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Day and month of 1980 DSM-III publication

Day and month of 1980 DSM-III publication



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I cannot for the life of me find the exact date -- day, month, year -- for the original DSM-III publication. The Google Citation, Amazon info, APA page, and others only list 1980. Does anyone know? Thanks.


At this present moment I cannot find full date information, but looking at a copy of the DSM-III I have found, on the bottom of the 3rd page of the PDF it points out:

First Printing, February 1980
Second Printing, May 1980


Day and month of 1980 DSM-III publication - Psychology

Timeline of Psychology (387BC to Present)

387 BC Plato suggested that the brain is the mechanism of mental processes.

335 BC Aristotle suggested that the heart is the mechanism of mental processes.

1774 AD Franz Mesmer detailed his cure for some mental illness, originally called mesmerism and now known as hypnosis.

1793 Philippe Pinel released the first mental patients from confinement in the first massive movement for more humane treatment of the mentally ill.

1808 Franz Gall wrote about phrenology (the idea that a person's skull shape and placement of bumps on the head can reveal personality traits.

1834 Ernst Heinrich Weber published his perception theory of 'Just Noticeable Difference,' now known as Weber's Law.

1848 Phineas Gage suffered brain damage when an iron pole pierces his brain. His personality was changed but his intellect remained intact suggesting that an area of the brain plays a role in personality.

1859 Charles Darwin published the On the Origin of Species, detailing his view of evolution and expanding on the theory of 'Survival of the fittest.'

1861 French physician Paul Broca discovered an area in the left frontal lobe that plays a key role in language development.

1869 Sir Francis Galton, Influenced by Charles Darwin's 'Origin of the Species,' publishes 'Hereditary Genius,' and argues that intellectual abilities are biological in nature.

1874 Carl Wernicke published his work on the frontal lobe, detailing that damage to a specific area damages the ability to understand or produce language

1878 G. Stanley Hall received the first American Ph.D. in psychology. He later founded the American Psychological Association.

1879 Wilhelm Wundt founded the first formal laboratory of Psychology at the University of Leipzig, marking the formal beginning of the study of human emotions, behaviors, and cognitions.

1883 The first laboratory of psychology in America is established at Johns Hopkins University.

1885 Herman Ebbinghaus introduced the nonsense syllable as a means to study memory processes.

1886 Sigmund Freud began performing therapy in Vienna, marking the beginning of personality theory.

1890 The term "Mental Tests" was coined by James Cattell, beginning the specialization in psychology now known as psychological assessment.

1890 Sir Francis Galton developed the technique known as the correlation to better understand the interrelationships in his intelligence studies.

1890 William James published 'Principles of Psychology,' that later became the foundation for functionalism.

1890 New York State passed the State Care Act, ordering indigent mentally ill patients out of poor-houses and into state hospitals for treatment and developing the first institution in the U.S. for psychiatric research.

1892 Foundation of the American Psychological Association (APA) headed by G. Stanley Hall, with an initial membership of 42.

1895 Alfred Binet founded the first laboratory of psychodiagnosis.

1896 Writings by John Dewey began the school of thought known as functionalism.

1896 The first psychological clinic was developed at the University of Pennsylvania marking the birth of clinical psychology.

1898 Edward Thorndike developed the 'Law of Effect,' arguing that "a stimulus-response chain is strengthened if the outcome of that chain is positive."

1900 Sigmund Freud published 'Interpretation of Dreams' marking the beginning of Psychoanalytic Thought.

1901 The British Psychological Society was founded.

1905 Alfred Binet's Intelligence Test was published in France.

1906 The Journal of Abnormal Psychology was founded by Morton Prince.

1906 Ivan Pavlov published the first studies on Classical Conditioning.

1911 Alfred Adler left Freud's Psychoanalytic Group to form his own school of thought, accusing Freud of overemphasizing sexuality and basing his theory on his own childhood.

1911 Edward Thorndike published first article on animal intelligence leading to the theory of Operant Conditioning.

1912 William Stern developed the original formula for the Intelligence Quotient (IQ) after studying the scores on Binet's intelligence test. The formula is

1912 Max Wertheimer published research on the perception of movement, marking the beginnings of Gestalt Psychology.

1913 John E. Watson published 'Psychology as a Behaviorist Views It' marking the beginnings of Behavioral Psychology.

1913 Carl G. Jung departed from Freudian views and developed his own theories citing Freud's inability to acknowledge religion and spirituality. His new school of thought became known as Analytical Psychology.

