
Disorders
• Conduct Disorder and Oppositional Defiant Disorder – moved from
former First Diagnosed in Infancy…section
• Intermittent Explosive Disorder, Kleptomania, & Pyromania – moved
from former Impulse-Control Disorder section

38. Substance-Related and Addictive Disorders
• Gambling – moved from former Impulse-Control Disorder section
• No longer a separation of substance abuse and dependence
• Categories reduced by combining amphetamine and cocaine into
stimulants; phencyclidine included in hallucinogens; and nicotine
expanded to tobacco

39. Personality Disorders
• Personality Disorder diagnoses remain unchanged in Section II
• Another alternative approach is proposed in Section III to be used
for further study; it contains changes proposed in drafts of DSM-5
which were not ultimately accepted
• The alternate section has 6 rather than 10 diagnoses with criteria
focusing on personality traits and personality functioning