How Does the Diagnostic and Statistical Manual of Mental Disorders (DSM) Work?

is a living document. It's currently in its fifth edition, known appropriately as the DSM five, having been updated about once every fifteen years by its governing body, the American Psychiatric Association, since they first published it in nineteen fifty two. It's updated so often because our understanding of the human mind keeps updating based on science. For example, before the nineteen seventies, homosexuality was often considered to be a mental illness.

The American Psychiatric Association, or APA, classified it as such in the first iteration of the DSM. This held with prevaill and cultural norms, but then activists started protesting at annual meetings of the APA and presented scientific evidence opposing those norms. In nineteen seventy three, it was put to the vote and a majority of APA members agreed that home sexuality should no longer be considered a mental disorder.

Although it took baby steps to get there, this change was a huge leap for gay rights and helped shift sidal thinking on home sexuality. It also demonstrated the power of the DSM on public opinion. The DSM doesn't offer advice on medications or other treatments for the one hundred and fifty seven disorders currently described in its pages. Rather, it was designed to help healthcare professionals identify and diagnose mental health conditions, such as those that impact personality, cognition,

and mood. The manual also provides uniform diagnostic codes for each issue, which are used to facilitate medical billing and data collection. Often, if a condition isn't listed in the DSM US, health and chure companies won't pay for the treatment of it. The manual is primarily used in the United States, with much of the rest of the world's health professionals turning instead to the World Health Organization's International Classification of Diseases or ICD, which covers all diseases, not

only those psychological in nature. The APA encourages healthcare professionals to consider the DSM five and the ICD as companion publications designed to be compatible with each other. The ICD is currently in its eleventh edition, having started up in the eighteen nineties and been updated about every ten years. The history of the DSM goes back way further than the nineteen fifties. It was developed in response to an obvious need for systems by which to classify mental health.

The US Census of eighteen forty took small steps toward the eventual development of the manual by adding a question about incidents of what they called idiocy or insanity to their survey. This was possibly the first attempt statistical information gathering related to mental health. In eighteen eighty, the Census flushed out the mental health category to include issues like dementia, melancholia, epilepsy,

and mania. In nineteen seventeen, the American Medico Psychological Association, the forerunner of the APA, and the National Commission on Mental Hygiene came up with a plan for gathering uniform health statistics and mental hospitals, which was then adopted by the Census Bureau in nineteen twenty one. The APA started to develop psychiatric classifications for various severe psychiatric disorders. After

World War Two. They shifted to a bigger classification system developed by the US Army as it was treating veterans with these systems as guides. They released the first official version of the DSM in nineteen fifty two. Each update is the result of years of task force meetings, discussion by work groups, and input by many psychiatric experts around

the world. Each listing the manual includes diagnostic criteria including a disorder symptoms and their duration necessary for a diagnosis, plus any other disorders to screen, four with common symptoms, and any antithetical symptoms that can help rule a diagnosis out. The listing also includes information about the prevalence, development, and course of the disorder, the risk, the prognostic factors, and

other relevant information. Finally, each disorder has that diagnostic code in common with the ICDs codes, which is helpful for the collection of data as well as streamlining the billing process for care providers and insurance agencies. It's no small feat for a mental health issue to be added to the DSM. The DSM four wasn't all that different from the DSM five, but the changes that did make the cut were thoroughly reviewed and discussed by some of the

foremost minds in the psychiatric field. The DSM four was published in nineteen ninety four, so the DSM five Task Force had to review all scientific studies published on psychiatric disord orders since then. Since the DSM five wasn't published until twenty thirteen, that's nearly twenty years worth of ongoing research to look at. Following comprehensive review, proposals to modify existing diagnoses were made, which required vigorous discussion and debate

among the committee members plus input from outside experts. All proposals were examined by the Task Force, as well as two additional committees created for a more independent opinion, being the Scientific Review Committee and a Clinical and Public Health Committee. However, since then, new changes to the process have streamlined it. Rather than waiting decades between issues, experts can now submit changes online, helping to make the manual more timely and current.

