Essay Example: History of Diagnostic and Statistical Manual

The Diagnostic and Statistical Manual (DSM) was developed by the American Psychiatrist Association (APA) and has enjoyed a seemingly hegemonic status since it has been widely accepted as the gold standard for the assessment and the categorization of mental disorders of various types. The reception of the DSM criteria is demonstrated in through its translation in over twenty languages and has been referred to by policymakers, criminal courts, third-party reimbursement entities, multiple educational institutions and clinical practice (Black & Grant, 2014). Indeed, the discipline and approach to psychological practice have transformed since the inception of the first version of DSM and with the formulation of the DSM-5 criteria, renewed discussions on contentious debates have been stimulated. Some of the issues that have been raised include whether or not epistemologically iterative steps have been undertaken in defining the often enigmatic and ambiguous nature of mental disorders. Although skeptics highlight the limited utility and scope of the DSM, one cannot afford to ignore the effect the guideline has exerted in the field of psychiatry and the society-at-large. Consequently, this essay analytically scrutinizes and contextualizes the significant developments that have been experienced including the future directions and research in the DSM criteria.

Developing the DSM-5 Criteria

The beginning of the 19th Century was marked with the attempted classification of psychopathology in the United States. Nonetheless, such efforts involved the collection of demographic information by the Bureau of Census for purposes of regulating the treatment accorded to the mentally ill rather than having interest in diagnosis (Frazier et al., 2012). The discovery that the etiological foundations of psychopathology are comprised variable, complex and obscure interactions of both external and internal factors culminated in the formulation of an even nonsological system that takes into account clinical utility. The expanding role has expanded to recognize the fact that the concepts of mental health go beyond the boundaries of mental institutions to include devising a reliable classification procedure for psychopathological conditions. Initially, collaboration between the National Committee for Mental Hygiene, Bureau of the Census and the APA led to the development of a formal and standardized nomenclature for psychopathological conditions (Frazier et al., 2012). As a result, the Statistical Manual for the Use of Institutions for the Insane was created, and this document is primarily perceived as the predecessor of the DSM. Initially, the guideline identified 22 different diagnostic categories with the majority being psychotic disorders with the common assumption ion presumed somatic etiology. This form of classification banked on Kraepelinian hypotheses that linked anomalies in behavior to the physical brain dysfunction which defined the nature of the psychological profession. The psychodynamic approach, which borrows most of its concepts from the works of Freud and Meyer, has surged regarding dominance as the paradigm yielded positive results in the treatment of clients who have a history of psychological trauma (Keel et al., 2012). The perception of psychopathology has undergone a paradigm shift in the sense that mental conditions are separate disease units from mental health to consider mental health as a continuum of inconsistent severity.

The psychodynamic theory gained prominence in both academic and clinical circles of psychiatry as the lead school of thought by the APA. The first version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was formulated in 1952 and was based on nonsological frameworks that culminated in the discovery of 102 diagnostic classifications were based on psychodynamic explanations (Maenner et al., 2014). The subsequent descriptions have led to sub-divisions in two groups of mental disorders namely the conditions that are caused by organic brain dysfunction and the effect of socio-environmental stressors. Moreover, the latter group was further fragmented into various psychoses, which denote incredibly severe conditions including schizophrenia, manic-depressive disorders, personality disorders, and anxiety. Adolf Meyer is perceived as a pioneer of the maladjustment model which forms the fundamental principles of the DSM-I criteria, and it provided the basis from which standardized categorization of mental disorders as developed (Nakai, Fukushima,Taniguchi, Nin, & Teramukai, 2013). Nonetheless, the perceived inadequacies in the DSM-I necessitated the need for the formulation of a second edition of the DSM, which was published in 1968. Equally important is the fact that that the DSM-II was mostly comprised of the psychodynamic conventions although there were few notable changes. The first modification involved the expansion of the definition of mental illness was aimed at expanding the interpretation of psychodynamic theory to include the lesser conditions, which were emerging within populations. This progression was signified by the additional diagnostic categories such as conditions without manifest psychiatric disorders and transient situational disturbances (Huerta et al., 2012). The second development was marked by the augmented systematic categorization and specificity that posits the reinstatement of the Kraepelinian tradition. This event was evidenced by multiple sub-categories such as the inclusion of eight new alcoholic mental disorders and the increase of qualifiers from four in DSM-I to nine in DSM-II, which adopted definitions such as chronic, acute, moderate and severe. Perhaps a significant change that was introduced in the DSM-II was the elimination of the term reaction in definitions that were about maladaptive responses that are demonstrated by an individual who experiences socio-environmental avenues of distress. These changes highlighted the need for the US-UK cross-cultural studies whose objective was to sensitize on the essence of a universal diagnostic procedure that creates the determination for different psychiatric illnesses.

