Reflecting on the Evolution of DSM and the Representation of Mental Disorders

e-HLbc’s latest product offer, the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its fifth edition, was first published in 1952 by the American Psychiatric Association (APA). While the DSM is now considered a leading manual by clinicians and researchers, its evolution since its inception has been beset by controversy.    

While the purpose of DSM is to classify and diagnose mental disorders, there is potential for wider use of the manual by scholars from a number of disciplines unrelated to medicine. Researchers in the fields of literary criticism, history, LGBT, and women’s studies may all be interested in the way illness, and behaviours deemed deviant, have been represented, classified, and treated by medical professionals over time. An issue of particular interest to humanities and social sciences scholars is the treatment of homosexuality in the manual.

In DSM-1 (1952), homosexuality was classified as a mental disorder. After much criticism, homosexuality was deleted from DSM-2 (1968). Other “sexual deviances,” however, reappeared in DSM-3 (1980), renamed “paraphilias,” and included gender identity disorders, such as transsexualism. DSM-4 (1994) amended its diagnosis so that paraphilia would only be diagnosed as a mental disorder if it caused patients “distress” or “impairment” in their everyday functioning (De Block & Adriaens, 2013).   DSM-5 (2013), goes further to differentiate between paraphilias and paraphilic disorders, patients diagnosed with the latter if they caused harm or risk to themselves or others.

There have been several significant changes to specific disorder descriptions made in DSM-5. For example, the autism spectrum disorder (ASD) in the latest edition incorporates four previously distinct disorders: autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder. Attention deficit hyperactivity disorder (ADHD) in DSM-5 is acknowledged to continue into adulthood, and the manual now allows adults to be diagnosed with ADHD with fewer symptoms than children. New diagnoses added to DSM-5 include binge eating disorder, premenstrual dysphoric disorder, and hoarding disorder (Grohol, 2013).

Although DSM-5 has changed significantly from its beginnings in the early 1950s, it is still not without its critics. There has been some criticism in the medical community that DSM-5 is insufficiently scientific, overly influenced by the pharmaceutical industry, and can result in excessively medicating and pathologizing mental symptoms (Strong, 2014). Nonetheless, physicians and psychologists continue to rely on the manual, and it remains a useful and relevant source of historical and sociological information for researchers in disciplines other than medicine. As a tool and a reflection of accepted psychiatric knowledge, DSM-5 is a living work that will continue to evolve along with the medical community and society’s understanding of mental health.