The Diagnostic and Statistical Manual of Mental Disorders (DSM)

Undergraduate Psychology, School of Arts & Sciences

What is the DSM?

The main purpose of the DSM is to provide a standard classification for all mental health

disorders, or simply put, a place for professionals and interested laypersons alike to find valid

and reliable information with regard to mental health diagnoses and treatment. A reliable system

of mental health diagnosis is important for anyone who may be both diagnosing and conducting

therapeutic endeavors, as it lends to the credibility of both those practicing in the helping fields

as well as the credibility of diagnosis as it relates to the world of therapeutic intervention.

Professionals who are encouraged to utilize the DSM work in many different settings, such as:

• Psychiatric hospitals

• Private practice

• Outpatient clinics

• Primary care physicians

All versions of the DSM have also provided important statistical information with regard to

psychiatric care, statistics that have proven useful in the monitoring of the application of modern

mental health practice (American Psychiatric Association [APA], 2012a).

History and the New Release

The first version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was

published in 1952 in an attempt to provide one consolidated source for verbiage describing

mental illnesses (Clegg, 2012). Changes and updates have continued since then with the most

recent version, the DSM-5, being released in May, 2013. The first major shift in focus came with
the DSM III, which viewed individuals as someone having a condition (schizophrenia) versus an

individual being a schizophrenic (Clegg, 2012). The DSM-IV was published in 1994 (with a text

revision, DSM-IV-TR, published in 2000), so it has been nearly 20 years since the release of a

new, full version (American Psychiatric Association, 2012b).

Who Uses the DSM and Why?

All versions of the DSM have been viewed by many to be the ultimate resource for those

who both diagnose and ultimately treat mental health disorders, while others view the DSM as

one source among many. However, both view the DSM as something to be utilized by trained

professionals only, as the information and recommendations contained within the boundaries of

the DSM can be very dangerous tools if they are not complimented by adequate training and

experience.

Pros and Cons of the DSM

The ability of the DSM to provide standard classification of mental health disorders as

noted previously is considered its main benefit. This is particularly useful in aiding in the

communication process between clinicians, because it provides a common language for various

conditions. The DSM is also helpful in practical areas as a diagnosis from an accepted source

such as the DSM, is often needed to allow for insurance reimbursement. It may also be useful to

the patient in reassuring him (or her) that there is an explanation for the symptoms experienced

(Murth et al., n.d.).

Many in the psychiatric community view the DSM in a much less favorable light. In fact,

many in the psychiatric community view the DSM as just another sign that we are venturing

farther down a path toward both over-diagnosis and ultimately unnecessary intervention.

Intervention that not only endangers the health of individuals seeking treatment, but also may be
leading us down a path toward treatment becoming less about what is best for the individual in

favor of a rush toward standardizing what may never be clearly standardized.

Development of the DSM-5

The American Psychiatric Association recruited a Task Force comprised of researchers

and clinicians. These Task Force members represent various professions in psychiatry,

psychology and social work. This group studied the latest research in the areas of diagnosis in

the DSM and worked together to develop the new manual (APA, 2012c).

Disagreement over DSM-5 Revisions

Advocacy groups for various disorders have voiced concern about some of the changes

in specific areas of the DSM-5. More information about some of these specific reactions can be

found in the links below and in the articles listed at the end of this document. Most notably the

National Institute of Mental Health has stated that the organization “will be re-orienting its

research away from DSM categories” (2013, para. 5).

Links on DSM-5 Controversy

• [Link]

dsm-5

• [Link]

Overview of Changes in the DSM-5

One major shift in the overall approach of the DSM is a move away from the multi-axial

system of diagnosis. The APA notes that one of the reasons that this system was originally set

up to address a lack in research for personality disorders, but that this problem no longer exists.
The multi-axial system was also seen as an unnecessary expenditure of time. For these

reasons it was eliminated from the DSM-5 (APA, 2013b).

The DSM-5 is organized in three main sections. Section 1 is the Basics, Section 2 is the

Diagnostic Criteria and Codes, and Section 3 is the Emerging Measures and Models.

Attention Deficit/Hyperactivity Disorder

The main change in this disorder has to do with recognition of the fact that the disorder may

continue into adulthood. As such guidance for clinicians in diagnosing adults is also provided

(American Psychiatric Association, 2013c). For more information see:

[Link]

Autism Spectrum Disorder

The DSM-IV contained four separate disorders (autistic disorder, Asperger’s disorder, childhood

disintegrative disorder, pervasive developmental disorder not otherwise specified). The biggest

change in the DSM-5 is that these disorders have been combined into one disorder with varying

severity levels (APA, 2013d). For more information see:

[Link]

Conduct Disorder

An additional specifier has been added for those that meet all criteria (APA, 2013e). For more

information see: [Link]

Disruptive Mood Dysregulation Disorder

This is a new disorder which was added to provide a diagnosis for children and adolescents

who exhibit severe outburst that exceed temper tantrums. Mood between outburst is also angry

and irritable (APA, 2013f). For more information see:

[Link]

Feeding and Eating Disorders

In this category binge eating disorder is now recognized. Disorders added include pica and

avoidant/restrictive food intake disorder. Criteria have been changed for anorexia nervosa and

bulimia nervosa (APA, 2013g). For more information see:

[Link]

Gender Dysphoria

This is a revision of DSM-IV’s Gender Identity Disorder (APA, 2013h). For more information see:

[Link]

Intellectual Disability

This is an update/revision of DSM-IV’s Mental Retardation. The disorder is called Intellectual

Development Disorder and criteria have been changed (APA, 2013i). For more information see:

[Link]

Internet Gaming Disorder

This is not added to the DSM-5, but has been slated for future research and consideration for

future versions of the manual (APA, 2013j). For more information see:

[Link]

Major Depressive Disorder

The main change for this disorder involves removal of the “bereavement exclusion,” which

stipulated individuals who have experienced a recent loss could not be diagnosed. (APA,
2013k). For more information see:

[Link]

Mild Neurocognitive Disorder

This is a new edition to the DSM-5 designed to help in early detection of problems before more

serious conditions such as dementia develop (APA, 2013l). For more information see:

[Link]

Mood Disorders

Bipolar and related disorders are now listed in a separate, stand-alone section in the DSM-5.

Mood Disorders are now called depressive disorders (APA, 2013m). A new specifier has been

included in the Mood Disorders section to replace the “Mixed Episode” diagnosis (APA, 2013n).

For more information see:

[Link]

Obsessive Compulsive and Related Disorders

These disorders are now grouped in their own chapter, distinguishing them from other anxiety

disorders (APA, 2013o). For more information see:

[Link]

df

Paraphilic Disorders

Used to distinguish behavior that causes distress to the individual or harm to others, this term is

an update of the previous term paraphilias (APA, 2013p). For more information see:

[Link]
Personality Disorders

Although some changes were proposed in this category, no changes were made in terms of the

10 personality disorder categories that were in the DSM-IV. The proposed revisions have been

added to section III of the manual to encourage further study and possible inclusion in a future

version (APA, 2013b). For more information see:

[Link]

Posttraumatic Stress Disorder

PTSD has been moved from anxiety disorders to a new category entitled Trauma- and Stress-

or-Related Disorders. Events leading to PTSD have been clarified, and additional consideration

is given to behavioral symptoms of PTSD (APA, 2013q). For more information see:

[Link]

Schizophrenia

The DSM-IV-TR listed both positive and negative symptoms for schizophrenia, in the DSM-5

only negative symptoms are listed (APA, 2013m). Subtypes are eliminated in the DSM-5 and

two criteria are now required for diagnosis as opposed to one previously. An area has also been

included in Section III for future study (APA, 2013r). For more information see:

[Link]

Sleep–Wake Disorders

The grouping of various disorders has been rearranged with a goal of helping general mental

health clinicians and medical professionals know when to refer to a sleep specialist (APA,

2013s). For more information see: [Link]

wake%20Disorders%20Fact%[Link]
Social Anxiety Disorder

This is an update of the previous social phobia. Criteria have been expanded to include

additional social situations (APA, 2013t). For more information see:

[Link]

Social (Pragmatic) Communication Disorder

This condition is new in the DSM-5 and includes diagnostic for individuals who have difficulties

communicating in social settings to the extent that it impairs functioning (APA, 2013u). For more

information see:

[Link]

Somatic Symptom Disorder

Criteria have been changed for diagnosis; however an emphasis has been placed on a

requirement for the symptoms to lead to impairment in functioning (APA, 2013v). For more

information see:

[Link]

Specific Learning Disorder

Learning disorders will be identified by this new diagnosis, but specific areas will be identified

through specifiers that indicate areas of difficulty (APA, 2013w). For more information see:

[Link]

Substance-Related and Addictive Disorders

Substance abuse and substance dependence are now combined into one disorder, substance

use disorder, with varying levels of severity. Gambling disorder has been added as a behavioral
addiction (APA, 2013x). For more information see:

[Link]

Useful links on the changes in the DSM-5

• [Link]

psychiatric-association

• [Link]

• [Link]

dsm-5-no

• [Link]

• [Link]

ignore-its-ten-worst-changes

• [Link]

Articles that can be found in the University Library regarding the DSM-5

Collier, R. (2010). DSM revision surrounded by controversy. CMAJ: Canadian Medical

Association Journal= Journal De L'association Medicale Canadienne, 182(1), 16–17.

Cosgrove, L., & Krimsky, S. (2012). A comparison of DSM-IV and DSM-5 panel

members financial associations with industry: A Pernicious problem persists. Plos

Medicine, 9(3), 1–4.

Johnson, R. (2013). Forensic and culturally responsive approach for the DSM-5: Just

the facts. Journal of Theory Construction & Testing, 17(1), 18–22.