The development of criteria for psychiatric disorders necessitated the importance of validity and reliability. The concept of validity is adopted in an5-phase scale to integrate family studies, laboratory data, follow-up studies, excluding characteristics and clinical factors. Robins and Guze whose procedure provided a reference point for different criteria of different diagnostic groupings premiered the validation of the DSM (Koukopoulos & Sani, 2014). The validation process was aimed at developing an iterative and adjustment structures by new information that facilitates the expansion of the criteria. Equally important is the fact that the pioneer researchers in psychiatric science concluded that no biological evidence supports the development of diagnostic criteria. Nonetheless, the controversy surrounding the diagnostic criteria was settled in the 1950s whereby an official diagnostic principle was formulated in the US an was incorporated in various sectors namely the in asylums, the defense forces and the Department of Veterans Affairs (VA) and the American Prison Association (Frazier et al., 2012). This new development was subdivided into two sections namely disorders with verified organic brain disorders, and those that were lacking in the criteria as mentioned above (Black & Grant, 2014). The latter set of complications was dubbed as being functional and was further subdivided into a list of disorders such as psychoneurosis, personality, and psychosis. The development of DSM-II necessitated the need to address the inconsistencies that existed between the DSM, the International Classification of Diseases and the World Health Organization who at the time had universal controlling interests as policymakers (Black & Grant, 2014).

The advent of DSM-III was signified by the need for cementing the validity and reliability of the diagnostic criteria where a formal operationalization of diagnosis in psychiatry was required. This progression was characterized by the invention of a tiered and multi-axial system for determining which replaced psychodynamic ideologies with theoretical tenets that supported the etiology of mental health disorders. Nevertheless, the improvements introduced in DSM-III was highly controversial in the sense that it provided a radical redirection in the diagnosis of psychiatric diagnosis and is widely perceived as being the landmark paradigm shift. Perhaps this is because there was the advent of operationalized and empirically based information which compounded to the legitimization and adoption into the medical specialty. This ideology was swiftly followed by the development of the subsequent edition, which was christened DSM-III-R, and its purpose was to provide utilitarian value based suggestions posited by researchers and physicians (Tandon et al., 2013). Thus, the diagnostic ranking was eliminated and was instead replaced with the enhancement of comorbidity results that were obtained through epidemiological research studies. Barely a year after publication of the DSM-III-R, a task force was formulated to develop the DSM-IV criteria with the only alteration being the inclusion of clinically significant distress. This was later followed by the publication of the DSM-IV-TR, which emerged at the turn of the millennium and served the purpose of providing an update in the research literature for the related facets of the existing disorders (Volkmar & Reichow, 2013).

The DSM-5, which is the current version of diagnostic criteria, was developed for purposes of integrating neurobiological and etiological research in the definition of psychiatric disorders including the need to augment the clinical aspects of the criteria. Additionally, these objectives hinged on the incorporation of cross-cutting measures, dimensional, environmental and developmental history of diagnosing mental health disorders. The most significant change in the DSM-5 was the elimination of a multi-axial structure in diagnosis, which was based on the ambiguities in the interaction between psychiatric and medical diagnosis including the poor clinical and psychometric validity. The diagnostic criteria have shifted overtime where the DSM-I and DSM-II were formulated with the intention of the gathering of statistical data on the prevalence of mental disorders. Moreover, the Feighner criteria that were adopted in DSM-III was aimed at providing reliability and validity of the diagnostic criteria and grouping clients into homogenous samples to optimize research data (Volkmar & Reichow, 2013). The development of the DSM-III-R criteria was aimed at improving clinical utility in diagnosis with a majority of the contributions coming from clinicians inputs. In recent times, managed care organizations, pharmaceutical companies, insurance companies, and governments have resorted to utilizing systematic diagnostic criteria for reimbursement and financial components in clinical practice. Alterations have also been highlighted by the inclusion and exclusion of some disorders, which warrant specificity in the narration. For instance, Posttraumatic Stress Disorder and Borderline Personality Disorder were not part of the American Diagnostic criteria, and they were only incorporated in the DSM-III. Other disorders such as Aspergers disorder, acute stress, and bipolar II disorder were only incorporated in the DSM-IV (Taheri & Perry, 2012). Conversely, the independent diagnosis of the Aspergers syndrome was eliminated and was included in the list of autism spectrum disorder. Somatisation disorder was also verified and included in multiple versions of...