DSM - 5

INTRODUCTION TO THE DSM – 5

USE OF THE MANUAL
DSM-5 REVISION – INTRODUCTION

• Driven by practical considerations – the APA acknowledged that reliable diagnosis is

essential for
• Guiding treatment
• Arriving at accurate prevalence rates
• Identifying clinical samples for research
• Documenting important information like comorbidities, mortality rates

• Since the release of the DSM IV in 1994 – tremendous progress in research (cognitive
neuroscience, brain imaging, epidemiology and genetics)
• Categorical vs. dimensional approach – well defined symptom boundaries vs. symptom
clusters and spectrums
REVISION OF THE DSM-5 – MULTIDISCIPLINARY
APPROACH
• Physicians • Neuroscientists
• Psychologists • Neuropsychologists
• Social workers • Patients’ families
• Counselors • Lawyers
• Nurses • Consumer organizations
• Epidemiologists • Advocacy groups
• Statisticians
A BRIEF DSM HISTORY

• A predecessor of the DSM was first published in 1844 (‘idiocy’, ‘insanity’)

• Early 1900s – 7 categories of mental illness – mania, melancholia, monomania, paresis,
dementia, dipsomania and epilepsy, later revised to 22 groups in the 1940s
• DSM-I published in 1952 – 106 disorders termed as ‘reactions’ based on Freudian
principles – psychotic disorders, visceral disorders, neurotic disorders and personality
disorders
• DSM-II published in 1968 – 182 disorders
• DSM-III published in 1980 after heavy criticism of the DSM-II (Szasz) – dropped the
psychodynamic perspective and laid more emphasis on empirical research. Expanded to
265 diagnostic categories (PTSD, ADD, deletion of homosexuality)
A BRIEF DSM HISTORY

• DSM-III-R published in 1987 – 292 categories, leaned towards the role of biology and
genetics in psychological disorders – Kraeplin. Ego-dystonic homosexuality was deleted
• DSM-IV published in 1994 – about 297 diagnostic categories, all disorders were based on
empirical research. The term ‘clinical significance’ was introduced
• DSM-IV-TR – disorders remained unchanged. Only background information and familial
patterns were updated based on recent research. Multiaxial diagnostic system was used
• Axis I – clinical syndromes
• Axis II – personality and developmental disorders
• Axis III – general medical conditions
• Axis IV – psychosocial and environmental issues
• Axis V – Global Assessment of Functioning
DSM-5 REVISION PROCESS

• 12 year process beginning in 1999 when the APA evaluated strengths and weaknesses of
the DSM
• The APA coordinated with the WHO, the WPA and the NIMH to organize a series of
conferences, the proceedings of which were published in a monograph – ‘A Research
Agenda for DSM-V’
• 13 international DSM research planning conferences were organized subsequently, to
prepare for revisions of both DSM and ICD
• DSM-5 Task Force was set up with a multidisciplinary range of expertise
• David Kupfer, University of Pittsburgh (Chair), Darell Regier, Director, Division of
Research (Vice-Chair) of the DSM-5 Task Force
DSM-5 REVISION PROCESS

• 6 study groups – to address conceptual issues and guide overall development

• Spectrum disorders
• Gender and culture
• Functional impairment and disability assessment
• Diagnostic assessment instruments

• 13 diagnostic workgroups were put in place - 6 years of conducting literature reviews,

secondary analyses, developing draft diagnostic criteria, publishing reports, performing
field trials
• Changed from DSM-V to DSM-5
DSM-5 REVISION PROCESS

• Efforts were made to avoid conflict of interests (e.g. Listerine, e.g. Alison Bass’ ‘Side
Effects’ and GlaxoSmithKline’s Paxil, Christopher Lane’s ‘Shyness: How Normal Behavior
Became a Sickness’)
• Novel scientific findings for the last 2 decades were considered
• 4 principles to guide revision –
• Revision must be feasible to use in routine clinical practice
• Revision should be guided by research evidence
• Continuity should be maintained with previous editions of DSM
• There should not be any constraints on the degree of change between DSM-IV and DSM-5
OVERVIEW OF THE DSM-5, MAY 2013

• 3 sections
I. Introduction and use of the manual
• Review of development
• Goals
• Changes
• Non-axial diagnostic format
II. Diagnosis and revised chapter organization
III. Emerging measures and models
• Conditions requiring further research
• Dimensional measures
• Cultural formation
• Glossary