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ABSTRACT
The first major attempts to categorize psychiatric disorders in the
United States occurred in the mid-1800s, when census data were
collected that included insanity and idiocy of household members. In Europe, Florence Nightingale promoted the use of nonfatal disease classification for morbidity and treatment in 1860.
By the late 1800s, Kraepelin categorized disorders, and his sixth
edition of the Compendium der Psychiatrie was widely adopted by
both Europeans and Americans. In 1952, the American Psychiatric
Association published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Since then, the manual
has been periodically updated, expanded, and edited to reflect
social and scientific beliefs about the etiology and categorization
of psychiatric illness and care. In this article, we explore the historical and ongoing development of the DSM and its implications for
psychiatric nurses.
people who were in asylums or dependent on others for support (Genealogy Trails, n.d.). The purpose of the
form was to learn more about people
in these situations. It included more
categories of mental illness: mania,
melancholia (depression), monomania (impulse control, conduct, and
delusional disorders), dementia, and
dipsomania (alcohol craving and
binge drinking). Epilepsy was also included as a psychiatric disorder.
KRAEPELINIAN GROUPING OF
MENTAL DISORDERS
The Compendium der Psychiatrie,
an early work by German psychiatrist
Emil Kraepelin (1883), argued that
psychiatric care was as legitimate as
general medical treatment and should
be investigated systematically. In the
sixth edition of the Compendium der
Psychiatrie, Kraepelin (1899) categorized disorders into a notable dichotomy with separate etiologies and treatment trajectories. His work was based
on longitudinal studies of clinical
presentations and generational family
histories (Sanders, 2011). Kraepelin
categorizations were quickly adopted
in Europe and America for the purposes of diagnosing psychiatric disorders
and are considered to be the foundation of modern psychiatric classification systems (Palm & Mller, 2011).
One Kraepelin category of diagnoses was exogenous (i.e., originating
outside of the person) and treatable.
This included manic-depressive disorders and melancholia (depression).
The other category was endogenous
(i.e., originating inside a person), organic, and incurable. Dementia praecox, which means premature dementia
and referred to schizophrenia, was included in the latter category. Kraepelin identified three clinical varieties of
this disease: catatonic, characterized
by motor activity disruption (excessively active or inhibited); hebephrenic, characterized by inappropriate
emotional reactions and behavior; and
paranoid, characterized by delusions of
grandeur and persecution.
24
INTERNATIONAL CLASSIFICATION
OF DISEASES
While Kraepelin was developing
his own classifications of mental illness, other health care providers and
governments were searching for effective ways to classify and organize
medical data. Most focused solely on
recording death/mortality statistics.
At the Fourth International Statistical Congress in 1860, nursing
research pioneer, Florence Nightin-
DEVELOPMENT OF THE
DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS
At the same time the ICD was
being developed, psychiatrists were
working to classify mental disorders in
a separate manual. In 1917, the Committee on Statistics of the American
Medico-Psychological
Association
(now the APA) in collaboration with
the National Commission on Mental Hygiene, published the Statistical
Manual for the Use of Institutions for
the Insane. This book contained 22
groups of mental illnesses. The focus
was on severe mental and neurological illnesses seen in institutionalized
patients (Tartakovsky, 2011). There
were 10 editions of this manual until
1942.
Military and Veterans Administration psychiatrists found little use in
the APAs publication, as most disorders they treated were absent. They
were primarily interested in stress and
anxiety reactions, personality disorders, and somatoform disorders. In
1943, the U.S. Office of the Surgeon
General, Army Services Forces, developed their own nomenclature, the
Medical 203 classification, which expanded the utility of this text to the
somewhat less acute outpatient conditions of soldiers and veterans. Psychiatrist and Brigadier General William
C. Menninger led the Group for Advancement of Psychiatry and heavily
influenced momentum to advance a
common language in the psychiatric
community (Millon, Krueger, & Simonsen, 2010).
DSM-I
TABLE 1
SUMMARY OF CHANGES IN THE DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS (DSM), BY EDITION
Year Published
Number of
Diagnoses
Page Count
DSM-I
1952
106
130
DSM-II
1968
182
134
DSM-III
1980
265
494
DSM-IV
1994
297
886
DSM-IV-TR
2000
365
943
Version
TABLE 2
ABBREVIATED TIMELINE OF THE DSM-5 DEVELOPMENT
Time Period
19992007
20042007
20062008
April 2010
April 2012
Field trial testing for diagnostic categories and crosscutting dimensional measures are implemented
October 2011
April 2012
Spring 2012
Note. DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, fifth edition.
Adapted from American Psychiatric Association (2012c).
l Axis
IV: Environmental and
psychosocial stressors.
l Axis V: A score based on the
Global Assessment of Functioning
Scale.
Prominent diagnostic changes included the addition of posttraumatic stress
disorder and the exclusion of neuroses
(Peele, 2008). A DSM-III revision by
the APA in 1987 removed the diagnosis
of ego-dystonic homosexuality. Sexual
disorders not otherwise specified (NOS)
remained and included the specifier of
distress related to sexual orientation.
More than 1 million copies of
the DSM-III were sold to psychiatric
professionals and the general public
alike. Allen Frances (2012), chair of
the DSM-IV Task Force, notes that
the discussion of psychiatric diagnosis made a transition from the clinical
area to conversation at cocktail parties. While the psychiatric community
made a shift from Freudian hidden
motivations and dream analysis, so too
did the enlightened reader who began
to consider his own symptoms and
those of others.
DSM-IV
KEYPOINTS
Halter, M.J., Rolin-Kenny, D., & Grund, F. (2013). DSM-5: Historical Perspectives. Journal
of Psychosocial Nursing and Mental Health Services, 51(4), 22-29.
1.
2.
The first edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM) was published in 1952. The latest edition (DSM-5) is to be published in
May 2013.
3.
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Dr. Halter is Associate Dean, Ms. Grund is
Interim Dean, Ashland University, Mansfield,
Ohio; and Dr. Rolin-Kenny is Assistant Professor,
University of Texas at Austin, School of Nursing,
Austin, Texas.
Dr. Rolin-Kenny and Ms. Grund have disclosed
no conflicts of interest, financial or otherwise. Dr.
Halter receives travel support from Contemporary
Forums and royalties from Elsevier.
Address correspondence to Margaret Jordan
Halter, PhD, APRN, Associate Dean, Ashland
University, 1020 S. Trimble Road, Mansfield,
OH 44906; e-mail: peggyhalter1@gmail.com.
Received: October 14, 2012
Accepted: February 7, 2013
Posted: March 6, 2013
doi:10.3928/02793695-20130226-03
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