1916 Stanford-Binet intelligence test was published in the United States.

1917 Robert Yerkes (President of APA at the time) developed the Army Alpha and Beta Tests to measure intelligence in a group format. The tests were adopted for use with all new recruits in the U.S. military a year later.

1920 John B. Watson and Rosalie Rayner published the Little Albert experiments, demonstrating that fear could be classically conditioned.

1921 Psychological Corporation launched the first psychological test development company, not only commercializing psychological testing, but allowing testing to take place at offices and clinics rather than only at universities and research facilities.

1925 Wolfgang Kohler published 'The Mentality of Apes' which became a major component of Gestalt Psychology.

1927 Anna Freud, daughter of Sigmund Freud, published her first book expanding her father's ideas in the treatment of children.

1929 Wolfgang Kohler criticizes behaviorism in his publication on Gestalt Psychology.
1932 Jean Piaget published 'The Moral Judgment of Children' beginning his popularity as the leading theorist in cognitive development.

1932 Walter B. Cannon coined the term homeostasis and began research on the fight or flight phenomenon.

1935 Thematic Apperception Test (TAT) was published by Henry Murray.

1936 Egas Moniz published his work on frontal lobotomies as a treatment for mental illness.
1938 Electroshock therapy was first used on a human patient.

1939 Wechsler-Bellevue Intelligence Test was published which eventually became the most widely used intellectual assessment.

1939 The Canadian Psychological Associated was founded.

1942 Carl Rogers published 'Counseling and Psychotherapy' suggesting that respect and a non-judgmental approach to therapy is the foundation for effective treatment of mental health issues.

1942 Jean Piaget published 'Psychology of Intelligence' discussing his theories of cognitive development.

1942 Minnesota Multiphasic Personality Inventory (MMPI) was developed and fast became the most widely researched and widely accepted psychological assessment device.

1945 The state of Connecticut passed licensure legislation for psychologists, becoming the first state to recognize psychology as a protected practice oriented profession.
1945 The Journal of Clinical Psychology was founded.

1945 Karen Horney published her feministic views of psychoanalytic theory, marking the beginning of feminism.

1949 Boulder Conference outlines scientist-practitioner model of clinical psychology, looking at the M.D. versus Ph.D. used by medical providers and researchers, respectively.

1950 Erik Erikson published 'Childhood and Society,' where he expands Freud's Theory to include social aspects of personality development across the lifespan.

1952 A study on psychotherapy efficacy was published by Hans Eysenck suggesting that therapy is no more effective that no treatment at all. This prompted an onslaught of outcome studies which have since shown psychotherapy to be an effective treatment for mental illness.

1952 The Diagnostic and Statistical Manual of Mental Disorders (DSM) was published by The American Psychiatric Association marking the beginning of modern mental illness classification.

1952 Chlorpromazine (Thorazine) first used in the treatment of schizophrenia.

1953 B.F. Skinner outlined behavioral therapy, lending support for behavioral psychology via research in the literature.

1953 Code of Ethics for Psychologists was developed by the American Psychological Association.

1954 Abraham Maslow helped to found Humanistic Psychology and later developed his famous Hierarchy of Needs.

1957 Leon Festinger proposed his theory of 'Cognitive Dissonance' and later became an influence figure in Social Psychology.

1961 John Berry introduced the importance of cross-cultural research bringing diversity into the forefront of psychological research and application.

1961 Carl Rogers published 'On Becoming a Person,' marking a powerful change in how treatment for mental health issues is conducted.

1963 Alfred Bandura introduced the idea of Observational Learning on the development of personality.

1963 Lawrence Kolberg introduced his ideas for the sequencing of morality development.

1967 Aaron Beck published a psychological model of depression suggesting that thoughts play a significant role in the development and maintenance of depression.

1968 DSM II was published by the American Psychiatric Association.

1968 First Doctor of Psychology (Psy.D.) professional degree program in Clinical Psychology was established in the Department of Psychology at The University of Illinois - Urbana/Champaign.

1969 Joseph Wolpe published 'The Practice of Behavior Therapy.'

1971 First Doctorate in Psychology (Psy.D.) awarded (from The University of Illinois - Urbana/Champaign).

1973 APA endorsed the Psy.D. degree for professional practice in psychology.

1980 DSM III published by the American Psychiatric Association.

1983 Howard Gardner (professor at Harvard University) introduced his theory of multiple intelligence, arguing that intelligence is something to be used to improve lives not to measure and quantify human beings.

