How the DSM Developed: What You Might Not Know
Here’s an excerpt from the DSM-III about manic-depression (bipolar disorder):
Manic-depressive illnesses (Manic-depressive psychoses)
These disorders are marked by severe mood swings and a tendency to remission and recurrence. Patients may be given this diagnosis in the absence of a previous history of affective psychosis if there is no obvious precipitating event. This disorder is divided into three major subtypes: manic type, depressed type, and circular type.
296.1 Manic-depressive illness, manic type ((Manic-depressive psychosis, manic type))
This disorder consists exclusively of manic episodes. These episodes are characterized by excessive elation, irritability, talkativeness, flight of ideas, and accelerated speech and motor activity. Brief periods of depression sometimes occur, but they are never true depressive epi- sodes.
296.2 Manic-depressive illness, depressed type ((Manic-depressive psychosis, depressed type))
This disorder consists exclusively of depressive episodes. These episodes are characterized by severely depressed mood and by mental and motor retardation progressing occasionally to stupor. Uneasiness, apprehension, perplexity and agitation may also be present. When illusions, hallucinations, and delusions (usually of guilt or of hypochondriacal or paranoid ideas) occur, they are attributable to the dominant mood disorder. Because it is a primary mood dis- order, this psychosis differs from the Psychotic depressive reaction, which is more easily attributable to precipitating stress. Cases in- completely labelled as “psychotic depression” should be classified here rather than under Psychotic depressive reaction.
296.3 Manic-depressive illness, circular type ((Manic-depressive psychosis, circular type))
This disorder is distinguished by at least one attack of both a depressive episode and a manic episode. This phenomenon makes clear why manic and depressed types are combined into a single category. (In DSM-I these cases were diagnosed under “Manic depressive reaction, other.”) The current episode should be specified and coded as one of the following:
296.33* Manic-depressive illness, circular type, manic*
296.34* Manic-depressive illness, circular type, depressed*
296.8 Other major affective disorder ((Affective psychosis, other))
Major affective disorders for which a more specific diagnosis has not been made are included here. It is also for “mixed” manic-depressive illness, in which manic and depressive symptoms appear almost simultaneously. It does not include Psychotic depressive reaction (q.v.) or Depressive neurosis (q.v.). (In DSM-I this category was included under “Manic depressive reaction, other.”)
(You can check out the entire DSM-III here.)
Not much changed from DSM-III to DSM-IV. There was another increase in the number of disorders (over 300), and this time, the committee was more conservative in their approval process. In order for disorders to be included, they had to have more empirical research to substantiate the diagnosis.
DSM-IV was revised once, but the disorders remained unchanged. Only the background information, such as prevalence and familial patterns, was updated to reflect current research.
The DSM-5 is slated for publication in May 2013 — and it’s going to be quite an overhaul. Here are posts from Psych Central for more information about the revision:
- A Look at the DSM-5 Draft
- A Review of the DSM-5 Draft
- Personality Disorders Shake-Up in DSM-5
- Overdiagnosis, Mental Disorders and the DSM-5
- DSM-5 Sleep Disorders Overhaul
- You Do Make a Difference in the DSM-5
- The Two Worlds of Grief and Depression
Sanders, J.L., (2010). A distinct language and a historic pendulum: The evolution of the diagnostic and statistical manual of mental disorders. Archives of Psychiatric Nursing, 1–10.
The DSM story, Los Angeles Times.
History of the DSM from the American Psychiatric Association.
Tartakovsky, M. (2011). How the DSM Developed: What You Might Not Know. Psych Central. Retrieved on May 6, 2015, from http://psychcentral.com/blog/archives/2011/07/02/how-the-dsm-developed-what-you-might-not-know/