DSM Past, present and future Hans Nilsson Chairman of the IEA DSM-Programme.
The Evolution of DSM
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Transcript of The Evolution of DSM
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Janet B.W. Williams, PhDProfessor Emerita of Clinical Psychiatric Social Work,
Dept. Of Psychiatry, Columbia UniversitySenior VP of Global Science, MedAvante, Inc.
12/7/13
The Evolution of DSM
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Why the DSM (1952)?
• Pre-1952: several different national systems in
• use, multiple state systems• Dissatisfaction with existing
classifications• APA develops its own • First glossary definitions of disorders• Of little or no interest to clinicians,
researchers
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Diagnostic and Statistical Manual of Mental Disorders and International Classification of
Diseases
DSM ICD
1952 DSM
1968 DSM-II ICD-8
1980 DSM-III ICD-9-CM
1987 DSM-III-R
1994 DSM-IV ICD-10
2000 DSM-IV-TR
2013 DSM-V
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DSM-I Classification
• Acute/chronic brain disorders• Mental deficiency• Psychotic disorders• Psychophysiologic disorders• Psychoneurotic disorders• Personality disorders • Transient situational personality
disorders
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Significance of DSM-I (1952)
• First glossary of definitions of categories• APA in control of classification• Influence of Adolph Meyer
“Schizophrenic reaction” “Manic depressive reaction” “Anxiety reaction”
• Psychoanalytic concepts in neuroses and psychophysiologic disorders• “...utilization of various defense
mechanisms...”
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DSM-I Description of Manic Depressive Reaction, Manic Type (1952)
“This group is characterized by elation or irritability, with overtalkativeness, flight of ideas, and increased motor activity. Transitory, often momentary, episodes of depression may occur, but will not change the classification from the manic type of reaction.” (p. 25)
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DSM-II Classification
• Mental retardation• Organic brain syndromes• Psychoses• Neuroses• Personality disorders and certain other
non-psychotic mental disorders• Psychophysiologic disorders• Special symptoms• Transient situational disturbances
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Significance of DSM-II (1968)
• APA decides to use ICD-8 (slightly modified)
• British hegemony in ICD
• Eliminating “Reaction”
• Multiple diagnoses encouraged
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DSM-II Description of Manic-depressive Illness, Manic Type (1968)
“This disorder consists exclusively of manic episodes. These episodes are characterized by excessive elation, irritability, talkativeness, flight of ideas, and accelerated speech and motor activity. Brief periods of depression sometimes occur, but they are never true depressive episodes.” (p. 36)
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Eli Robins, MD
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Robert L. Spitzer, MDChair, DSM-III and DSM-III-R
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Text EditorDSM-IIICoordinator of DSM-III Field TrialsDSM-III-R Task Force
Janet B.W. Williams, DSW (now PhD)
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Noah Spitzer-Williams, 1984
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What Principles Guided DSM-III?• Inclusiveness• Descriptive approach: usable across
theoretical orientations• Diagnostic (“operational”) criteria• Expanded descriptions• Multiaxial system• ICD compatibility a formality
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Goals of DSM
• communication: precision in language, “short-hand”
• clinical: facilitate identification, treatment, and prevention of mental disorders
• research: further understanding of etiology• education: teach psychopathology• data collection: statistical registry
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Types of Information in the Text• Essential features• Associated features• Age at onset• Course• Impairment• Complications• Predisposing factors• Prevalence• Sex ratio• Familial pattern• Differential diagnosis
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DSM-III Controversies
• Task Force unrepresentative
• Definition of mental disorder
• Dysthymia (Neurotic depression) vs Neurotic depression (Dysthymia)
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January 3, 2005
THE DICTIONARY OF DISORDER
by ALIX SPIEGEL
www.newyorker.com
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Multiaxial System – Eliminated in DSM-5• Axis I: Clinical Conditions• Axis II: Personality Disorders and Mental
Retardation• Axis III: general medical conditions• Axis IV: psychosocial stressors and
environmental problems• Axis V: Global Assessment of Functioning Scale
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Person-in-Environment System
Four factors:• Social roles in relationship to others• Mental health• Social environment• Physical health
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DSM CasebooksDSM-IV SourcebooksStructured Clinical Interview for DSM (SCID)
- SCID-I (for Axis I)- SCID-RV (Research Version)- SCID-CV (Clinician Version)
- SCID-II (for Axis II)- SCID-CT (for Clinical Trials)
Additional Materials
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1987: DSM-III-R
• originally intended to be just a “fine tuning”• corrected inconsistencies and incorporated
latest research• disadvantage: change too disruptive
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Allen Frances, MDChair, DSM-IV
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1994: DSM-IV
• revision process based on empirical review• elimination of the term “organic”• expansion of appendix categories• new and deleted categories
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DSM-IV Process
• Decentralization of revision process• Literature reviews and data reanalysis• Field trials• ICD-10 compatibility• Avoid public controversy• “User-friendly”• High threshold for new diagnoses
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2000 - DSM-IV Text Revision
• fills 12+ year gap between DSM-IV and DSM-V• based on comprehensive lit review from
1992 to 1999• no changes to criteria sets allowed• most changes to Associated Features
and Disorders, Age, Culture and Gender Features, Prevalence, Course, and Familial Pattern
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Michael First, MDDSM-IV Text Editor
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David Kupfer, MD and Darrel Regier, MD Co-chairs, DSM-5
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Michael B. First, MD• Professor of Clinical Psychiatry• Research Psychiatrist, NYSPI• schematherapy and psychopharmacology practice
in Manhattan• Forensic expert• Editor of Text and Criteria for DSM-IV and DSM-IV-TR• Editorial and Coding Consultant for DSM-5• Chief technical and editorial consultant on ICD-11