1988 American Psychological Society established.

1990 The emergence of managed care prompts the APA to become more political, leading to the idea of Prescribing Psychologists and equity in mental health coverage.

1994 DSM IV published by the American Psychiatric Association.

1995 First Psychologists prescribe medication through the U.S. military's psychopharmacology program.

1997 Deep Blue, the supercomputer at the time, beats the World's best chess player, Kasparov, marking a milestone in the development of artificial intelligence.

1998 Psychology advances to the technological age with the emergence of e-therapy.

1999 Psychologists in Guam gain prescription privileges for psychotropic medication.

2002 New Mexico becomes the first state to pass legislation allowing licensed psychologists to prescribe psychotropic medication.

2002 The push for mental health parity gets the attention of the White House as President George W. Bush promotes legislation that would guarantee comprehensive mental health coverage.


The Past, Present, and Future of the DSM

At nearly a thousand pages long and weighing more than 3 lb, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, otherwise known as the DSM-5, is by most estimations a considerable tome. Yet the weight of the DSM transcends its mere dimensions. Since first published in 1952, psychiatry's "bible," as it's often called, has been both a boon and a bust to its publisher, the American Psychiatric Association (APA). It's provided guidance to mental health professionals ― not to mention plenty of revenue to the country's leading psychiatry association ― yet has also served as a whipping post for those who see the book as outdated, unscientific, and dogmatic.

"It's easy to criticize the DSM," said Jeffrey A. Lieberman, MD, professor and chair of psychiatry at Columbia University College of Physicians and Surgeons in New York City. "But at this point, it represents a system that is as good as we can have, given our current state of knowledge.

"Is it ideal?" asked Lieberman, who served as APA president from May 2013 to May 2014. "By no means. But there's no better alternative. Hopefully, research will soon enable modifications that will lead to pathologic diagnostic assessments, like every other field of medicine has."

Others take a more cynical view of the manual. "What the DSM does successfully is provide a cultural anthropology of mental suffering," said Gary Greenberg, PhD, a Connecticut-based psychologist and author of The Book of Woe: The DSM And The Unmaking Of Psychiatry.

Yet, it's this provision that also makes Greenberg uncomfortable with the book. The way he sees it, the DSM is as much the product of politics, history, and society as it is of science.

"The categories into which the DSM sorts disorders and the criteria it provides for them are themselves artifacts of society," he told Medscape Medical News. "The APA is part of that social organization."

The origins of the DSM date to the 1800s, when the United States began collecting statistical information on its citizens. Reflecting a growing concern at the time for the mentally ill and a desire to classify mental disorders, the 1849 census incorporated a category for "idiocy/insanity." Yet, the US marshals who performed the census counts were given no instructions on how to make such classifications. Nevertheless, enumerations of the mentally ill and the "mentally retarded" were included in the six US censuses between 1840 and 1890.

With time, classifications of mental illness evolved. In 1888, the Report on the Defective, Dependent, and Delinquent Classes of the Population of the United States, as Returned at the Tenth Census was published. The report defined seven categories of mental illness: dementia, dipsomania, epilepsy, mania, melancholia, monomania, and paresis. These definitions were soon adopted by the fledgling American Medico-Psychological Association (AMPA), which in 1921 would change its name to the American Psychiatric Association.

The number of diagnoses grew to 22 in 1917, when the AMPA, in conjunction with the National Commission on Mental Hygiene, published the so-called Statistical Manual for the Use of Institutions for the Insane . During World War II, the US Army developed its own classification system, Medical 203 , which addressed the needs of service members with symptoms of mental illness.

Medical 203 was one of the first classification systems to embrace the concept that life circumstances and stressful events could lead to mental illness. The document, issued in 1943 under the auspices of the Office of the Surgeon General, ultimately comprised 52 disorders, categorized into five main categories.

A Modern Manual

The first iteration of the DSM, DSM-I, was published in 1952 after the APA Committee on Nomenclature and Statistics was charged with developing a version of Medical 203 that would standardize the usage of its predecessors. To do so, the APA implemented a process that has resonated through subsequent versions of the document and that led to much of its criticisms: it circulated its proposed changes to approximately 10% of the association's members for their approval or disapproval and listed 106 mental disorders, including several categories of "personality disturbance" and "neurosis."

