Diagnostic and Statistical Manual of Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders (DSM), medical reference book published by the American Psychiatric Association (APA) that describes and classifies all known mental illnesses and emotional disorders. The fourth edition, referred to as DSM-IV, was issued in 1994 and lists more than 300 psychiatric disorders.

Most American psychiatrists, psychologists, researchers, and other mental health professionals use DSM. It provides an objective, standardized way to determine if a person has a mental illness. There are no blood tests or other laboratory procedures to diagnose most mental illnesses. Instead, mental health professionals must use their own judgment to determine if a person is mentally ill. Diagnosis requires careful observation of the person’s symptoms and behaviors and evaluation of the person’s personal and medical history. DSM helps to assure an accurate diagnosis by providing a common reference for therapists and researchers to use in communicating about mental illness. In addition, health insurance companies use DSM in determining payment for mental health services. A psychiatrist must list an official DSM code number on each health insurance claim form submitted for a patient.

DSM-IV groups psychiatric disorders into 16 major diagnostic classes, such as mood disorders, anxiety disorders, and substance-abuse disorders. The entry for each disorder includes a definition and a list of signs and symptoms that can be used as diagnostic criteria.

Psychiatrists and psychologists use the list of symptoms as a general guideline for making a diagnosis, rather than as a checklist. They combine DSM information with their own findings from an examination of the patient. If applicable, a DSM entry cites physical or laboratory tests that can help in reaching a diagnosis. Each entry also includes information on the typical age at which the disease occurs, how it changes over time, the number of people affected in the general population, and whether it occurs more frequently in members of the same family. The book also lists factors that psychiatrists and others can use in determining the severity of a patient’s condition.

DSM originated from a 1917 project in which the American Psychiatric Association (then called the American Medico-Psychological Association) and the United States Bureau of the Census developed a classification system of 59 mental illnesses to collect uniform data on hospitalized mental patients. The APA expanded the system with publication of the first DSM in 1952, listing 106 mental illnesses. Updated versions followed: DSM-II was published in 1968, DSM-III in 1980, and DSM-III-R (a revision of DSM-III) in 1987. A special, 27-member task force of experts worked for five years to develop DSM-IV, published in 1994. More than 1000 psychiatrists and other experts helped decide what diseases and other information should be included in the book.

Critics of DSM believe that the book regards too many normal human traits and behaviors as possible psychiatric illnesses. They are concerned that DSM authors sometimes use personal and social values, rather than scientific evidence, to judge whether behavior is abnormal. For example, homosexuality was classified as a disorder until 1973, when the APA acknowledged that many gay and lesbian people showed no signs of dysfunction and were satisfied with their sexual orientation.

Many mental health professionals in Western Europe and other parts of the world use a different classification system, the International Classification of Diseases (ICD), published by the World Health Organization, an agency of the United Nations. Developers of the two systems work together to ensure compatible terminology about mental illness.