#shawleveryday2019 Day 44

The Diagnostic and Statistical Manual of Mental Disorders (or DSM) is the primary resource for mental health professionals for the definition and classification of mental health disorders. The manual was first published in 1952 and is currently in its 5th edition (DSM-V). It reflects the changing perception of mental illness and how our better understanding of the science behind the illness can change how things are classified.

The best known example is that in the DSM-I, homosexuality was classified as a mental illness as a sociopathic personality disorder and wasn't removed until May 1974. The DSM-I and DSM-II largely focus on mental illness as being a result of maladapting to life's problems and did not detail symptoms for each diagnosis.

The Rosenhan experiment published in 1973, wherein pseudo-patients went to mental hospitals and faked auditory hallucinations to gain entry (which they did!), highlighted the difficulty with the DSM-II's classifications. The DSM-III introduced a multi-axial classification as well as a more empirical approach to diagnoses and was considered a revolution in the mental health community.

The DSM-IV did not shift very far from the DSM-III, but many of the disorders were broken down into additional subtypes. This led to an increase in the number of possible classifications, which caused some people to think that mental illnesses were growing in the population.  However, it was generally seen as a better fine-tuning to get a more specific diagnosis rather than being part of a too-broad one.

The current edition of the DSM is the DSM-5 (released in 2013), which goes away with the axis approach of the DSM-III. It additionally adjusted a variety of classifications.

• autism spectrum disorder subsumed autistic disorder, Asperger's disorder, childhood disintegrative disorder, and PDD NOS
• ADHD placed in neurodevelopmental disorders category and adds details for diagnosis in adults
  
• a schizophrenia spectrum is now recognized
  
• disruptive mood dysregulation disorder added to depressive disorders
  
• several new obsessive compulsive disorders added (e.g., hoarding, skin-picking, substance-induced)
  
• gender dysphoria added
  
• binge-eating disorder added to feeding and eating disorders
• gambling disorder added to the the substance-related and addictive disorders chapter (previously classified as an impulse-control disorder)
  
• grief is removed as an exemption for being diagnosed with major depressive disorder, and guidance is given on how to differentiate grief from depressive disorders
• increased detail on PTSD symptoms
• mental retardation is now referred to as intellectual disability (words mean things!)
• premenstrual dysphoric disorder added

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While there are criticisms with the DSM-5, we've definitely come a long way in our understanding of mental health and there will continue to be research and adjustments as we learn even more.

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