Pomeroy, E. C., & Parrish, D. E. (2012). The new DSM-5: Where have we been and

where are we going? Social Work, 57(3), 195–200.

The DSM has been the primary classification system for mental health disorders used in

the United States since the first version was published in 1952. Significant research and

evaluation went into the publication of the current version, however, there is some controversy

surrounding the manual. Major changes in the current version are outlined in this document for

those interested in knowing more about current diagnostic criteria. Keep in mind that

appropriate licensure and training is required when making a diagnosis.

American Psychiatric Association (2013a). From planning to publication: Developing DSM-5.

Retrieved from [Link]

[Link]

American Psychiatric Association. (2013b). Personality disorders. Retrieved from

[Link]

American Psychiatric Association. (2013c). Attention deficit/hyperactivity disorder. Retrieved

from [Link]

American Psychiatric Association. (2013d). Autism spectrum disorder. Retrieved from

[Link]

df

American Psychiatric Association. (2013e). Conduct disorder. Retrieved from

[Link]

American Psychiatric Association. (2013f). Disruptive mood dysregulation disorder. Retrieved

from

[Link]

0Fact%[Link]

American Psychiatric Association. (2013g). Feeding and eating disorders. Retrieved from

[Link]

American Psychiatric Association. (2013h). Gender dysphoria. Retrieved from

[Link]

American Psychiatric Association. (2013i). Intellectual disability. Retrieved from

[Link]

American Psychiatric Association. (2013j). Internet gaming disorder. Retrieved from

[Link]

df
American Psychiatric Association. (2013k). Major depressive disorder and the “bereavement

exclusion.” Retrieved from

[Link]

American Psychiatric Association. (2013l). Mild neurocognitive disorder. Retrieved from

[Link]

[Link]

American Psychiatric Association. (2013m). Diagnostic and statistical manual of mental

disorders-5. Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2013n). Mixed feature specifier. Retrieved from

[Link]

American Psychiatric Association. (2013o). Obsessive compulsive and related disorders.

Retrieved from

[Link]

[Link]

American Psychiatric Association. (2013p). Paraphilic disorders. Retrieved from

[Link]

American Psychiatric Association. (2013q). Posttraumatic stress disorder. Retrieved from

[Link]

American Psychiatric Association. (2013r). Schizophrenia. Retrieved from

[Link]

American Psychiatric Association. (2013s). Sleep-wake disorders. Retrieved from

[Link]

American Psychiatric Association. (2013t). Social anxiety disorder. Retrieved from

[Link]
American Psychiatric Association. (2013u). Social pragmatic communication disorder. Retrieved

from

[Link]

[Link]

American Psychiatric Association. Somatic symptom disorders. (2013v). Retrieved from

[Link]

pdf

American Psychiatric Association. (2013w). Specific learning disorder. Retrieved from

[Link]

pdf

American Psychiatric Association. (2013x). Substance-related and addictive disorders.

Retrieved from

[Link]

American Psychiatric Association. (2012a). DSM. Retrieved from

[Link]

American Psychiatric Association. (2012b). DSM: History of the manual. Retrieved from

[Link]

American Psychiatric Association. (2012c). Frequently asked questions. Retrieved from

[Link]

American Psychiatric Association. (2012d). DSM-5 field trials. Retrieved from

[Link]

Clegg, J. W. (2012, Nov.). Teaching about mental health and illness through the history of the

DSM. History of Psychology, 15(4), 364–370.

Collier, R. (2010). DSM revision surrounded by controversy. CMAJ: Canadian Medical

Association Journal= Journal De L'association Medicale Canadienne, 182(1), 16–17.

financial associations with industry: A Pernicious problem persists. Plos Medicine, 9(3),

1–4.

Insel, T. (2013).Director’s blog: Transforming diagnosis. Retrieved from

[Link]

Jaslow, R., & Castillo, M. (2013). Controversial update to psychiatry manual, dsm-5, arrives.

CBA News. Retrieved from [Link]

57585129/controversial-update-to-psychiatry-manual-dsm-5-arrives

Johnson, R. (2013). Forensic and culturally responsive approach for the DSM-5: Just the facts.

Journal of Theory Construction & Testing, 17(1), 18–22.

Lane, C. (May, 2013). The NIMH withdraws support for DSM-5. Psychology Today. Retrieved

from [Link]

support-dsm-5

Murth, N., Fry, A., Remakel-Henkles, S., Ludwig, L., Olsen, E., Kittelson, L.,…Hartman, P.

(n.d.). Limitations of the DSM-IV. Retrieved from

[Link]

Pomeroy, E. C., & Parrish, D. E. (2012). The new DSM-5: Where have we been and where are

we going? Social Work, 57(3), 195–200.

Society for the Humanistic Psychology Division 32 of the American Psychology Association.

Open letter to the DSM-5. Retrieved from [Link]