The DSM, published by the American Psychiatric Association, is the predominant force in psychiatric diagnosis in the USA and, alongside the World Health Organization’s International Classification of Diseases (ICD). It has spurred debate, controversy, and has become the constant redefinition of what we understand to be “normal” and “abnormal”.

The DSM began life in 1952, a post-war period heralding the growing assessment and medicalization of mental illness. The first edition of the manual was published, specifically for use in the USA, when the European-orientated ICD was in its sixth edition. The contents page of this early incarnation lists 106 named mental health disorders.

Following minor revisions of the DSM in 1968, a revolution in psychiatric diagnosis took place. At the vanguard were Eli Robins and Samuel Guze who, in a seminal article in 1970, advocated that the existence of clinical disorders could be validated by their distinction from other disorders. Building upon revised diagnostic criteria, a number of subsequent revisions to the DSM took place; the most radical being DSM-III in 1980, which saw the number of psychiatric diagnoses rocket to over 260 and a closer alignment found with the ICD system used more commonly in Europe.

The current edition, DSM-IV, followed in 1994, elevating the total number of disorders listed within its pages to just under 300 and organizing those disorders according to a “multi-axial” system - categories such as clinical disorders, personality disorders, and acute medical or physical conditions.

The revisions made to the DSM over the last 60 years reflect, on the one hand, the continual refinement and attempts to distinguish between and categorize various symptoms, and on the other hand, sharp criticisms and controversy regarding cultural bias, the previous inclusion of homosexuality as a mental disorder, and the over-medicalization of mental health fuelled by the pharmaceutical industry.

Nonetheless, the DSM manuals have undoubtedly played a formative role in our understanding of how many mental health disorders develop and may be prevented or treated leading to radical changes in patient care.
It is against this historical development that the DSM now faces its next major revision: DSM-V will be published in May 2013. Despite the three years remaining until the publication date, the revision was first conceived over a decade ago in 1999 by key leaders of the APA and National Institute of Mental Health in the USA. Since that time the views of participants from numerous conferences and task forces have been consolidated and scores of white papers and monographs have been written.

A draft version of the forthcoming DSM-V manual was released for consultation and comment in February of this year. Taking stock of the feedback, Prevention Action will, over the coming days, explore the proposal and will consider what the fifth edition might mean for prevention science and efforts to improve the mental health outcomes of children.

References:
http://www.dsm5.org

Robins & Guze (1970). Establishment of Diagnostic Validity in Psychiatric Illness: Its Application to Schizophrenia. American Journal of Psychiatry, 126, 983 - 987.