The New DSM–5: Where Have We Been and Where Are We Going?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is celebrating its 60th birthday this year. Many generations of social work students have graduated since the inception of this diagnostic tool, which has become the encyclopedia for helping professionals across the country. As we anticipate the upcoming publication of the DSM-5 in May 2013, it is worth briefly reflecting on where we have come and where we are going in terms of the use of this manual within social work to guide our assessments and interventions with clients who live with mental and emotional challenges. The DSM, though developed and published by the American Psychiatric Association (APA), has gained wide acceptance over the past several decades as the authoritative codebook for mental disorders. It is used not only by the medical profession, but also by the majority of mental health professionals, insurance companies, researchers, grant-funding agencies, and academicians in the United States for diagnostic, assessment, and educational purposes. Its development has consistently reflected the U.S. zeitgeist, including the relevant import of theory or research in guiding the conceptualization of mental illness, the definition of mental illness, and political and social developments within mainstream American culture. Prior to the publication of the DSM-I in 1952, numerous classification systems were used to describe mental illness, leading to a confusing array of terms that often described the same phenomena and preventing a common language across mental health providers (Keely, Burgess, & Blashfield, 2008). One of the first classifications of mental illness was developed for the purpose of the census in the 1880s and consisted of seven categories: mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy (Grob, 1991). This nosology proved to be problematic, leading the Bureau of the Census to use the Statistical Manual for the Use of the Institutions for the Insane in 1917. This nranual was developed by committees of the American Medico-Psychological Association and the National Commission on Mental Hygiene. Mental disorders were divided into 22 categories in this initial volume, which was revised 10 times through 1942, and continued to be used as the official classification system for the purpose of the U.S. census (Keely et al., 2008). During this same period of time, psychoanalysis took a tirol hold in the United States and was considered the bedrock of psychiatric treatment. When the DSM-I was published in the early 1950s, it contained 108 descriptions of mental disorders referred to as "reactions"--a term coined by Adolph Meyer (Keely et al., 2008). This was a vast improvement over the seven broad categories developed in the 19th century, as the DSM was based on lessons learned by psychiatrists during World War II and incorporated diagnoses intended for outpatient populations (Grob, 1991). The first DSM was constructed by a very small committee of APA members who prepared and circulated drafts of the materials to their membership and related organizations for feedback and suggestions (Keely et al., 2008). Sixteen years later, in 1968, APA revised the DSM-II nosology to include 182 disorders and 10 classes of disorders described in less than 40 pages (Corcoran & Walsh, 2010; Keely et al., 2008). As with the DSM-I, a small comnfittee of APA members and a similar process was used to develop this manual, with particular attention to increasing its alignment with the International Classification of Diseases (ICD). Although the DSM-II retained many of the psychoanalytic underpinnings for describing symptom constellations, including retaining the word "neurosis" in some categories, the term "reaction" was eliminated. As with the earlier version, there was not a serious effort to justify the classification DSM-5tal disorders on the basis of scientific evidence. Of particular interest is the controversy that erupted over the inclusion of homosexuality in the DSM-II as a mental illness. …