"One of the strangely unscientific aspects of the DSM is that it's largely the product of horse trading," explained Edward Shorter, PhD, Jason A. Hannah Professor of the History of Medicine and professor of psychiatry at the University of Toronto, Toronto, Canada. "People sit down around a big table and say, 'I'll give you your diagnosis if you give me mine.'

"This is a totally unscientific way of doing business," he continued. "We didn't come up with the speed of light by having a consensus conference, and it's not how psychiatric science should be conducted, either. To think that this is responsible for the official psychiatry diagnostic manual is just gob smacking."

"The consensus diagnosis issue is a legitimate concern, but I don't think it's a fatal flaw," Lieberman noted. "Knowing the process intimately, the consensus method is only used in the absence of data, when you have to use clinical judgment. Because if there's no data, then what methods do you use?"

It would be 16 years before the APA released a second version, DSM-II, which was published in 1968. Although the document expanded the number of disorders to 182, it was otherwise similar to its predecessor.

Although from 1952 to 1968, the DSM had come to assume a more important role in the practice of psychiatry, the document was still little more than a reference guide during its first two decades. That all changed in the early 1970s, when the manual crossed paths with Robert Spitzer, MD, who, through his work with the DSM, would go on to become one of the most influential psychiatrists of the 20th century.

In 1974, Spitzer, along with Joseph L. Fleiss, PhD, wrote an article asserting that DSM-II was an unreliable diagnostic tool. Among other things, the authors found that practitioners who used DSM-II rarely agreed when diagnosing patients who had similar symptoms, a phenomenon the military had recognized years before. During World War II, for example, military officials observed that rejection rates for would-be soldiers varied widely between states. Upon closer examination, it was found that psychiatrists responsible for making these decisions used widely divergent diagnostic criteria.

Several years later, in 1949, a study demonstrated that three psychiatrists could offer widely disparate diagnoses of the same patient. These findings were corroborated in a 1962 article by Beck and colleagues, who found very low rates of diagnostic agreement among clinicians.

So when Spitzer was appointed to chair the task force charged with revising DSM-II in 1974, it came as little surprise that one of his primary goals would be to improve the document's reliability. Among other things, Spitzer sought to bolster the uniformity and validity of psychiatric diagnoses.

Spitzer was not alone in his beliefs. As part of the revision, he established 25 committees to tackle the process, a vast cadre of people who believed psychiatry could be improved through science. Yet, despite their ideals, Spitzer and his colleagues were hamstrung by a relative lack of systematic research in the field. That, however, did not stop them from meeting regularly to devise more specific and comprehensive descriptions of mental disorders.

"American psychiatry was dominated by the analysts right up until the 1970s," Shorter explained. "DSM-III was a real game changer. It was produced by a task force that had no interest in psychoanalysis at all. They claimed to be ideology free, though in fact they were quite committed to biological concepts of illness and drug treatment.

"And the disease classification they came up with was a striking departure from what had gone before," Shorter told Medscape Medical News.

"DSM-III was a pivotal transition point for psychiatry, where it moved from an arbitrary theory- and opinion-driven discipline to something that was regimented, systematized, and meticulously defined," Lieberman added.

Revolution or Rehash?

Although DSM-III would be heralded as constituting a revolution in the field of psychiatry, its development was not without controversy. Chief among the issues was the proposed deletion of the concept of neurosis, which had been a mainstream of psychoanalytic therapy for generations and was cited frequently in both DSM-I and DSM-II.

Nevertheless, Spitzer and his colleagues saw the concept as vague and unscientific. After significant pressure and months of debate, they eventually reached a compromise ― the word "neurosis" appeared parenthetically, and only a handful of times. Importantly, the manual also addressed the concept of homosexuality. The DSM-II category "sexual orientation disturbance" was changed to "ego-dystonic homosexuality." This change was largely the result of protests by gay rights activists against the APA, which began in 1970.

When it was finally published in 1980, the DSM-III was nearly 500 pages long and boasted 265 diagnostic categories, a vast departure from its predecessors. Yet, Spitzer's efforts did much more than increase the DSM's girth. For the first time, the manual was deemed scientifically sound, a development that led to worldwide acceptance by psychiatrists and psychiatric institutions and, importantly, many insurers.

