What Is the Diagnostic & Statistical Manual?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the reference book used by psychologists and psychiatrists when diagnosing mental illnesses. Although a publication of the American Psychological Association, the DSM is assembled and reviewed by mental health practitioners based on current research in the mental health fields.

Purpose

• The DSM identifies and classifies mental illnesses based on related causes and symptoms, generating a checklist of essential and nonessential symptoms that practitioners use when assigning a diagnosis. Because a mental illness may have a root cause--for example, biochemical imbalances may cause depression--providing a diagnosis allows the practitioner to prescribe the best therapy or treatment. When a psychiatrist diagnoses a patient with depression, for example, she knows what medications and treatments are likely to be most effective.

History

• Classification of mental illness from a medical standpoint began with Emil Kraepelin in the late 19th century. The International Classification of Diseases (ICD) originated in 1893, followed by the American Medico-Psychological Association's "Statistical Manual for the Use of Institutions for the Insane" in 1918. The first edition of the DSM was published in 1952, and six revisions have been made since then to reflect changing ideas about classification and the role that diagnosis should play in deciding treatment of mental illness. The current edition of the DSM, the DSM-IVTR, was published in 2000.

Organization

• The DSM provides five axes that clinicians use to generate a diagnosis. These five axes include temporary mental illnesses, enduring psychological abnormalities--such as cognitive disabilities or personality disorders--medical conditions, social and environmental issues and adaptive abilities. When the DSM presents an individual disorder, it groups symptoms into checklists called diagnostic criteria. For a person to meet the diagnostic criteria, they must present a certain number of symptoms on the list, show symptoms for a prescribed duration of time or exhibit impaired functioning because of the disorder.

Debates

• Because mental illness carries a social stigma, controversies frequently arise around the diagnosis of mental disorders and, hence, the DSM as well. Some argue that what practitioners label mental illness is, in fact, part of the continuum of normal behavior, just at greater extremes than what is exhibited by the majority of the population. Others point out that diagnosis can punish normal traits common in minority or oppressed groups. For example, homosexuality persisted as a DSM diagnosis until a 1973 revision, and other diagnoses favor typically masculine behavior, such as assertiveness, while pathologizing typically feminine behavior, such as shyness.

Future

• The next revision of the DSM is scheduled for release and publication in 2012. According to Roger Peele, a member of the DSM-V task force, in addition to considering necessary restructuring of the diagnostic categories, the new revision will also focus more heavily on establishing a research basis for its contents, utilizing peer review and considering how factors such as gender, culture and ethnicity affect the diagnosis and presentation of mental illnesses.