How the Diagnostic and Statistical Manual of Mental Disorders Works


The DSM Classification Process
Dr. James G. Shanklin, a hospital psychiatrist, administers electric shock and anesthesia to a patient in 1949. The DSM was originally developed to catalog psychiatric disorders at a time when mentally ill people received poor or no treatment. Bettman/Getty Images

The first official version of the DSM was released in 1952, with the most recent version — DSM-5 — published in 2013 [sources: Kawa and Giordano, APA]. Each update was the result of years of DSM-5 Task Force meetings, discussion by work groups and input by many psychiatric experts around the world. Today, the manual includes a trio of components for each disorder:

Diagnostic classification contains the list of mental disorders officially recognized. All diagnoses are assigned a diagnostic code (obtained from the World Health Organization's ICD), which is helpful for collection of data, as well as streamlining the billing process for providers and medical institutions.

Diagnostic criteria are also available for every disorder. The criteria lists symptoms, including their duration, that must be present to achieve a particular diagnosis. There are also a litany of other disorders and symptoms listed that should first be ruled out.

Descriptive text for each disorder contains information about prevalence, development and course, risk and prognostic factors, and other relevant information.

It's no small feat for a mental illness to be added to the DSM. In fact, DSM-IV wasn't all that different from DSM-5, but the changes that did make the cut were thoroughly reviewed and discussed by some of the foremost minds in the psychiatric field. DSM-IV was published in 1994, so the DSM-5 Task Force had to review all scientific studies published on psychiatric disorders since then. Remember, DSM-5 wasn't published until 2013, so that's nearly 20 years' worth of research to look at.

Following the 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, the Scientific Review Committee and a Clinical and Public Health Committee [source: APA].

New editing changes have streamlined the process, however. 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, so they can make diagnosis changes in real time.

"This has been a major advance," says Dr. Philip Wang, director of the APA's research division, which supervises the DSM. He says this change has effectively turned DSM-5 into a "living document," of sorts. "Let's say there is enough scientific evidence and let's say there is a valid change, to have to wait 15 or 20 years for clinicians and patients to benefit from that change is unconscionable," he adds.

Once a change is made, users can hover over it in the online version to find out the pertinent details, what the previous material was, and the supporting scientific evidence that inspired the edit. "It's completely transparent, continuous, and at the end of the day, it hopefully is good for clinicians and benefits patients," Wang says.

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