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The “bible” of psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders (DSM), has had a very interesting, and at times frightening, evolution. Intended to improve reliability and never intended to become a “cookbook,” the DSM has unfortunately been taken quite literally by the insurance industry, the legal system, and others.

The DSM-V is slated for release in May 2012. The original DSM was released in 1952, and the DSM II in 1968. These two early versions nearly went unnoticed and were not widely used clinically. However, the DSM III, and especially the DSM-III R, became much more recognized as providing some degree of standardization of psychiatric diagnosis.

In January 2005, The New Yorker published an article, “The Dictionary of Disorder,” which takes the reader on an interesting journey in the life of psychiatrist Robert Spitzer and his efforts to create the DSM-III and DSM III-R with the goal of improving the reliability of psychiatric diagnosis.

Spitzer assembled groups of data-oriented psychiatrists to complete the task. The problem was that much of the data needed to complete the DSM-III and III-R did not exist. The article accounts some rather improvisatory methods by which new disorders were identified.

While Spitzer’s efforts likely netted an improved diagnostic system for psychiatric disorders, it quickly became clear that much of the DSM-III and DSM-III R was not backed up by science.

The article briefly discusses how the process for creating the DSM-IV and DSM-IV TR (the current version) was improved.

The article was both enlightening and disturbing but definitely worth reading. I’m glad to see the process for listing psychiatric conditions and their respective criteria in the DSM is improving, but I remain skeptical. As the article points out, diagnostic reliability is likely to be poorest in the therapist’s office–the very real-world place where we need reliability!

What are your thoughts about the DSM? Please leave your comments, which you may do anonymously.

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