Over the past decade, psychologists and other medical professionals have debated the legitimacy of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Since the publication of the fifth edition, DSM-5, in 2013, critics have raised issues around the reliability and validity of this diagnostic criteria and the overall role of diagnoses in mental health. In fact, in May 2022, a team of over 200 professionals directly contributed to a text revision of this fifth edition (DSM-5-TR). All these revisions and task forces for diagnostic criteria begs the question, why is there such a strong push for improving the gold standard in psychiatric diagnoses? And how has this gold standard developed overtime?
The push towards a standardized diagnosis system in American psychiatry was not yet considered during the late 1800s. Instead, institutions relied on “in-house diagnostics systems, generally based on prototypical case studies” and focused more on individual abnormalities rather than common symptoms for disorders. The first step towards a standardized system for diagnosis did not occur in a clinical setting. Instead, it was the US Census Bureau who issued the Statistical Manual for the Use of Institutions (SMUI) in an attempt to determine the prevalence of mental disorders in the nation in 1920. It was not until 1952, that the APA published the very first DSM-I which offered a standardized set of diagnoses for clinical practice. However, the first and second edition (1968) of the DSM were made without an evidence or research-based consideration.
In the late 1900s, the development of the DSM-III prompted a drastic shift in the American standardized diagnostic system. In 1979, Robert Spitzer, of the New York State Psychiatric Institute, published the DSM-III which provided a more empircal and biological approach to psychiatric diagnoses. This “paradigm-shift” marked a larger attempt to “re-medicalize psychiatry” and evaluate the validity and reliability of diagnostic criteria. The following revisions to the DSM, leading up to the DSM-5-TR have furthered this movement. Now, critics are once again dissatisfied with the clinical use of DSM, this time, because it fails to differentiate between psychiatric disorders and causes “diagnostic comorbidity”.
Thus, American psychiatry has evolved exponentially over the past two centuries by developing a standardized system for psychiatric diagnoses and switching to a biological and empirical process of diagnosis. With psychologists and other medical professionals finding new ways to evaluate and revise the current manual, we can expect far more changes for diagnostic processes and clinical practice in the coming years.