The Diagnostic & Statistical Manual of Mental Disorders version IV (DSM-IV) under review.

First published in 1952 by the American Psychiatric Association (APA), the Diagnostic & Statistical Manual of Mental Disorders is a particularly insidious publication that stands as the ‘Bible’ of Psychiatry in the Western world. Since the first edition there have been five major revisions and each revision expanded to include an ever increasing number of neatly classified mental disorders along with symptoms and diagnoses. The DSM is widely used by clinicians, researchers, pharmaceutical companies, health insurance firms, and policy makers both in the United States and worldwide.

The second version of the manual, DSM-II, published in 1968, was 134 pages long and listed 182 disorders. Some diseases previously included in earlier editions of the DSM were later removed, most notably homosexuality. Pioneering research into human sexuality in the 1940’s and 1950’s by researchers like Kinsey and others added the weight of empirical data to the development of a politically active gay community in the United States and this placed mounting pressure on the APA to remove homosexuality from the DSM. So, largely as a result of the earlier work of researchers in sexuality coupled with changing social norms and increasing socio-political protests by gay activists, the APA were more or less forced to remove homosexuality as a discrete mental disorder. Although it was dropped from the DSM in the seventh printing of DSM-II in 1974 its diagnosis was replaced with a new category of ‘sexual orientation disturbance’ which is now known as ‘Gender Identity Disorder (GID).’ If the English have rarely been inclined to accept normal human (sexual) behaviour, our more fundamentalist American cousins have been even less so!

DSM-II was followed in 1980 by DSM-III, 494 pages long and listed 265 diagnostic categories. Subsequently, categories were renamed, reorganized, significant changes in criteria were made and a revised version, DSM-III-R, was published in 1987. The last major revision of the manual, the fourth edition (‘DSM-IV’), was published in 1994, although a ‘text revision’ was released by the APA in July 2000.

DSM-IV is currently under review and DSM-V is scheduled for publication in 2012. An early draft of DSM-V, cleverly titled DSM-IV-TR(!), was released for comment in 2009 and  the primary goal of this interim text version was, according to the APA website ‘to maintain the currency of the DSM-IV text’ and in addition ‘some of the diagnostic codes were changed to reflect updates to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) coding system adopted by the U.S. government.’ 

Well isn't that good news? Now there will some parity between the two major classifications of mental diseases used both in the USA and Europe. This should make things much easier for mental health professionals so that those from opposite sides of the pond will, on publication of DSM-V, be singing from the same hymn-book but, it is suspected, the tune will be somewhat different! Scheduled for publication in 2012 what new deep humanitarian insights into human behaviour DSM-V will bring remains to be seen Mmmmm.... ?