DSM

   : Diagnostic and Statistical Manual of Mental Disorders

   American Psychiatric Association (from 1952). (See also "St. Louis School of Psychiatry"; Spitzer, Robert L..) This series of diagnostic handbooks, coming from a country that was not yet a world power upon the psychiatry stage, began with a low international profile. By the time the most recent version appeared in 1994, the DSM (also referred to as "the Manual" in this text) had become the global standard of diagnosis, placing the competing ICD series (International Classification of Diseases) of the World Health Organization in the shade.

   ☺ DSM "One" (1952). Called "DSM-I" of course only in retrospect, this initial guide to classification was heavily under the influence of Adolf Meyer of Johns Hopkins University. It referred to most conditions as "reactions" and gave only thumbnail sketches of each. Internationally, it went unheralded. George N. Raines (ca. 1908–1959), director of psychiatry at Georgetown University Medical Center, was head of the Committee on Nomenclature and Statistics. DSM-I contained 106 diagnoses.

   ☺ DSM-II (1968). This second edition reflected more the influence of psychoanalysis, then at the height of its influence upon American psychiatry. The conditions were mostly listed as "neuroses" rather than "reactions." The descriptions of each entity continued to be brief and without much indication of the clinical criteria required to fulfil the diagnosis. Ernest M. Gruenberg (1915–1991), an epidemiologist and professor of psychiatry then at Columbia University, was head of the nomenclature committee. Robert Spitzer advised the committee as a "consultant." DSM-II contained 182 diagnoses.

   The "St. Louis criteria" of psychiatric illness (1972). As part of the diagnostic rethinking leading up to DSM-III, John Feighner and the other members of the St. Louis school published in 1972 in the Archives of General Psychiatry an article on "Diagnostic Criteria for Use in Psychiatric Research." The authors, who included Eli Robins, Samuel Guze, Robert Woodruff (1934–), George Winokur, and Rodrigo Muñoz (1939–), proposed "formal diagnostic criteria," in place of "best clinical judgment," that clinicians would have to apply in making a diagnosis. The illnesses were limited to 14, and the operational criteria were laid out in point form in what was to become classic DSM-III style. For example: "At least three of the following manifestations must be present for a diagnosis of ‘definite’ schizophrenia," the authors said, and listed five criteria. (See also "Feighner Diagnostic Criteria.")

   The Research Diagnostic Criteria (1978) as a preview of DSM-III (1980). Robert Spitzer, Columbia University psychologist Jean Endicott (1936–), and Eli Robins, building on the work of the St. Louis school, proposed in 1978 in the Archives of General Psychiatry a revised list of diagnoses to be used in research. Called the Research Diagnostic Criteria, the RDC system included "panic disorder," described as similar to anxiety neurosis; they identified "generalized anxiety disorder with significant depression" (the mirror image of their concept "minor depressive disorder with significant anxiety") and maintained previous concepts of phobia. Because of Spitzer’s centrality in the production of DSM-III, which appeared 2 years later, the RDC criteria set the stage, to some extent, for DSM-III (yet not entirely; see Depression: Recent Concepts: DSM-III [1980]).

   ☺ DSM-III (1980). This third edition of the Manual recognized the growing importance of diagnosis in American psychiatry and was drastically revised, instituting detailed operational criteria that had to be met to qualify for a diagnosis. The conditions were changed from "neuroses" to "disorders," although at the bidding of the psychoanalytic community the word "neurosis" was included in parentheses after many "disorders." The Manual laid out five "axes" on which diagnoses might be made: axis I for most mental disorders except those in axis II, which were personality and developmental disorders; axis III for physical disorders; axis IV for "severity of psychosocial stressors"; and axis V, "highest level of adaptive functioning past year." In practice, axis I was used far more often than any of the others, and with time the convention became adopted that axis I meant drug-treatable, and axis II meant lifelong character pathology and basically untreatable. Robert Spitzer was chair of the task force on nomenclature. Within a short time, DSM-III became the worldwide gold standard of psychiatric diagnosis. By May 1982, a little more than 2 years after its launch in February 1980, it had gone through eight printings, each averaging about 30,000 copies. DSM-III contained 265 diagnoses.

   ☺ DSM-III-R (1987). This revised version ("R") of the third edition changed very little, although it was, at 567 pages, considerably longer than the previous version (DSM-III was 494 pages; DSM-I was 132 pages). Robert Spitzer remained the head of the nomenclature "work group." DSM-III-R contained 292 diagnoses.

   ☺ DSM-IV (1994). This version was substantially unchanged from the previous, except for being longer still (886 pages), with ever more diagnoses and descriptions of criteria that had to be met. Allen Frances (1942–) of Columbia University was head of the "task force" that devised it. DSM-IV contained 307 diagnoses.