"DSM-III was very popular at the time, because psychiatry was moving from a psychoanalytic orientation to drug treatment," said S. Nassir Ghaemi, MD, MPH, author and psychiatrist at Harvard University and Tufts University in Boston, Massachusetts. "The psychoanalytic approach didn't really need rigorous diagnosis you were dealing more with emotions and psychological constructs. But for drugs, people felt a need for more than just symptoms."

That may not have been the official rationale for the massive changes in DSM-III, but Ghaemi says it was one of the main reasons the manual was so quickly adopted by clinicians and insurers. Nevertheless, he sees the manual as a victim of its own success.

"It was so popular that it became a bible," he told Medscape Medical News. "We've created a bunch of terms ― most of which were created out of the blue with no scientific rationale ― but just because we would all agree on the definitions. And now we act as if they were handed down by God himself and can never be changed. And that's essentially what's happened in the last 40 years."

Spitzer, who died in 2016, may not have agreed. Both he and the APA truly believed DSM-III was a more scientifically sound, reliable version of its former self. Nevertheless, these beliefs could not withstand rigorous scientific analysis. In a notable 1992 study of DSM-III's test-retest reliability, Janet B. Williams, DSW, and colleagues (Spitzer was also an author of the article) found that for the latest edition, the kappa values ― which express the extent of agreement between two clinicians diagnosing the same patient ― were not much different from those reported in the pre-DSM-III studies.

In 1987, under Spitzer's guidance, a revised version of the document (DSM-III-R) was published. Among its many changes was the removal of "ego-dystonic homosexuality," a diagnosis largely subsumed under "sexual disorder not otherwise specified."

But when the APA decided to publish DSM-IV, it was not Spitzer who chaired the task force but rather renowned psychiatrist Allen Frances, MD, chairman of the Department of Psychiatry at Duke University, Durham, North Carolina. Although Frances sought to rein in the addition of new mental disorders, the DSM nevertheless continued to expand. Published in 1994, the DSM-IV boasted 886 pages and 410 disorders. Such an expansion required considerable effort. The task force was overseen by a steering committee of 27 people, which created 13 work groups with from five to 16 members, plus as many as 20 advisers. Six years later, a so-called "text revision" of DSM-IV was published ― DSM-IV-TR.

Almost 20 years later, in 2013, the latest version of the DSM ― DSM-5 ― was published. Although this edition is characterized by several notable clinical changes, including deletion of the five subtypes of schizophrenia and autistic spectrum disorder, it was the political and social climate surrounding its publication that underscored its significance.

In a blog post, Thomas R. Insel, MD, who was then director of the National Institute of Mental Health (NIMH), was critical of the manual and called for the NIMH to stop funding research projects that relied exclusively on DSM-5 criteria, citing the manual's "lack of validity." Two weeks later, he backed away from those comments and issued a joint statement with Lieberman ― who was APA's president-elect at the time ― that the DSM "represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care."

"We never stopped funding DSM-based research," said Bruce N. Cuthbert, PhD, who heads the Research Domain Criteria (RDoC) unit at the NIMH. "In fact, about 50% of our grant applications that get funded are pure DSM disorders, like they always were."

Even before its 2013 publication, there was a flood of criticism of DSM-5. In 2011, for instance, a vocal group of psychologists decried its proposed revisions, saying it would create a culture in which otherwise healthy people would be overdiagnosed and overtreated. The Society for Humanistic Psychology ― a division of the American Psychological Association ― collected thousands of signatures on a petition in response to what it claimed was a dangerous broadening of the definition of many mental disorders, a phenomenon it believed could lead to overtreatment with pharmaceuticals.

Some criticism came from unexpected sources, including DSM-IV's chair, Frances. In a December 2012 blog post in Psychology Today, Frances said the APA's approval of DSM-5 was the "saddest moment" in his lengthy career of studying, practicing, and teaching psychiatry. He went on to note that the revision was "deeply flawed" and contained a number of changes that seemed "clearly unsafe and scientifically unsound."

In highlighting several DSM-5 changes that he said "make no sense," Frances advised clinicians to cast a critical eye toward the book and use it as a guide rather than a bible.

Interestingly, this approach is espoused by John Talbott, MD, professor emeritus of psychiatry at the University of Maryland School of Medicine, Baltimore, and former president of the APA. Talbott, who has practiced for more than 50 years, said, "If you let the specifics of the DSM tie you down, it prevents you from practicing the art of medicine. So I would hope people would not be bound by it but be flexible and use their clinical judgment instead."

