TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 167 History of the DSM The original DSM was psychiatry’s first attempt to standardize mental illness classification. Published in 1952 by the APA, the DSM represented an alternative to the WHO’s sixth edition of the ICD that included a section on mental disorders for the first time (APA, 2000). Focused on clinical utility, the first DSM was grounded in psychodynamic formulations of mental disorders (Sanders, 2011). Emphasizing Adolf Meyer’s psychobiological view, this version of the manual claimed that mental illness represented “reactions” of the personality to psychological, social or biological aspects of client functioning (APA, 2000). A particularly noteworthy characteristic of the DSM ’s first edition is that of the 106 conditions it included, only one diagnosis—adjustment reaction of childhood/adolescence—was relevant to youth (Sanders, 2011). The APA published the next iteration, the DSM-II, in 1968. This version included 11 diagnostic categories and 182 disorders (APA, 1968). Reflecting significant changes in theoretical ideology, the focus of the manual shifted from psychopathology (i.e., reactions) to psychoanalysis (i.e., neuroses and psychophysiological disorders; Sanders, 2011). Authors of the DSM-II maintained a narrative focus when describing disorders. APA began working on the DSM-III in 1974 and published it in 1980. This iteration differed significantly from previous editions and represented a dramatic shift to a more medically focused model (APA, 1980; Wilson, 1993). Authors of the DSM-III stressed use of empirical evidence to develop diagnoses and claimed theoretical neutrality, signaling a clear attempt to separate the DSM from its psychoanalytic origins (Maser, Kaelber, & Weise, 1991). A new multiaxial system included attention to biopsychosocial conceptualization. For the first time, the DSM-III contained descriptive diagnoses with a focus on positivistic, operationally defined and explicit diagnostic criteria (Wilson, 1993); narrative text also included information such as familial patterns, cultural considerations and gender (Sanders, 2011). The age of empirically based treatments had arrived, and widespread use of the DSM-III became commonplace. Intended at first only to include minor changes, the APA published substantial modifications to text and diagnostic criteria within the DSM-III-R (1987); as a result, a number of scholars criticized the document intensely (APA, 2000; Blashfield, 1998; Scotti & Morris, 2000). Expanding to 297 diagnoses, Axis I descriptions nearly exceeded 300 pages, while attention to Axes IV and V remained limited to just a few pages. Many scholars continued to question the multiaxial system and validity of field trials (Rogler, 1997). Heavy critique of the DSM-III and the DSM-III-R led to relatively mild changes to the DSM-IV , published in 1994 (APA, 2000). At nearly seven times the length of the original DSM , this version totaled 365 diagnoses in 886 pages. A text revision ( DSM-IV-TR ) published in 2000 included wording modifications to ensure nonstigmatizing, person-first language (Scotti & Morris, 2000). The APA also included empirically based information for each diagnosis and diagnostic code modifications to maintain consistency with the ICD-9 (APA, 2000). Like its predecessors, the DSM-IV-TR was heavily critiqued by scholars due to a heavy emphasis on a medical model and rigid classification systems (Eriksen & Kress, 2006; Ivey & Ivey, 1998; Scotti & Morris, 2000). Issues of comorbidity, questionable reliability, controversial diagnoses and excessive use of not otherwise specified (NOS) diagnoses were hot topics among critics (Beutler & Malik, 2002). APA identified these issues as driving forces for structural and philosophical changes in the DSM-5 (APA, 2013). The DSM-5 Revision Process Beginning in 1999, one year before the APA published the DSM-IV-TR , the APA began working on a new edition, which would be more scientifically based, increase clinical utility and maintain continuity with previous