American Classification of Mental Disorders (DSM)

1918

The first official American classification of mental disorders appeared in 1918 as the Statistical Manual for the Use of Institutions for the Insane. It was developed in response to demand from the US Census Bureau, which needed to count the number of insane people in institutions. The manual appeared in several editions, most of them focused almost entirely on the psychoses. By the tenth edition (1942), various other psychoneuroses, including anxiety states, were described. The US Army also developed a manual for diagnosing mental disorders.

The first version of the manual now in common use, The Diagnostic and Statistical Manual of Mental Disorders, or DSM, was published in 1952 by the American Psychiatric Association. It drew upon the earlier classification manuals and was particularly reflective of the psychoanalytically oriented perspective of psychiatrists who had served in the war. As in the earlier publications, serious mental illnesses, such as The Schizophrenias and bipolar disorder, dominated the manual. Psychoanalytic constructs of neuroses were threaded throughout. For the time period, this made sense, as most practitioners did not place primary emphasis on diagnostic purity.

The second edition of the DSM was published in 1968 and followed much the same plan. Now, however, there were more subdivisions of the major disorders; for example, whereas DSM-I simply listed alcoholism, DSM-II listed the additional categories of episodic excessive drinking and habitual excessive drinking.

The most dramatic change to the DSM came with the seventh printing of the second edition, published in 1974. When the American Psychiatric Association held their convention in San Francicso, California, in 1970, gay activists disrupted the conference and demanded that homosexuality no longer be listed as a mental disorder. After much internal debate and conflict, the association finally agreed and changed the manual to describe homosexuality as a sexual-orientation disturbance beginning with the next printing.

SEE ALSO DSM-III (1980)

This 1980s poster from the National Institute for Mental Health uses a cluster of symptoms to describe or “classify” depression, much like the Diagnostic Manual of Mental Disorders (DSM).