Classification of Mental Disorders: The Guidebook

PsychologyAbnormal Psychology

Research into the field of psychopathology has jumped leaps and bounds. The development of psychotic drugs, treatment methods, approaches, and even how we understand psychological disorders has changed. Gone are the days when mental disturbance was attributed to the anger of gods and demons. As the scientific inquiry into the subject matter was made, newfound discoveries changed the landscape of psychology. One more thing that changed was the method of diagnosis. An important addition to this landscape was the development of the Diagnostic and Statistical Manual of Mental Disorders or DSM. DSM established itself at the core of western psychiatry, forever changing how clinicians, researchers, and psychologists diagnose and treat psychological disorders.

A Demand for a Classification System

After attaining a scientific grounding in the 19th century, demands for a classification system grew louder. In theory, there are three ways to create a classification system of diseases or nosology: authority, consensus, and the medical model. Initially, the classification of disorders was done by authority; In this case, it was Emil Kraepelin, a German nosologist. Subsequently, his first book came out in 1883 and went to the 8th edition. Kraepelin's work formed a solid backdrop against which DSM was later built.

The origin of the DSM

Technically, DSM started in October 1945 when psychoanalyst William Menninger created his diagnostic roster titled "Technical Medical Bulletin no. 203". The creation of this roster can be regarded as the inception of DSM. The first edition of DSM came into being in 1952 with little to no influence on the international psychology scene, and DSM-II came out in 1968. Later, in 1980, DSM-III was published, which marked a turning point. For one, it dethroned psychoanalysis from the high pedestal within psychology; Also, it relinked psychiatry and other medical fields by adopting a medical model approach for classification. Subsequently, DSM-III-R (Revised) was published in 1984 and DSM-IV in 1994, followed by DSM-IV-TR in 2000.

DSM-V

Published in May 2013, DSM-V marked the first major revision in the DSM-IV of 1994. The task force to work on DSM-V came together in 2007, intending to combine the latest scientific and clinical research and improve the usability of the manual by clinicians and researchers. Priority was also given to providing the best care possible for the patients. The project involved more than 400 experts from over 13 countries; the represented psychology, psychiatry, neurology, pediatrics, epidemiology, primary care, research methodology, and statistics. 13 international conferences were held between 2003 and 2008. Information was compiled to fill up the gaps in the current knowledge. To ensure diversity representation, each team task force and work group had at least one international member. DSM-V actively encouraged detailed studies on transcultural psychiatry and the influence of social and environmental factors linked to disease risk, heritability, and resiliency factors.

Classification of disorders in DSM-V

Table 1: DSM-5 Diagnostic Chapters
S. No.	Title
1	Neurodevelopmental Disorders
2	Schizophrenia Spectrum And Other Psychotic Disorders
3	Bipolar And Related Disorders
4	Depressive Disorders
5	Anxiety Disorders
6	Obsessive-Compulsive And Related Disorders
7	Trauma- And Stressor-Related Disorders
8	Dissociative Disorders
9	Somatic Symptom And Related Disorders
10	Feeding And Eating Disorders
11	Elimination Disorders
12	Sleep-Wake Disorders
13	Sexual Dysfunctions
14	Gender Dysphoria
15	Disruptive, Impulse-Control. And Conduct Disorders
16	Substance-Related And Addictive Disorders
17	Neurocognitive Disorders
18	Personality Disorder
19	Paraphilic Disorders
20	Other Mental Disorders

Source: The DSM-5: Classification And Criteria Changes By Darrel A. Regier, Emily A. Kuhl, David J. Kupfer

Changes in DSM-V

For certain disorders, diagnosis criteria were combined, like in the case of Autism Spectrum Disorder (ASD), Somatic Symptom Disorder, Specific Learning Disorder, and Substance Abuse Disorder. For other disorders, they were split into independent disorders, such as emotionally withdrawn/inhibited and indiscriminately social/disinhibited disorders separated from reactive attachment disorder. Another change was replacing the phrase "general medical condition" with "another medical condition wherever necessary. The term mental retardation from DSM-IV was replaced with intellectual disability. Furthermore, similar changes were also made in the naming and diagnosis criteria for multiple disorders like communication disorders, ADHD, Schizophrenia, Schizoaffective Disorder, Catatonia, Bipolar and Related Disorders, Depressive Disorders, and so on.

DSM vs. ICD

The turning point in the history of psychology's nosology came with DSM-III; However, even DSM-III did not have a big international reach and participation. Around this time International Classification of Diseases (ICD) was out with its eighth edition. ICD goes far back to 1984 and is published by World Health Organization (WHO). ICD-8 and DSM-III had little in common at that time, but the two manuals of the nosology of diseases have become similar over the years. This is largely due to the collaborative agreements between the two organizations. Regardless, differences between the two exist.

• For one, ICD is produced by an international health agency, whereas a single nation's professional association publishes DSM.
• Second, the primary focus of WHO is to reduce the mental health burden in countries; It is global in its orientation. However, DSM is part of U.S. psychiatrists specifically.
• ICD needs approval from the World Health Assembly, and whereas DSM needs only to be approved by a World Health Assembly.
• Lastly, the sales and distribution of the two manuals are very different - ICD is distributed as widely as possible at cheaper rates, whereas DSM makes up a significant portion of the American Psychiatric Association's revenue.

Keeping DSM separate from IDC is impossible in the long run, given the agreement between the two organizations. However, DSM would still be an important textbook for psychiatric diagnosis and have its standing over the ICD.

Conclusion

Despite significant changes and ensuring better and smoother research, application, treatment, and diagnosis of psychological disorders, some criticisms have been raised concerning DSM-V. One of them is the exclusion of bereavement. This was done to ensure that individuals experiencing grief due to the loss of a loved one are not wrongly labeled as mentally unstable. However, this step backfired, preventing individuals dealing with the major depressive disorder after a loss from being not diagnosed aptly. Recently, DSM-V-TR was published, which is a revised version of DSM-V. It includes new clarification, references, and diagnostic criteria and is updated to match the International Classification of Disease-10-CM (ICD-10-CM) codes.