The Diagnostic and Statistical Manual of Mental Disorders ( DSM ) is known by many names. It’s also been the subject of quite a bit of controversy over the years for its association with mental illness diagnoses, which can be stigmatizing to those people living with said diagnosis(es). This article will explore how this manual came to be, whether or not it’s changed over time, what changes have been made to it recently in the DSM V, and how something like this is developed.
A Little History
In 1844 German psychiatrist Dr Daniel Hack Tuke published his book Illustrations of the Influence of the Mind upon the Body in Health and Disease. In this book, he described a condition that is now known as Tourette syndrome. Although his account of this disorder was not taken seriously at the time, in 1885, an English doctor by the name of Dr George Gilles de la Tourette wrote a paper on nine of his patients with this condition and presented it to a medical society in Paris. It wasn’t until years later that a British doctor named Dr Arthur Hammond suggested that the condition be renamed after Dr Gilles de la Tourette.
In 1888 an American neurologist, Dr Franklin J. Moses, brought over from Paris many photographs of people who exhibited symptoms associated with Tourette syndrome. In order to study these symptoms further, he organized a group of eleven doctors for a meeting in New York City, where they outlined their observations and came up with some guidelines for classifying the condition.
The doctors who were involved in this early development of Tourette syndrome wanted to create something that was more than just a list of case studies. They proposed the idea of grouping patients together based on their symptoms, which laid the groundwork for what would later be called “classification.” The group was also known as the New York Academy of Medicine. For years following these initial meetings, this same group met annually to discuss research regarding mental illness and bring awareness to it within society.
It wasn’t until 1984 that an official manual was created by the American Psychiatric Association (APA) like we know today -with all information up-to-date and written down in one place. This version is now referred to as the DSM-III. The information in this book is given to clinicians, mental health professionals, researchers, pharmacists, and insurance companies who can use it to diagnose their patients.
The DSM V
In May of 2013, the APA released the newest version of this manual -the DSM-V. Like other versions before it, there are some changes between the DSM-IV and the DSM-V that have sparked controversy within both medical communities and laypeople alike. Some feel that including things like hoarding disorder or caffeine withdrawal in this guide will cause people to become more stigmatized for these conditions, while others feel that it will help get sufferers needed treatment faster than waiting for full-blown psychosis or mania to set in. There are also some questions as to whether or not the DSM-V goes too far in certain areas, such as including grief caused by the loss of a loved one as an official mental illness (which was not included in previous versions).
What is clear, though, is that this manual does not provide an exact diagnosis. It’s more like a guide -a road map for clinicians who use it to know what symptoms they should be looking for when diagnosing patients. It’s up to each individual doctor (who has had several years of higher education and experience) to make sure they rule out every other similar condition before giving their patient an official diagnosis.
Another concept that can cause confusion is how often these change since there are many variables to consider when it comes to the DSM-V. For example, some disorders have been moved or renamed like Asperger’s and Autism, while others have been removed completely. There are also two different manuals that come with the book -one for health professionals and one for researchers.
Therapists who work in private practice usually go by the information contained in the health professional version of this manual since they don’t need to worry about research projects like psychiatrists do. Still, there are many cases where an illness described in either manual can be applied to both medical communities, making it difficult to keep track of all the changes (and even more difficult not knowing how much these changes will affect you). One thing is for sure, though; there will always be controversy surrounding any diagnostic guide since the treatment of mental health is complex and subjective.
One thing should be clear, though; if you are concerned about your condition, speak to your doctor about it. He or she will take the time to listen to your concerns so they can help you get better.