Stefan G. Hofmann - International Perspectives on Psychotherapy

The publication of the first DSM ( DSM-I ) was motivated by increasing malcontent with the unstandardized and unreliable methods of assessment and diagnosis favored prior to the mid-twentieth century. Consequently, the APA formed the Committee on Nomenclature and Statistics, which set out to classify mental illnesses properly. The committee spit all psychiatric illnesses into three categories based on the psychoanalytic approach: Psychoses, Neuroses, and Character disorders. These categories were named but not described further, as the committee believed vague definitions were more clinically useful (Blashfield, Flanagan, & Raley, ). The DSM-II , published in 1968, added short descriptions of each disorder, but still kept everything very vague. This version yielded low diagnostic reliability, and was not used in countries other than the United States. The publication of the DSM-III in 1980 constituted a major change in the nosology of mental disorders. Whereas the previous two versions were primarily psychoanalytic in nature, this version attempted to take an atheoretical approach to classification in order to be useful for clinicians with various theoretical viewpoints. Additionally, disorder categories were more scientifically defined and structured, which increased diagnostic reliability and validity. The DSM-III introduced the multiaxial system, which included five levels of influence on an individuals overall diagnostic picture: characteristics of the clinical disorder itself (Axis I), personality style and/or mental retardation (Axis II), relevant medical disorders (Axis III), environmental factors (Axis IV), and overall functional impairment (Axis V). This framework allowed clinicians to gather information about the individuals functioning in a number of areas, rather than limiting information to the disorder symptomatology. DSM-IV , published in 1994, changed many disorder criteria, as well as added many new features to each description, such as information related to race, gender, culture, expanded description of diagnostic features, and information on differential diagnosis. This version barely depended on expert consensus, relying instead on literature reviews and clinical trials to update and verify diagnostic criteria.