DSM history and DSM5

1. DSM
(DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
DISORDERS)
- - NEHA FARHEEN M
I yr – M.Phil Clinical Psychology Trainee

2. CONTENTS
I
• Introduction
• History / Short story of DSM
II
• Improvement in DSM-5 over DSM-IV TR
• Structure of DSM-5
III
• Similarities and Difference – DSM & ICD
• Current controversies & Limitations.

3. INTRODUCTION
What is DSM ?
 Diagnostic manual used by counselors,
psychologists and psychiatrists;
 Help guide diagnostic decision making;
 Only classification system addressing mental
disorders in current widespread use in most
professional settings;

4. HISTORY

5. STORY OF DSM
 1st version of 1952 and had 60 disorders;
 1st & 2nd edition (1968) based on psychoanalytic
traditions;
 3rd version in favor of biomedical model (1980);
 DSM-III-R (1987) changed diagnostic criteria for several
mental illness;
 DSM-IV (1994) had a interim text revision called DSM-
IV-TR (2000) before it has now taken shape as DSM-5
(2013);

6. IMPROVEMENTS IN DSM-5 OVER
DSM-IV TR
 Reflect developmental and life span approach;
 Gender-cultural issues integrated; Introduced new cross-
cultural symptom measures; Guidelines for cultural
formulation interviews;
 Latest evidence from genetics & neuroimaging taken into
account to improve disorder descriptions;
 Substance abuse disorders restructured for clarity-consistency;
 Introduced a dimensional approach to diagnosis since many
disorders are now thought to exist along a continuum than as
distinct categories;
 Multi-axial system of DSM-IV eliminated in DSM-5;
 Global Assessment of Functioning Scale which had poor
reliability and validity replaced with Disability Assessment
Schedule;

7. IMPROVEMENTS IN DSM-5 OVER
DSM-IV TR (CONT…..)
 Added optional alternative model for diagnosis of personality
disorders;
 Restructured order of chapters;
 Aspergers and PDD consolidated into ASD as there was no
evidence to support their separation;
 Diagnostic criteria for bipolar and depressive disorders
streamlined;
 New diagnostic categories include: Disruptive Mood
Dysregulation Disorder; Hoarding Disorder; Binge Eating
Disorder; Excoriation Disorder;
 Revised Diagnosis: Internet-use Gaming Disorder; Non-
suicidal self injury; Suicidal Behavior Disorder;
 Rejected proposed disorders: Anxious Depression;
Hypersexual Disorder; Parental Alienation Syndrome;
Sensory Processing Disorder;

8. STRUCTURE OF DSM-5…
 Section 1
includes an introduction and instructions on how to use
the new version;
 Section 2
covers the diagnostic categories;
 Section 3
includes conditions that need additional research, a
glossary of terms, and other important information.

9. DSM & ICD: SIMILARITIES...
 Both are diagnosis and categorizing manuals require two
or more symptoms to make a diagnosis;
 Both are NOT self diagnosis manuals; Intended for use
by qualified health professionals, more specifically
psychiatrists;
 Both are officially recognized manuals used to
categorize and diagnose mental disorders;
 Attempts are on to further harmonize between the two
systems of disease classification;

10. DSM & ICD: DIFFERENCES…1
 Internationally, DSM used mainly in the USA;
 ICD is larger manual, encompasses all types of diseases/disorders; Only chapter V is
relevant for mental disorders;
 DSM is purely for mental disorders;
 ICD brought out of international collaboration;
 ICD produced by a global health agency with a constitutional public health mission;
 DSM issued by single national professional body-American Psychiatric Association;
 ICD primary focus on classification is to help countries to reduce burden of mental
disorders. Its development is global, multidisciplinary and multilingual; DSM
primary constituency is U.S. Psychiatrists;
 ICD approved by World Health Assembly comprising of 193 member countries;
 DSM approved by assembly of APA members;
 ICD is low cost and available free on internet;
 DSM is copyrighted and generates income for APA;

11. DSM-ICD DIFFERENCES…2
 DSM criteria very specific and detailed
 ICD more of prototype descriptions with less detailed criteria and
minimum background information to guide diagnosis;
 DSM always been multi-axial except now.
 ICD always been non-axial;
 DSM used by licensed mental health professionals with advanced
degrees;
 ICD accessible to wide rage of health care professionals with wide
educational backgrounds;
 Conceptual differences; Ex: Bulimia nervosa is characterized by
’morbid dread of fatness’ while DSM requires ‘self evaluation’; PTSD
is much broader in ICD-10 than DSM5;
 Differences can cause problems in research comparisons;
 ICD-11 expected in 2017

12. CURRENT CONTROVERSIES..1
 Dimensional vs. Categorical Approaches; Do mental
disorders really exist? Single disorders rarely exist in
pure text book form; Separate disorders vs. sub types;
Diagnosis of mental disorders is dubbed as subjective;
 No biomarkers or genetic markers, lab tests, blood tests,
brain scans as basis for diagnostic criteria;
 Mostly based on patient self reports or key informant
reports; Subjectivity is inevitable to some extent;
 Financial implications of revising diagnostic
classifications;
 Manual is based on the biomedical model;
 No clear line of demarcation between normal-abnormal;
 Manual itself says that it should not be used as
‘cookbook’;