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Diagnostic and Statistical Manual of Mental Disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), offers a common language and standard criteria for the classification of mental disorders. It is used, or relied upon, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, the legal system, and policy makers together with alternatives such as the International Statistical Classification of Diseases and Related Health Problems (ICD), produced by the World Health Organization (WHO). The DSM is now in its fifth edition, DSM- 5, published on May 1. It evaluated the patient on five axes or dimensions rather than just one broad aspect of 'mental disorder'. These dimensions relate to biological, psychological, social and other aspects The DSM evolved from systems for collecting census and psychiatric hospital statistics, and from a United States Army manual. Revisions since its first publication in 1.
The ICD is the other commonly used manual for mental disorders. It is distinguished from the DSM in that it covers health as a whole. While the DSM is the official diagnostic system for mental disorders in the US, the ICD is used more widely in Europe and other parts of the world. Critics, including the National Institute of Mental Health, argue that the DSM represents an unscientific and subjective system. The DSM can be used clinically in this way, and also to categorize patients using diagnostic criteria for research purposes. Studies done on specific disorders often recruit patients whose symptoms match the criteria listed in the DSM for that disorder. An international survey of psychiatrists in 6.
ICD- 1. 0 and found the former was more often used for clinical diagnosis while the latter was more valued for research. The first official attempt was the 1. Three years later, the American Statistical Association made an official protest to the U. S. House of Representatives, stating that .
Wines was appointed to write a 5. Report on the Defective, Dependent, and Delinquent Classes of the Population of the United States, As Returned at the Tenth Census (June 1, 1. Wines used seven categories of mental illness: dementia, dipsomania (uncontrollable craving for alcohol), epilepsy, mania, melancholia, monomania and paresis. These categories were also adopted by the Association.
This included 2. 2 diagnoses and would be revised several times by the APA over the years. This moved the focus away from mental institutions and traditional clinical perspectives. A committee headed by psychiatrist Brigadier General. William C. Menninger developed a new classification scheme called Medical 2. War Department Technical Bulletin under the auspices of the Office of the Surgeon General.
This nomenclature eventually was adopted by all Armed Forces. The foreword to DSM- 1 states this . In 1. 95. 0, the APA committee undertook a review and consultation. It circulated an adaptation of Medical 2. VA system, and the Standard's Nomenclature to approximately 1.
APA members. 4. 6% replied, of which 9. DSM- I), the Diagnostic and Statistical Manual of Mental Disorders was approved in 1. The structure and conceptual framework were the same as in Medical 2. Homosexuality: A Psychoanalytic Study of Male Homosexuals, a large- scale 1. Irving Bieber and other authors, was used to justify inclusion of the disorder as a supposed pathological hidden fear of the opposite sex caused by traumatic parent. This view was widely influential in the medical profession.
These challenges came from psychiatrists like Thomas Szasz, who argued that mental illness was a myth used to disguise moral conflicts; from sociologists such as Erving Goffman, who said mental illness was merely another example of how society labels and controls non- conformists; from behavioural psychologists who challenged psychiatry's fundamental reliance on unobservable phenomena; and from gay rights activists who criticised the APA's listing of homosexuality as a mental disorder. A study published in Science by Rosenhan received much publicity and was viewed as an attack on the efficacy of psychiatric diagnosis. It was published in 1. It was quite similar to the DSM- I. Both the DSM- I and the DSM- II reflected the predominant psychodynamic psychiatry. Symptoms were not specified in detail for specific disorders.
Many were seen as reflections of broad underlying conflicts or maladaptive reactions to life problems, rooted in a distinction between neurosis and psychosis (roughly, anxiety/depression broadly in touch with reality, or hallucinations/delusions appearing disconnected from reality). Sociological and biological knowledge was incorporated, in a model that did not emphasize a clear boundary between normality and abnormality. Fleiss demonstrated that the second edition of the DSM (DSM- II) was an unreliable diagnostic tool. Via Rhine Ii Fast Ethernet Adapter Win Xp download Glennallen here. In reviewing previous studies of 1. Fleiss and Spitzer concluded that .