The Future of Psychiatric Diagnosis

So what does the future hold for the DSM? If the past is any predictor, then the answer could be more of the same, particularly with respect to how the APA determines diagnoses. Nevertheless, the association says some aspects of the book will be different going forward. Observers noted that with DSM-5, the edition number was indicated by an Arabic number rather than a Roman numeral. The APA says that that will facilitate more frequent revisions of the DSM. So it's possible there will be a DSM-5.1 before there is a DSM-6.

"After publication of DSM-5, the APA decided to shift the model of revision that had existed until that point in time," said Paul S. Appelbaum, MD, professor of psychiatry at the New York State Psychiatric Institute, New York City, who is a former APA president. "Previously, revisions took place periodically, when the entire manual was put into play at the same time.

"Now the model is one of ongoing iterative revision, as warranted by the advances in the field for a particular diagnosis." As chair of the DSM Steering Committee, Appelbaum oversees that process, one that he intends to make more rapid, efficient ― and inclusive ― than previous revisions have been.

"Anybody who has an interest in psychiatric diagnosis and believes that they have data to support a change can submit a proposal," he told Medscape. "These proposals are initially reviewed by the steering committee. If they pass the first level of screening, they will be sent to one of five review committees, which undertakes a more detailed review and makes a recommendation for approval or disapproval." After going back to the steering committee for approval or disapproval, the proposed change will be made available for public input. The proposed changes will go back to the steering committee and will go through the APA's traditional approval process via the APA assembly and, finally, the APA board.

In contrast to previous iterations of the DSM, these changes will be made immediately to the online version, which Appelbaum said will be the "canonical version" at any point in time. "And the further out you get from any hardcopy edition, the more important it is to consult the online version to ensure that there have not been substantial changes." he added.

In the meantime, potential alternatives to the DSM are being explored, including the Research Domain Criteria. When created in 2009, the RDoC ― a research framework for investigating mental disorders ― was largely the basis for Insel's passionate criticism of the DSM. Now, however, the NIMH makes it clear that RDoC is not intended to be a diagnostic guide or to replace current diagnostic systems. Instead, the website states the goal of the RDoC "is to understand the nature of mental health and illness in terms of varying degrees of dysfunction in general psychological/biological systems."

"There's an increasing amount of enthusiasm for this approach, both in the United States and internationally," said Cuthbert. "And it's useful to know that we're not the only group working on alternatives to the DSM."

RDoC's current focus is on research, not diagnosis. "In 2020, we still use that same system," said Cuthbert. "What's different is that people are now looking at different research efforts. And we like to think that one of the real contributions of RDoC has been to really open up the field just as we hoped for: looking at the study of mental disorders in different ways. So even though there's a lot of research going on and we're talking about different ways we can move forward, for the moment in 2020, the DSM is still the manual."

Creators of other tools seem more open about the desire to address the perceived shortcomings of the DSM. In 2017, an international team of 33 authors wrote an article describing the Hierarchical Taxonomy of Psychopathology (HiTOP). HiTOP proposes to address the reliability and validity problems of traditional taxonomies in several ways, including viewing mental health as a spectrum between pathology and normality. Importantly, HiTOP simplifies its classifications by clarifying psychopathology dimensions at multiple levels of hierarchy. Perhaps most importantly, HiTOP aims to adhere to the latest scientific evidence rather than rely on expert opinion.

Although for many of DSM's critics, HiTOP might represent a step ahead, some clinicians still think the best strategy is to start from scratch.

Count among these Ghaemi, who has been one of the DSM's most vocal opponents. "I think the alternative would be to simply base diagnostic criteria on our best research, end of story, no further discussion," he said.

"So if our best research shows that a 2-month-old should get diagnosed with bipolar disorder, then we should do it, even if we don't like it," he said.

One of Ghaemi's suggestions for replacing DSM is to go back to the diagnostic criteria popularized in the 1970s. "Back then, there were about 20 diagnoses with enough scientific research to back them up. DSM-III took those 20 and it added about another 270 others to it, most of which were just based on clinical belief.

"So my view would be to get rid of the ones that are based on clinical belief and leave the ones that are based on research criteria," he says.

Another option, Ghaemi added, is to simply use nothing. "No other specialty in medicine has its professional organization defining the criteria for every single diagnosis in that specialty. Psychiatry is the only one," he said.

Shorter agrees. "I think nosology should be taken out of the hands of the APA ― which is a professional guild, not a scientific organization ― and given to a scientific organization, such as the Karolinska Institute or the NIMH, and start again from the ground up.

