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What Is the DSM?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guidebook widely used by mental health professionals—especially those in the United States—in the diagnosis of many mental health conditions. The DSM is published by the American Psychiatric Association has been revised multiple times since it was first introduced in 1952. The most recent edition is the fifth, or the DSM-5. It was published in 2013.

The DSM features descriptions of mental health conditions ranging from anxiety and mood disorders to substance-related and personality disorders, dividing them into categories such as major depressive disorder, generalized anxiety disorder, and narcissistic personality disorder. These disorders are grouped into chapters based on shared features, e.g., Feeding and Eating Disorders; Depressive Disorders; Schizophrenia Spectrum and Other Psychotic Disorders.

For each disorder category, the manual includes a set of diagnostic criteria—lists of symptoms and guidelines that psychiatrists, psychotherapists, and other health professionals use to determine whether a patient or client meets the criteria for one or more diagnostic categories. For diagnosis of major depressive disorder, for example, the current DSM states that a person shows at least five of a list of nine symptoms (including depressed mood, diminished pleasure, and others) within the same two-week period. It also requires that the symptoms cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning,” along with other stipulations.

Updates to these diagnostic categories and criteria are made through a years-long research and revision process that involves groups of experts focusing on distinct areas of the manual.

How Has the DSM Changed?

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The DSM has always been a lightning rod for debate about psychiatric diagnosis and classification. Since the 1950s, various categories of disorders have been added to the manual, altered, or removed altogether based on evolving clinical expertise and research and changes in the field of psychiatry, including a pivot away from psychoanalysis. As the DSM is the dominant text for making mental health diagnoses in America, many of these changes are considered historically significant, such as when the DSM ceased to classify homosexuality as a form of mental illness. Other shifts have been controversial, including the omission of Asperger’s disorder from the DSM-5 in favor of a broader autism spectrum disorder category.

The DSM coexists with various alternative diagnostic tools, although these other guides are generally less commonly used. The most widely consulted counterpart of the DSM, the International Classification of Diseases (ICD), covers mental health disorders along with a vast number of other health conditions. The ICD is the primary diagnostic tool for mental health professionals in many countries outside the U.S.

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