Diagnostic and Statistical Manual of Mental Disorders 5: A Quick Glance

By Vahia, Vihang | Indian Journal of Psychiatry, July-September 2013 | Go to article overview

Diagnostic and Statistical Manual of Mental Disorders 5: A Quick Glance


Vahia, Vihang, Indian Journal of Psychiatry


Byline: Vihang. Vahia

Dr. Dilip Jeste, the then President of the American Psychiatric Association, released the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) [sup][1] on May 18, 2013 at the 166 [sup]th Annual Meeting of the APA at San Francisco. This was a landmark achievement for the APA. Indian psychiatrists should take additional pride in the fact that Dr. Dilip V. Jeste is actually one of us. He used to be an Overseas Member of the Indian Psychiatric Society (IPS).

History of the DSM

Earliest documented efforts to gather epidemiological data on mental illness commenced in the USA in the year 1840. Mental illnesses were then classified under a single category of idiocy/insanity. Inaccurately defined categories of mental illness like mania, melancholia, monomania, general paralysis of the insane, dementia, and dipsomania were included in the US Census of 1880. In 1918, the American Medico-Psychological Association published a manual of classification of mental illnesses that listed 22 categories. The manual was designed for the use of Institutions for the Insane. The American Medico-Psychological Association was later renamed APA in 1921. During World War II, the US army prepared a manual of medical illnesses called the ' Medical 203 '. The US Navy revised the Medical 203 to formulate the "Standard Classified Nomenclature of Disease" or the "Standard". Office of the US Surgeon General adopted the Standard to classify illnesses on the battle grounds and among veterans returning from the war. The Veterans Administration adopted the Standard with few modifications. After the war, psychiatrist with experience of using the Standard during the Second World War continued to use it in civilian practice. The World Health Organization (WHO) included a chapter on Mental Disorders in its International classification of Diseases (ICD) 6 (1949). It resembled the Standard . In the year 1950, the APA set up a committee on nomenclature and statistics. This committee published the first DSM in the year 1952. [sup][2],[3],[4],[5],[6]

The first edition of DSM (1952) was titled 'Diagnostic and Statistical Manual of Mental Disorders'. It did not carry any number attached to its title. Authors of the manual had perhaps not envisaged that the manual would be revised periodically. The second edition (1968) was titled Diagnostic and Statistical Manual of Mental Disorders, Second Edition. The trend of fixing a roman suffix to the newer editions of the DSM commenced with the third edition which was titled DSM III (1980). DSM III also pioneered the multiaxial system of evaluation and classification of mental disorders. A revised version was christened DSM III R (1987). The trend continued while publishing the DSM IV (1994) and its text revised edition the DSM IV TR (2000). [sup][2],[3],[4],[5],[6]

The most recent edition of the DSM was initially labeled DSM V. As the process of developing the manual progressed, the Roman numerical 'V' was replaced by the alpha numerical '5'. This would facilitate subsequent revisions being numbered as 5.1, 5.2 and so forth. While facilitating the numbering, it is also a tacit acceptance that the DSM 5 is not the ultimate manual of classification of mental disorders. It is a document that reflects current consensus of the leading academicians, clinicians, and researchers in the field of mental health. [sup][5],[6],[7]

Methodology

By the year 1999, even as the DSM IV TR was being published, clinicians and researchers had noticed several flaws in the DSM IV. The DSM IV TR (2000) did not propose any substantial modifications to the doctrine of DSM IV (1994). The diagnostic criteria continued to result in rather frequent diagnosis of comorbidity. Heterogeneity within the diagnostic groups was unacceptable to the researchers and it contaminated treatment outcome. The erratic thresholds for inclusion and exclusion could not differentiate the normal from abnormal or syndromal from subsyndromal disorders. …

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