"In other words, there should not be a DSM," Shorter added. "The whole concept of how we classify illness needs an entirely new goal, with entirely new people at the helm."

Not surprisingly, Lieberman takes a more tempered view of the issue. "If somebody has something better, please publish it or bring it forward," he said. "But to say, 'This is terrible and we're not going to use it,' well, that's just self-defeating."

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Medscape Medical News © 2020

Cite this: The Past, Present, and Future of the DSM - Medscape - Dec 15, 2020.


If you are working in any field that involves human behavior, sooner or later you will need to cite the Diagnostic and Statistical Manual of Mental Disorders (DSM). Published by the American Psychiatric Association (a.k.a. “the other APA”), the DSM provides a set of common criteria and language for talking about dysfunctions of the mind and emotions. From the beginning, the DSM has been widely used as a guide by state and federal agencies for the reporting of public health statistics and the fulfillment of legislative mandates, as well as its use as a classification guide for research and clinical psychologists. The DSM has gone through five revisions since it was first published in 1952, and each of those revisions has included substantial changes in structure and definitions. Some of these have been fairly controversial, such as the attempt to remove the term neurosis from DSM-III and the varying treatment of sexual disorders. A new edition (DSM-5) is in preparation, with a projected release date of May 2013, and major changes have been proposed for it as well. Because of these changes and their effects on areas as disparate as longitudinal research parameters and health insurance benefits, it’s important to be precise when citing the DSM. Below are some guidelines to use in citing the most recent edition.

Citation Examples

When a DOI is available, provide it after the publisher information. Individual chapters and other book parts are also assigned DOIs.

In text, cite the name of the association and the name of the manual in full at the first mention in the text thereafter, you may refer to the traditional DSM form (italicized) as follows:

After you have spelled out the name of the manual on first mention in the text, format the parenthetical citation as follows:

What About DSM-5?

The DSM-5 hasn’t been released yet, but there’s been much discussion of the proposed content. If necessary, refer to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. DSM-5) in text when you cite these discussions. We’ll be back in May 2013 with tips on how to cite the DSM-5 itself, so mark your calendar!

UPDATE: DSM-5 has arrived! Go here for information on how to cite it.

Comments

If you are working in any field that involves human behavior, sooner or later you will need to cite the Diagnostic and Statistical Manual of Mental Disorders (DSM). Published by the American Psychiatric Association (a.k.a. “the other APA”), the DSM provides a set of common criteria and language for talking about dysfunctions of the mind and emotions.

From the beginning, the DSM has been widely used as a guide by state and federal agencies for the reporting of public health statistics and the fulfillment of legislative mandates, as well as its use as a classification guide for research and clinical psychologists.

The DSM has gone through five revisions since it was first published in 1952, and each of those revisions has included substantial changes in structure and definitions. Some of these have been fairly controversial, such as the attempt to remove the term neurosis from DSM-III and the varying treatment of sexual disorders. A new edition (DSM-5) is in preparation, with a projected release date of May 2013, and major changes have been proposed for it as well.

Because of these changes and their effects on areas as disparate as longitudinal research parameters and health insurance benefits, it’s important to be precise when citing the DSM. Below are some guidelines to use in citing the most recent edition.

Citation Examples

When a DOI is available, provide it after the publisher information. Individual chapters and other book parts are also assigned DOIs.

In text, cite the name of the association and the name of the manual in full at the first mention in the text thereafter, you may refer to the traditional DSM form (italicized) as follows:

After you have spelled out the name of the manual on first mention in the text, format the parenthetical citation as follows:

What About DSM-5?

The DSM-5 hasn’t been released yet, but there’s been much discussion of the proposed content. If necessary, refer to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. DSM-5) in text when you cite these discussions. We’ll be back in May 2013 with tips on how to cite the DSM-5 itself, so mark your calendar!

UPDATE: DSM-5 has arrived! Go here for information on how to cite it.


Theoretical Evaluation

Theoretical Evaluation

This caregiver sensitivity theory is supported by research from, Wolff and Van Ijzendoorn (1997) who conducted a Meta-analysis (a review) of research into attachment types.

They found that there is a relatively weak correlation of 0.24 between parental sensitivity and attachment type – generally more sensitive parents had securely attached children.

