DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association provides an organized standard criteria for the classification of mental disorders, and is intended for common, as well as clinical use. The DSM is used in the United States as the diagnostic guide to modern perceptions of mental illness. It is used or relied heavily upon by clinicians, physicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and public policy makers.

The current version is the DSM-IV-TR, updated as of 2001. The current DSM is organized into a five-part axial system. The first axis incorporates 'clinical disorders. The second axis covers personality disorders and intellectual disabilities. The remaining axes cover medical, psychosocial, environmental, and childhood factors functionally necessary to provide diagnostic criteria for accurate healthcare assessments. The APA has stated that they intend to release an updated version of the DSM in May of 2013, which will include a number of sweeping changes to the categorization of disorders.

Editions of the DSM

The clinical need for a universal classification system for mental disorders was present long before the American Psychiatric Association;s development of the DSM. As early as 1818, Dr. Christian Nasse is credited with attempting to organize how mental disorders were conceptualized by establishing the 'Journal for the Healing and Diagnosis of Pathological Mental Disorders'. However, there was very little agreement in the medical community regarding how psycho-pathology should be classified. Dr. Nasse summed assessed the situation accurately, by stating that every worker dealing with mental disorders felt he had to offer a classification system of his own. This appears to be an true with the identification of, at least, thirty-nine official and unofficial classifications systems described by Dr. Stengel in a 1959 review areticle. The proposed classification systems varied drastically because they focused on different aspects of psycho-pathology as the defining features of mental illnesses.

That being said, the offical classification of "mental and nervous diseases" in the United States was originated in the mid-19th century through federal intervention. In 1840, the Bureau of the Census classified citizens with psychiatric conditions in one of two categories: 1) Insane, 2) Imbecile. this would remains the governments formal standard of classification for the next four decades. However, this was expanded in 1880 into seven potential clinincal categories: 1) Mania, 2) Melancholia, 3) Monomania, 4) Paresis, 5) Dementia, 6) Dipsomania, and 7) Epilepsy. The Bureau of Census maintained this system until the First World War, when the entire system was overhauled into specifications of individual types of Insanity.

1918: Statistical Manual for the Use of Institutions for the Insane

The Committee on Statistics of the American Medico-Psychological Assocation, what is now known as the American Psychiatric Association (APA), together with the National Commission on Mental Hygiene, developed a new guide for mental hospitals which included twenty-two individual diagnoses. This system was focused on individual criteria and clinical utility than the former system. They are as follows: disorders.

• Traumatic Psychoses
• Senile Psychoses (Modern Dementia)
• Psychoses with Cerebral Arteriosclerosis
• General Paralysis
• Psychoses with Cerebral Syphilis
• Psychoses with Huntington's Chorea
• Psychoses with brain tumor
• Psychoses with other brain or nervous disease
• Alcohol Psychoses
• Psychoses due to drugs or other exogenous toxins
• Psychoses with pellagra
• Psychoses with somatic diseases
• Manic Depressive Psychoses (Modern Bipolar Disorder)
• Involution Melancholia (Related to, but not identical with Major Depressive Disorder)
• Dementia Praecox
• Paranoia or Paranoic Conditions
• Epileptic Psychoses
• Psychoneuroses and Neuroses
• Psychoses with constitutional psychopathic inferiority (Modern Borderline Personality Disorder)
• Psychoses with mental deficiency
• Undiagnosed Psychoses
• Not Insane

This statisical manual was re-published ten times until its discontinuation in 1942. Additionally, the American Psychiatric Association subsequently collaborated with the New York Academy of Medicine to develop a nationally acceptable psychiatric nomenclature that would be incorporated within the first edition of the American Medical Association's Standard Classified Nomenclature of Disease. This nomenclature was designed primarily for diagnosing inpatients with severe psychiatric and neurological conditions.

1952: Diagnostic and Statistical Manual- I

World War II saw the large-scale involvement of American psychiatrists in the selection, processing, assessment and treatment of soldiers with potential psychiatric conditions. This moved the clinical focus away from the state mental institutions, inpatient treatment and traditional clinical perspectives of the prior century. Further, standard classification of "mental diseases" became a clinical necessity, as organization on a national scale became pivitol. A federal commission developed a committee that was headed by psychiatrist Brigadier General William C. Menninger, who developed a new classification scheme called 'Medical 203' that was issued in 1943 as a War Department Technical Bulletin under the directives of the Office of the Surgeon General. The foreword to the DSM-I states the US Navy had itself made some minor revisions to the text, but "the Army established a much more sweeping revision, abandoning the basic outline of the Standard and attempting to express present day concepts of mental disturbance. This nomenclature eventually was adopted by all Armed Forces", and "assorted modifications of the Armed Forces nomenclature [were] introduced into many clinics and hospitals by psychiatrists returning from military duty." The Veterans Administration also adopted a slightly modified version of 'Medical 203'.

The foreword to DSM-1 states this "categorized mental disorders in rubrics similar to those of the Armed Forces nomenclature." An APA Committee on Nomenclature and Statistics was empowered to develop a version specifically for use in the United States, to standardize the diverse and confused usage of different documents. In 1950 the APA committee undertook a review and consultation. It circulated an adaptation of 'Medical 203', the Veterans Administration system and the Standard's Nomenclature, to approximately 10% of APA members. 46% replied, of which 93% approved, and after some further revisions (resulting in it being called DSM-I), the Diagnostic and Statistical Manual of Mental Disorders was approved in 1951 and published in 1952. The structure and conceptual framework were the same as in 'Medical 203' and many passages of text were identical to its military counterpart. The manual was a total of one hundred and thirty pages long and listed one hundred and six mental disorders. This included several categories of 'personality disturbance', generally distinguished from Neurosis.

Associated Links

• Official DSM-5 development website
• The DSM I and DSM II
• Topic Center from the Psychiatric Times: DSM-5
• How the DSM Developed: What You Might Not Know
• DSM-IV-TR Official Site
• Reproduction of Medical 203
• Origins of DSM-I: a study in appearance and reality.
• The Multiaxial System of Diagnosis in DSM-IV Criteria
• DSM Wikipedia Page
• The Development of the DSM