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The Diagnostic & Statistical Manual of Mental Disorders version IV (DSM-IV) under review.

Updated on June 27, 2011

Are You mad?

Are You Mad?
Are You Mad?

DSM-IV Under Review

 

First published in 1952 by the American Psychiatric Association (APA), the Diagnostic & Statistical Manual of Mental Disorders is a particularly insidious publication that stands as the ‘Bible’ of Psychiatry in the Western world. Since the first edition there have been five major revisions and each revision expanded to include an ever increasing number of neatly classified mental disorders along with symptoms and diagnoses. The DSM is widely used by clinicians, researchers, pharmaceutical companies, health insurance firms, and policy makers both in the United States and worldwide.

 

The second version of the manual, DSM-II, published in 1968, was 134 pages long and listed 182 disorders. Some diseases previously included in earlier editions of the DSM were later removed, most notably homosexuality. Pioneering research into human sexuality in the 1940’s and 1950’s by researchers like Kinsey and others added the weight of empirical data to the development of a politically active gay community in the United States and this placed mounting pressure on the APA to remove homosexuality from the DSM. So, largely as a result of the earlier work of researchers in sexuality coupled with changing social norms and increasing socio-political protests by gay activists, the APA were more or less forced to remove homosexuality as a discrete mental disorder. Although it was dropped from the DSM in the seventh printing of DSM-II in 1974 its diagnosis was replaced with a new category of ‘sexual orientation disturbance’ which is now known as ‘Gender Identity Disorder (GID).’ If the English have rarely been inclined to accept normal human (sexual) behaviour, our more fundamentalist American cousins have been even less so!

 

DSM-II was followed in 1980 by DSM-III, 494 pages long and listed 265 diagnostic categories. Subsequently, categories were renamed, reorganized, significant changes in criteria were made and a revised version, DSM-III-R, was published in 1987. The last major revision of the manual, the fourth edition (‘DSM-IV’), was published in 1994, although a ‘text revision’ was released by the APA in July 2000.

 

DSM-IV is currently under review and DSM-V is scheduled for publication in 2012. An early draft of DSM-V, cleverly titled DSM-IV-TR(!), was released for comment in 2009 and  the primary goal of this interim text version was, according to the APA website ‘to maintain the currency of the DSM-IV text’ and in addition ‘some of the diagnostic codes were changed to reflect updates to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) coding system adopted by the U.S. government.’ 

 

Well isn't that good news? Now there will some parity between the two major classifications of mental diseases used both in the USA and Europe. This should make things much easier for mental health professionals so that those from opposite sides of the pond will, on publication of DSM-V, be singing from the same hymn-book but, it is suspected, the tune will be somewhat different! Scheduled for publication in 2012 what new deep humanitarian insights into human behaviour DSM-V will bring remains to be seen Mmmmm.... ?

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    • meloncauli profile image

      meloncauli 

      6 years ago from UK

      Great hub!

      I have seen a DSM and my thoughts were instantly this:

      Imagine if you were to put every single physical ailment in a book ( a bible like the DSM), for all doctors to reference for diagnosis. Imagine how thick and almost impossible that would be?

      Now consider the DSM and the amount of mental illnesses there are.

      Psychiatrists are doctors first who have specialized in psychiatry. Imagine how simple their diagnosing is as compared to a medical general practitioner! I went into the wrong career!

    • Lita P. profile image

      Lita P. 

      8 years ago from Chicago/ Midwest

      I just wrote my own little Hub about the DSM.

      Lita

    • Lita P. profile image

      Lita P. 

      8 years ago from Chicago/ Midwest

      Great tongue-in-cheek, informative and subtle article. Lita P.

    • lisa brazeau profile image

      lisa brazeau 

      8 years ago from Canada

      I work in emergency and have always found it 'uncomfortable' to say the least, that a type of diagnosis depends on the doctor on duty!

      Thanks for a great article!

    • ncmonroe1981 profile image

      ncmonroe1981 

      8 years ago from West Virginia

      Thank you for the prompt and thorough answer! It's taken me a while to get back here. I can see your point, and really like what you said about diagnoses not being diseases.

      One of the things that has been bothering me about DSM diagnosis is that there seems to be some evidence (in the form of MRI and SPEC scan pictures) of organic (and brain-centered) origins for many of disorders listed (including multiple types of AD/HD, Bipolar I Disorder, Major Depressive Disorder, and Schizophrenia (various types)).

      This leads me to believe that A. some of the things in the DSM may have clear etiology, which would also mean that there is a better way to diagnose them, and B. the things that don't fall into that category may be the result of abnormal societal conditions.

    • Wytchewoode profile imageAUTHOR

      Steven Dark 

      8 years ago from Bohemia

      Mmmmm .... well, yes, slightly tongue in cheek with a hint of irony maybe. The DSM may be useful as a guide, and a very rough one at that, much like a tourist guide to a foreign country that lays out some possibilities for the traveller who then chooses their own direction. I'm not convinced DSM is useful in diagnosis; 'psychiatric' disorders do not fall into neat and precise categories and take no account of personality or other psycho-sociological factors in atiology which, to my mind, are far more important than diagnosis. Furthermore, professionals with different backgrounds will diagnose according to their own theoretical framework and frequently will disagree on the 'condition', its aetiology and treatment. My position is clearly in line with the thoughts of RD Laing and others who follow the notion that 'Diagnoses are not diseases' (Mindham et al, 1992) and that perhaps what are termed psychiatric conditions are not in fact 'abnormal' but maybe natural responses to abnormal situations. Put simply (and oversimplyifying a complicated view), it is not the patient who is mad but society which manufactures the madness.

    • ncmonroe1981 profile image

      ncmonroe1981 

      8 years ago from West Virginia

      Do I detect your tongue in your cheek? Since I'm currently finishing up my DSM course, I'm interested in knowing how you feel about the use of DSM diagnosis in patient treatment?

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