By Catherine A. Sanderson, Amherst College
Psychological disorders that require a specific diagnosis are often based on more specific criteria. In the United States, there is a manual created by the American Psychiatric Association called the Diagnostic and Statistical Manual of Mental Disorders (DSM). First issued in 1952, this manual received major revisions in 1968, 1980, 1994, and in 2013.
Group of Psychological Disorders
The DSM from 2013 describes symptoms for around 400 different psychological disorders, which are grouped into 22 different categories. These are sometimes classified even more broadly, into five groups:
- Neurodevelopmental: describing brain disorders that begin at birth or from early in life
- Neurocognitive disorders: those that affect the brain later in life, including traumatic brain injury and Alzheimer’s
- Internalizing disorders: such as anxiety or depression
- Externalizing disorders—like the manic phase of bipolar
- A miscellaneous group of other disorders: including those involving sleep, eating, and addiction
The DSM also describes other aspects of each disorder, including the typical age at which symptoms start occurring, which gender is more affected, how common treatment approaches are and how effective they are.
Controversies and Revisions
The DSM is very commonly used by doctors and therapists to figure out how to diagnose and treat people who are struggling with some type of mental illness. But it’s not without controversy.
Each new edition of the DSM revises what was previously seen as the state of the art knowledge. This means that how we classify different psychological disorders, and even what we consider a psychological disorder, actually changes over time.
Obsessive Compulsive Disorder as Updated in DSM
Obsessive-compulsive disorder, or OCD, has historically been seen as an anxiety disorder. This is largely because the disorder is diagnosed based on two types of features:
- obsessions, meaning persistent thoughts and urges that lead to distress or anxiety; and
- compulsions, meaning repetitive and time-consuming behaviors that are performed to reduce anxiety and/or prevent some dreaded hypothetical event from occurring
This disorder is clearly characterized by anxiety—people engage in compulsive behaviors, such as repeatedly washing their hands or re-checking to make sure the house is locked, or stepping over cracks in a sidewalk, as a way of managing their intense anxiety.
But in the 2013 edition of the DSM-5, obsessive-compulsive disorder was moved into its own category and is no longer seen as an anxiety disorder.
More recent research testing patterns of brain activation had suggested that anxiety seems to be rooted in problems with processing emotion. By contrast, obsessive compulsions seem to be rooted in problems with executive functioning, whether an inability to shift between tasks or an inability to inhibit certain responses. These findings led to a decision to classify OCD as a distinct disorder, instead of grouping it together with anxiety disorders.
Controversy around Grouping Homosexuality
This above example of a change in the DSM was pretty straightforward, but other changes have involved more controversy. For example, the first two editions of the DSM classified homosexuality as a disorder.
Only after data from researchers such as Alfred Kinsey, combined with social protests beginning with the Stonewall riots in 1969, was it changed to “sexual orientation disturbance” with a special printing in 1974. And only in 1987 was it entirely removed.
This article comes directly from content in the video series Introduction to Psychology. Watch it now, on Wondrium.
Experts on DSM
The DSM-5 also kept a disorder that some experts believed should be omitted. This disorder, known as Oppositional Defiant Disorder or ODD, is a type of impulse-control disorder, meaning a disorder that involves an inability to control one’s emotions or behaviors. Oppositional Defiant Disorder describes children and teenagers who talk back to parents and teachers, who sometimes refuse to obey authority figures, and who lose their tempers easily.
Some people believe this unnecessarily labels that child or teen “mentally ill” for what is frankly pretty common behavior for many teenagers.
Suggested Inclusions in DSM
There is also considerable debate about other conditions that some experts think should be included in the DSM. The 2013 DSM categorized gambling disorder as an addictive disorder, the first official purely behavioral addiction.
Research had shown that addiction to gambling shares many of the same symptoms as addiction to drugs and alcohol and that it can also be treated using some of the same approaches used to treat substance addictions.
But if gambling addiction is included, what about other forms of behavioral addiction, such as sex addiction and Internet addiction? Some experts believe that those types of addiction should also have been included and they weren’t.
International Classification of Diseases: Alternative to DSM?
While the DSM manual has generally been used by clinicians in the United States, the rest of the world has long used a different and broader system managed by the World Health Organization. This system, the International Classification of Diseases, has a much broader scope, classifying medical diseases as well as psychological disorders from around the world, with about 14,000 diagnoses.
Beginning with the 2018 edition, known as ICD-11, efforts were made to harmonize how these two systems classify psychological disorders. For example, attention-deficit hyperactivity disorder, or ADHD, first appeared in the DSM in 1968 as a “Hyperkinetic Reaction of Childhood”, and as ADD in 1980, but it was only added to the ICD-11 of 2018. These efforts at harmonization may make it possible for United States healthcare providers to also begin using the ICD.
Common Questions about APA’s ‘Diagnostic and Statistical Manual’
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was first issued in 1952 by the American Psychiatric Association to help us understand how we can try to prevent psychological disorders from occurring and also how to treat them.
The DSM classifies the psychological disorders into five broad groups namely: Neurodevelopmental disorders, Neurocognitive disorders, Internalizing disorders, Externalizing disorders, and a miscellaneous group of disorders.
While the DSM manual has generally been used by clinicians in the United States, the rest of the world has long used a different and broader system managed by the World Health Organization. This system, the International Classification of Diseases, has a much broader scope, classifying medical diseases as well as psychological disorders from around the world, with about 14,000 diagnoses.