Once approved by the APA Board of Trustees, clinicians and other DSM users are notified about the edit. Users can hover over the change in the online version to find out the pertinent details, what the previous material was, and the support arding scientific evidence that inspired the edit. For the article this episode is based on has to work, spoke doctor Philip Wang, director of the APA's Research Division, which supervises the DSM. He said, this has been a

major advance. Let's say there is enough scientific evidence, and let's say there is a valid change. To have to wait fifteen or twenty years for clinicians and patients to benefit from that change is unconscionable. The new system is completely transparent, continuous, and at the end of the day, it hopefully is good for clinicians and benefits patients. The changes from the fourth edition to the fifth edition were small but significant to address advances in scientific research and

issues with diagnoses that clinicians had been reporting. The DSM five combined nearly thirty disorders, eliminated two diagnoses entirely, and added fifteen. The DSM five has also revamped disorders into a lifespan approach. Instead of classifying certain issues as solely childhood disorders, it discusses how they change and manifest at all stages, and the DSM five emphasizes the importance of

parents in diagnosis and treatment. This new version also introduced Section three, which is for conditions where there's not enough scientific data yet to determine whether they should be classified as psychiatric disorders. Among these conditions are things like Internet

gaming disorder and caffeine use disorder. Section three also contains cross cutting measures and models that have potential to help clinicians better evaluate patients when they show symptoms that could be indicative of multiple disorders, and it also includes a Cultural Formulation Interview guide with questions to help clinicians identify how a patient's cultural background affects their perception and presentation

of psychiatric symptoms, treatment, and diagnosis. The APA's fact sheet about it explains a quote the interview provides, it's an opportunity for individuals to define their distress in their own words and then relate this to how others who may not share their culture see their problems. This gives the clinician a more complete foundation on which to base both diagnosis and care. Some key about faces that occurred in this update are proof that the DSM isn't opposed to

changing with the times. Here's some examples of major turnarounds. Consenting adults who enjoy relatively unconventional BDSM fetishes or cross dressing need not fear being diagnosed with mental illness anymore. The DSM five update depathologized kinky sex. They're now just people with a preference. It also removed the diagnosis of Asperger's syndrome and classified the symptoms associated with it and three other previous diagnoses under the umbrella autism spectrum disorder,

and it codifies medical acceptance of transgender people. The DSM five replaced the diagnosis of gender identity disorder with gender dysphoria, so those who don't identify with their assigned sex at birth are no longer considered to have a mental disorder. The new diagnosis spells out some of the challenges of living with gender dysphoria and the paths that people may

choose to resolve it. One complaint about the DSM is that once a condition is included in the manual, it may turn what once was considered normal behavior into a pathological illness that must be treated, often with medication. But Wang pointed out that the DSM five has incorporated an acuity measure to help with that. Since so many disorders range widely in their severity, these scales help clinicians better

evaluate symptoms and levels of impairment. For example, let's say you're grieving the death of a loved one, are you still able to cope with life? Or are you barely able to get out of bed? Once assessed, clinicians will be better able to land on the appropriate treatment, whether that's medication, watchful waiting, talk, therapy, or a combination of these. After all, the human mind is a marvelous thing, but mental wellness doesn't come automatically or easily for all of us.

People dealing with that, and not to mention the loved ones who support them deserve and up to date and fully vetted guide to help them and their care providers find the best treatments. The value in the decades of research and intense consideration that have gone into the DSM is one of the many reasons why the gold standard advice for anyone who's concerned about the mental health of themselves or a loved one is to reach out to

a healthcare professional. Access to tools like the DSM helps those professionals help us on a path towards having a better time in this sometimes difficult world. Today's episode is based on the article how the Diagnostic and Statistical Manual of Mental Disorders Works on how stufforks dot com, written by A. Leah Hoyt brain Stuff is production by heart Radio in partnership with HowStuffWorks dot Com and is produced

by Tyler Klang. Four more podcasts by heart Radio, visit the heart Radio app, Apple Podcasts, or wherever you listen to your favorite shows.