When you visit a psychiatrist, you may already have an idea about your diagnosis—you might think you have ADHD, complex PTSD, autism, depression, or bipolar disorder. After talking with you and gathering information, your psychiatrist may discuss a diagnosis with you. This diagnosis is based on criteria from a reference book called the DSM.
The DSM, which stands for the Diagnostic and Statistical Manual of Mental Disorders, is the main tool mental health professionals use to classify and define psychiatric conditions.
A Brief History of the DSM
The origins of the DSM are reflected in its name. In the late 1800s, the U.S. government decided to collect statistics on various mental conditions. At that time, terms like “insanity,” “mania,” “dementia,” and “dipsomania” (now recognized as alcohol use disorder) were commonly used. Even conditions like epilepsy were classified as psychiatric disorders.
Over the ensuing decades, this classification system was revised and expanded, primarily for use in medical institutions. After World War II, there was a significant push to broaden these categories to help doctors better understand the mental health challenges faced by soldiers and veterans. The first edition of the DSM was published in 1952. Since then, it has steadily ballooned, blurring the line between diagnosable disorder and ordinary human experience.
How Are Diagnoses Determined?
Ideally, psychiatric diagnoses are meant to represent clusters of symptoms and signs that reliably occur together. These diagnoses should have consistent neurobiological features (meaning, they must be associated with relatively specific and consistent changes in the brain), a predictable course over time if left untreated (known as a “natural history”), and a characteristic response to certain treatments.
In reality, few conditions meet all these criteria perfectly. So, based on these criteria, while it seems like bipolar disorder might be a diagnosis, schizoaffective disorder barely makes the cut. (We won’t even try to talk about adjustment disorder!) Criteria are developed for these diagnoses and then tested in large groups of people to get data and tweak the criteria further.
Why Use Psychiatric Diagnoses?
If psychiatric diagnoses are so tenuous, why does a psychiatrist use them at all? One very practical reason is that the entire industry of medicine, insurance, billing, payments,
research funding, and medications are organized around diagnoses. For patients, receiving a diagnosis can sometimes be validating. It may relieve feelings of shame and provide some guidance on what can be done to relieve their suffering, for some time. However, most people do not fit neatly into a single diagnostic category, and all diagnoses are imperfect representations or crude approximations of complex human experiences. As your psychiatrist gets to know you better over time, the specific diagnosis should take a back seat to understanding your unique personality, situation and needs.
Key Takeaways:
- The DSM began as a tool primarily for collecting mental health statistics at a population level.
- A DSM diagnosis is often a simplified way to understand a person’s challenges.
- Use a DSM diagnosis as long as it helps guide useful treatment—after that, a more individualized approach becomes important.