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Disorders also were split into two groups based on causality (Sanders, 2010):
(a) disorders caused by or associated with impairment of brain tissue function and (b)
disorders of psychogenic origin or without clearly defined physical cause or structural
change in the brain. The former grouping was subdivided into acute brain disorders,
chronic brain disorders, and mental deficiency. The latter was subdivided into psychotic
disorders (including affective and schizophrenic reactions), psychophysiologic autonomic
and visceral disorders (psychophysiologic reactions, which appear related to somatization),
psychoneurotic disorders (including anxiety, phobic, obsessivecompulsive, and depressive
reactions), personality disorders (including schizoid personality, antisocial reaction, and
addiction), and transient situational personality disorders (including adjustment reaction and
conduct disturbance).
Oddly enough, as Sanders points out: learning and speech disturbances are categorized
as special symptom reactions under personality disorders.
A Significant Shift
In 1968, the DSM-II came out. It was only slightly different from the first edition. It increased
the number of disorders to 182 and eliminated the term reactions because it implied
causality and referred to psychoanalysis (terms like neuroses and psychophysiologic
disorders remained, though).
When DSM-III was published in 1980, however, there was a major shift from its earlier
editions. DSM-III dropped the psychodynamic perspective in favor of empiricism and
expanded to 494 pages with 265 diagnostic categories. The reason for the big shift?
Not only was psychiatric diagnosis viewed as unclear and unreliable but suspicion and
contempt about psychiatry started brewing in America. Public perception was far from
favorable.
The third edition (which was revised in 1987) leaned more toward German psychiatrist Emil
Kraepelins concepts. Kraepelin believed that biology and genetics played a key role in
mental disorders. He also distinguished between dementia praecoxlater renamed
schizophrenia by Eugen Bleulerand bipolar disorder, which before that were viewed as
the same version of psychosis.
(Learn more about Kraepelin here and here.)
From Sanders (2010):
Kraepelins influence on psychiatry reemerged in the 1960s, about 40 years after his death,
with a small group of psychiatrists at Washington University in St. Louis, MO, who were
dissatisfied with psychodynamically oriented American psychiatry. Eli Robins, Samuel Guze,
and George Winokur, who sought to return psychiatry to its medical roots, were called the
neo-Kraepelinians (Klerman, 1978). They were dissatisfied with the lack of clear diagnoses
and classification, low interrater reliability among psychiatrists, and blurred distinction
between mental health and illness. To address these fundamental concerns and to avoid
speculating on etiology, these psychiatrists advocated descriptive and epidemiological work
in psychiatric diagnosis.
In 1972, John Feighner and his neo-Kraepelinian colleagues published a set of diagnostic
criteria based on a synthesis of research, pointing out that the criteria were not based on
opinion or tradition. In addition, explicit criteria were used to increase reliability (Feighner et
al., 1972). The classifications therein became known as the Feighner criteria. This became
a landmark article, eventually becoming the most cited article pub- lished in a psychiatric
journal (Decker, 2007). Blashfield (1982) suggests that Feighners article was highly
influential, but that the large number of citations (more than 140 per year at that point,
compared with an average of about 2 per year) may have been in part due to a
disproportionate number of citations from within the invisible college of the neoKraepelinians.
The change in the theoretical orientation of American psychiatry toward an empirical
foundation is perhaps best reflected in the third edition of the DSM. Robert Spitzer, Head of
the Task Force on DSM-III, was previously associated with the neo- Kraepelinians, and many
were on the DSM-III Task Force (Decker, 2007), but Spitzer denied being neo- Krapelinian
himself. In fact, Spitzer facetiously resigned from the neo-Kraepelinian college (Spitzer,
1982) on account that he did not subscribe to some of the tenets of the neo-Kraepelinian
credo presented by Klerman (1978). Nevertheless, the DSM-III appeared to adopt a neoKraepelinian standpoint and in the process revolutionized psychiatry in North America.
Its not surprising that the DSM-III looked quite different from earlier versions. It featured the
five axes (e.g., Axis I: disorders such as anxiety disorders, mood disorders and
schizophrenia; Axis II: personality disorders; Axis III: general medical conditions) and new
background information for each disorder, including cultural and gender features, familial
patterns and prevalence.
DSM-IV
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.
DSM-5
The DSM-5 is slated for publication in May 2013 and its going to be quite an
overhaul. Here are posts from Psych Central for more information about the revision:
According the the DSM-5 website, the following changes have been made due to
the comments:
For anorexia nervosa, numerical examples of body weight less than
85% of that expected were replaced simply with markedly low
weight to describe patients physical appearance.
Mechanisms of compensatory behavior for diagnosing bulimia
nervosa were expanded to include medication, excessive exercise,
and fasting.
Wording of one criterion for adjustment disorders was expanded to
include other important areas of functioning.
The Sexual and Gender Identity Disorders Work Group also made revisions to
language involving several disorders within that category:
For all Paraphilia Disorders, two specifiers were added: in
remission and in controlled environment.
Within Pedohebophilic Disorder a new classification that takes in
sexual preference for pubescent children as well as the
prepubescent wording of one criterion was revised to read use of
References/Further Reading
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, 110.
Grohol, J. (2015). You Do Make a Difference in the DSM-5. Psych Central. Retrieved on September 26, 2015, from
http://psychcentral.com/blog/archives/2010/05/30/you-do-make-a-difference-in-the-dsm-5/