The Evolution of the Classification of Psychiatric Disorders

Abstract

This article traces the history of classification systems for mental illness and then reviews the history of the American diagnostic system for mental disorders. The steps leading up to each publication of the Diagnostic and Statistical Manual (DSM) are described including leaders, timelines, pre-publication meetings, and field trials. Important changes in the purpose of the manuals are described with a focus on events leading to the manual’s third edition (DSM-III), which represented a paradigm shift in how we think about, and use, the classification system for mental illness. For the first time, DSM-III emphasized empirically-based, atheoretical and agnostic diagnostic criteria. New criticisms of the DSM-III and subsequent editions have arisen with a call for a new paradigm shift to replace diagnostic categories with continuous dimensional systems of classification, returning to etiologically-based definitions and incorporating findings from neurobiological science into systems of diagnosis. In the foreseeable future, however, psychiatric diagnosis must continue to be accomplished by taking a history and assessing the currently established criteria. This is necessary for communication about diseases and education of clinicians and scientists in medical fields, as well as advancement of research needed to further advance the diagnostic criteria of psychiatry.

Animal Models in Psychiatric Disorder Studies

“…The heterogeneity implicit in this classification system and the imprecise quantification of the symptoms make it impossible to deconstruct PDs within model organisms. In fact, an etiology-based nosology system has been advocate for psychiatry, and it has been proposed to identify the endophenotypes that occur in both healthy individuals and subjects with different psychopathologies [14]. Endophenotypes are basically quantitative trait-like deficits that are possible to assess by laboratory-based methods rather than by clinical observation.…”

Comparação da classificação dos transtornos do desenvolvimento infantil por meio do DSM-5, CID-10 e CID-11

“…Inicialmente, é sabido que o diagnóstico é essencial para prática da medicina; pois é, por meio dele, que se realiza a elaboração de tratamento, o estabelecimento de prognóstico, a comunicação entre profissionais acerca da patologia e a mensuração de dados para pesquisas e políticas governamentais (Stein et al, 2019). Com isso, a prática médica ganhou um maior embasamento técnico e científico com o advento dos sistemas de classificação de doenças, na medida em que uma maior sustentação e validação foram possibilitadas (Surís et al, 2016).…”

“…Todavia, a comunidade psiquiátrica americana não os reconhecia quanto a seus achados. Por volta dos anos de 1920, cada instituição americana utilizava seus próprios sistemas de classificação de doenças, produzidas a partir de um consenso entre os profissionais médicos e seus diagnósticos que serviam de modelo (Surís et al, 2016).…”

How many categories in a classification of psychiatric disorders do we need?

“…The Feighner criteria have been used in research in the USA. Its popularity had major influence on the decision to introduce it into the third revision of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM 3) (11). Both the ICD and the DSM were twice revised since then and still exist as the DSM 5 and the Chapter of mental and behavioral disorders in the ICD 10.…”