History of the Diagnostic and Statistical Manual in Diagnosis of Mental Disorders

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Table of Contents

Introduction
Summary of the Propositions
Dsm-III
Convergence
Factors That Contributed to Push for Improved Diagnosis
Conclusion
Work Cited

Introduction

The Diagnostic and Statistical Manual of Mental Disorders has increased in content over time. There has been a shift in the emphasis laid on each model of the manuals. These changes geared towards improving the diagnosis of mental disorders have resulted in historical changes leading to the present edition (Rogler 18). The scopes of these editions differ in the emphasis laid on the diagnosis of mental disorders. Various factors have contributed to the changes in these manuals. Factors pushing these changes in the manuals range from the rise in neo-Kraeplelinians to technological development. To understand the changes in history, Rogler describes the history of the development of the Diagnostic and Statistical Manual. This essay gives an overview of the five propositions set forward regarding the history of the manual. In addition, the essay analyses the third manual which was the most radical of manuals in history. Furthermore, the essay discusses the contributing factors that led to pushing for improved diagnosis.

Summary of the Propositions

The first proposition focuses on the changes of the DSM in theory. The course of the DSM changed to research-oriented descriptions and diagnosis of disorders. Initially, carrying out the diagnosis was based on psychodynamics formulations. In addition, the health practitioners relied on observation of disorders as a continuous structure of reactions to the biopsychosocial motivations (Rogler 10).

On the other hand, the next proposition categorizes diagnosis into contexts relevant to circumstances. These categories revolve around axes consisting of five categories of information. In addition, this proposition makes an effort to develop and explain the relationship in these five axes (Rogler 12). The proposition explains the development of these axes in a horizontal scope consisting of relevant information on diagnosis.

The third proposition explains the historical change in the manuals as occasioned by the inclusion of new categories of disorders. These new disorders either did not fit any definition in the previous manuals or split from the disorders in the old manuals. The splitting of the disorders led to an increase in the volume of the manuals. This process of splitting the disorders into two or more subtypes is differentiation (Rogler 14). Effectively, there was the accommodation of disorders that did not match descriptions in previous manuals. In addition, splitting enabled subtypes of disorders accommodation in newer manuals.

Alternatively, the fourth proposition explains the historical changes by explaining the structural changes in the DMS, just like the third proposition. Although there has been stability in the categories of diagnosing disorders, lumping disorders together led to the formation of one disorder. In addition, the proposition explains the incorporation of some disorders in others and the total elimination of other disorders. The practice of lumping two or more disorders together is convergence (Rogler 15).

Finally, the last proposition explains forces in history, pivotal in the transformation to DSM-III. This force, the proposition explains, was an informal college consisting neo-Kraeplinian psychiatrists (Rogler 16).

This college brought profound changes and a shift in the diagnosis of mental disorders. The changes brought by the neo-Kraeplinians effectively made the third model the one representing intervening and rupturing change in diagnosis.

Dsm-III

Rogler identified the third model of DSM as one reflecting a radical change in the diagnosis of psychiatric conditions by health practitioners (16). One significant way that this model varied from the other two is in its presentation of symptoms criteria in ordered sets. This model was able to describe the symptoms of mental disorders in a set criterion different from the other models (Rogler 16). Effectively, the DSM became more reliable as the definitions of the disorders were able to be understood even by those without medical knowledge. Another significant improvement in this model is its emphasis on research as a way of describing mental disorders (Rogler 16). In effect, arriving at a diagnosis of mental disorders was to be from a research point of view and not through assumptions.

Convergence

The process of convergence in history has decreased the number of disorders in the manuals. Convergence is the merging of two disorders or multiple disorders into one (Rogler 15). One case in point where convergence has taken place is the lumping of two types of schizophrenic disorders. The two Schizophrenia disorders were a simple type and another that was latent. These two types were included in the second model of the manual. However, when the two disorders were lumped together, they formed Schizotypal Personality Disorder in the third model. In this regard, the convergence of one or multiple disorders led to a reduction in the number of disorders in the manuals. However, it is essential to point out that, the change to Schizotypal Personality Disorder involved a dual process. First, the disorder was split and then converged with another type resulting in Schizotypal Personality Disorder (Rogler 15).

Factors That Contributed to Push for Improved Diagnosis

The rise of the neo-Kraepelinian psychiatrists was central to the shift in the framework in the third model of DSM. This informal group shared a common passion in research and belief centered on a general perspective about diagnosis in the psychiatry profession. Their rise coincided with changes in the values in American institutions. They hoped that this new version would dramatically improve clinicians’ diagnostic effectiveness. The body was instrumental in the drive for improved diagnosis (Rogler 16).

One other factor that led to the push for improved diagnosis was the development of computer technologies (Rogler 16). In this regard, computers affected research in the diagnosis of mental disorders. Research changed from the experimental type to one based on the study of diseases and their management.

Another factor contributing to pushing for improved diagnosis was the pressure in using therapeutic practices (Rogler 16). These practices in treating disorders were old and based their treatment on psychopharmacology. Effectively, psychopharmacology heightened the need for proper definition in diagnostic criteria central in the use of therapeutic interventions.

The third factor contributing to pushing for improved diagnosis was the responsibility of the practitioners on their patients. The rise in mental institutions necessitated the need for improved diagnosis (Rogler 17). Health practitioners wanted to devise ways that could help them interact better with their clients.

Conclusion

In conclusion, all the changes in the DSM focus on the improvement of the diagnosis of mental disorders. These changes have resulted in different categories of defining disorders and the elimination of some older disorders. In addition, diagnosis of disorders relied heavily on a theoretical framework before these changes were made. However, the changes changed the course of defining these disorders into research-based. Therefore, the changes have been pivotal in enhancing the accuracy and efficiency of the diagnosis of mental disorders.

Work Cited

Rogler, Lloyd. “Making Sense of Historical Changes in the Diagnostic and Statistical Manual of Mental Disorders.” Journal of Health and Social Behavior. 38,1 (1997): 9-20. Print.

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