Reliability appears to be only satisfactory for three categories: mental deficiency, organic brain syndrome (but not its subtypes), and alcoholism. The level of reliability is no better than fair for psychosis and schizophrenia and is poor for the remaining categories. The activists disrupted the conference by interrupting speakers and shouting down and ridiculing psychiatrists who viewed homosexuality as a mental disorder. In 1. 97. 1, gay rights activist Frank Kameny worked with the Gay Liberation Front collective to demonstrate against the APA's convention. At the 1. 97. 1 conference, Kameny grabbed the microphone and yelled: . Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you.
Anti- psychiatry activists protested at the same APA conventions, with some shared slogans and intellectual foundations. After a vote by the APA trustees in 1. APA membership in 1. The initial impetus was to make the DSM nomenclature consistent with the International Statistical Classification of Diseases and Related Health Problems (ICD), published by the World Health Organization. The revision took on a far wider mandate under the influence and control of Spitzer and his chosen committee members.
There was also a need to standardize diagnostic practices within the US and with other countries after research showed that psychiatric diagnoses differed markedly between Europe and the US. Louis and the New York State Psychiatric Institute. Other criteria, and potential new categories of disorder, were established by consensus during meetings of the committee, as chaired by Spitzer. A key aim was to base categorization on colloquial English descriptive language (which would be easier to use by federal administrative offices), rather than assumptions of etiology, although its categorical approach assumed each particular pattern of symptoms in a category reflected a particular underlying pathology (an approach described as .
The psychodynamic or physiologic view was abandoned, in favor of a regulatory or legislative model. Many new categories of disorder were introduced, while some were deleted or changed. A number of the unpublished documents discussing and justifying the changes have recently come to light. National Institute of Mental Health (NIMH) were conducted between 1. A controversy emerged regarding deletion of the concept of neurosis, a mainstream of psychoanalytic theory and therapy but seen as vague and unscientific by the DSM task force. Faced with enormous political opposition, the DSM- III was in serious danger of not being approved by the APA Board of Trustees unless . Additionally, the diagnosis of ego- dystonic homosexuality replaced the DSM- II category of .
It rapidly came into widespread international use and has been termed a revolution or transformation in psychiatry. However, according to a 1. Stuart A. Kirk: Twenty years after the reliability problem became the central focus of DSM- III, there is still not a single multi- site study showing that DSM (any version) is routinely used with high reliably by regular mental health clinicians.
Nor is there any credible evidence that any version of the manual has greatly increased its reliability beyond the previous version. There are important methodological problems that limit the generalisability of most reliability studies.
Each reliability study is constrained by the training and supervision of the interviewers, their motivation and commitment to diagnostic accuracy, their prior skill, the homogeneity of the clinical setting in regard to patient mix and base rates, and the methodological rigor achieved by the investigator. Categories were renamed and reorganized, and significant changes in criteria were made. Six categories were deleted while others were added.
Controversial diagnoses, such as pre- menstrual dysphoric disorder and masochistic personality disorder, were considered and discarded. Further efforts were made for the diagnoses to be purely descriptive, although the introductory text stated that for at least some disorders, . The task force was chaired by Allen Frances. A steering committee of 2.
The steering committee created 1. Each work group had about 2.
The work groups conducted a three- step process: first, each group conducted an extensive literature review of their diagnoses; then, they requested data from researchers, conducting analyses to determine which criteria required change, with instructions to be conservative; finally, they conducted multicenter field trials relating diagnoses to clinical practice. Some personality disorder diagnoses were deleted or moved to the appendix. The diagnostic categories and the vast majority of the specific criteria for diagnosis were unchanged. The DSM- IV- TR was organized into a five- part axial system. The first axis incorporated clinical disorders. The second axis covered personality disorders and intellectual disabilities.