Before the beginning of 20th century diagnostic practice in psychology was very general and psychoanalysis as we know it today did not exist. However, the development of a system for classification of psychological illnesses was crucial to the advancement of medical science. Therefore, the American Psychiatric Association created a classification called DSM.
First edition called DSM-I was published in 1952 and consisted of 128 categories, where descriptions of all disorders were written in short prose paragraphs and it was mostly on psychotic disorders. All terms used in this edition were relative and therefore the interpretation varied from clinician to clinician. The attempts to create proper descriptions of disorders continued. At the same time, a study by Phillip Ash (1949) showed that psychiatric classification lacked adequate reliability as different psychiatrists diagnosed same patients differently.
Meanwhile, the World Health Organization wanted to create a classification system that would be consensual and could be used in any country, including United States. The classification created by WHO was called ICD-8, and the American version was called DSM-II had a few differences from ICD-8. DSM-II was issued in 1968 and had 193 diagnostic categories. In contrast to DSM-I, much more attention was paid to anxiety disorders, personality disorder, depressive disorders and childhood-adolescence disorders. However, even with a new edition and classifications, different clinicians diagnosed same patients differently as they diagnostic definitions were nonspecific and very broad.
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To improve diagnostic reliability, a new classification system called DSM-III was created in 1980. Instead of just broad and short descriptions, DSM-II contained diagnostic criteria to specify the meaning of the categories. For each of 228 category there was also a description of the common demographic profile of patients experiencing tat specific disorder. It also contained a longer explanation of what that category implied and explanation about the course and onset of the disorder.
During this time, alternative approaches to the biological classification began to develop. And as it happened shortly after publishing of DSM-III, update had to be done. In addition to changes in diagnostic criteria, new categories were added. After these changes, new DSM-III-R was published in 1987 and contained 253 categories and had a big advance in sleep disorders.
Both researchers and clinicians looked for more consistency and clarity in the definitions of categories in order to perform useful studies and be more organized in diagnostic practice. The APA created 13 workgroups that performed literature reviews of diagnostic categories and created databases, and if needed, did some alterations. In 1994 a new edition called DSM-IV was created. It consisted of 383 categories that were descriptive and phenomenological, and also had an appendix for categories that needed further study. A revision, called DSM-IV-R was published in 2000 in which the clinical significance for tic disorders was dropped. Overall text revision clarified multiple issues concerning diagnosis of psychological disorders.
The work and research never stopped and work on DSM-5 neither. A new manual was created by 13 workgroups that consisted of more than 500 health professionals. They tested validity and reliability of categories and ended up with 541 diagnostic categories and it was published in 2013. DSM-5 consists of the diagnostic classification, diagnostic criteria set and the descriptive text.