However, in evaluation, critics of this theory argue that the correlation between parental sensitivity and the child’s attachment type is only weak. This suggests that there are other reasons which may better explain why children develop different attachment types and that the maternal sensitivity theory places too much emphasis on the mother.

Focusing just on maternal sensitivity when trying to explain why children have different attachment types is, therefore, a reductionist approach.

An alternative theory proposed by Kagan (1984) suggests that the temperament of the child is actually what leads to the different attachment types. Children with different innate (inborn) temperaments will have different attachment types.

This theory is supported by research from Fox (1989) who found that babies with an ‘Easy’ temperament (those who eat and sleep regularly, and accept new experiences) are likely to develop secure attachments.

Babies with a ‘slow to warm up’ temperament (those who took a while to get used to new experiences) are likely to have insecure-avoidant attachments. Babies with a ‘Difficult’ temperament (those who eat and sleep irregularly and who reject new experiences) are likely to have insecure-ambivalent attachments.

In conclusion, the most complete explanation of why children develop different attachment types would be an interactionist theory. This would argue that a child’s attachment type is a result of a combination of factors – both the child’s innate temperament and their parent’s sensitivity towards their needs.

Belsky and Rovine (1987) propose an interesting interactionist theory to explain the different attachment types. They argue that the child’s attachment type is a result of both the child’s innate temperament and also how the parent responds to them (i.e., the parents’ sensitivity level).

Additionally, the child’s innate temperament may, in fact, influence the way their parent responds to them (i.e, the infants’ temperament influences the parental sensitivity shown to them). To develop a secure attachment, a ‘difficult’ child would need a caregiver who is sensitive and patient for a secure attachment to develop.


Stemming social phobia

Psychologist Richard Heimberg seeks to improve the staying power of social phobia treatments by combining therapy with medication.

July/August 2005, Vol 36, No. 7

As a graduate student at Florida State University, Richard Heimberg, PhD, was fascinated by the effects of people's intense social anxiety on their relationships. However, in the 1970s, no name existed for this type of anxiety, and Heimberg says many people wrote it off as shyness or a personality trait.

After all, many people get a little anxious when delivering a speech to a crowd. But it's the more severe cases that cause Heimberg concern--when those fears of being judged by others become so persistent and intense that they extend to almost all social situations, from informal conversations to eating in public. People diagnosed with the condition, social phobia--also known as social anxiety disorder--may avoid many social situations out of fear that others will notice something unusual about them, like their shaking hands or blushing, and that their actions will embarrass or humiliate them.

To help them overcome the condition, Heimberg, a Temple University psychology professor, has made studying the origins of and treatments for social phobia his life's work.

In 1983, he became the first researcher to receive National Institute of Mental Health (NIMH) funding to study psychosocial treatments for social phobia after the term first appeared in the third edition of the Diagnostic Statistical Manual of Mental Disorders in 1980 (DSM-III).

"Dr. Heimberg has made huge contributions to social phobia research, developing a cognitive-behavioral treatment for social phobia and carrying out numerous randomized controlled trials that have demonstrated its effectiveness," says psychologist Jacqueline Persons, PhD, a former president of the Association for Advancement of Behavior Therapy (AABT) who served with Heimberg on the AABT board. "He has made important contributions to alleviate a great deal of suffering."

Since Heimberg secured the first NIMH social phobia treatment research grant, such funding has been readily available because the condition is quite common: It's the third most prevalent mental disorder behind depression and alcoholism. About 5.3 million American adults have social phobia, which usually begins in childhood or adolescence, according to NIMH.

For many social phobics, preoccupation with what others think may interfere in their job, school, relationships or other social activities.

"Everyday interactions can become very problematic for people with social anxiety disorder," says Heimberg who, as director of Temple University's Adult Anxiety Clinic, helps people change their thought processes in such interactions using cognitive-behavioral therapy (CBT) and medication. The treatment also encourages clients to expose themselves gradually to feared events.

A debilitating disorder

Since 1983, Heimberg has conducted a series of NIMH-funded studies on social phobia. Most recently, he received a $1.2 million, four-year NIMH grant--which he's in the second year of--to investigate whether the addition of CBT to medication treatments can help prevent patients' relapse.

Through his 20-plus years of research, Heimberg has found that nearly everyone fears social situations to some degree.

"Some people just think they are shy--that it's a personality trait--and that's just the way they are," says Heimberg. "But. if a person starts fearing many social situations, [and as a result] lives alone or drops out of school, that's not shyness--that's an impairment."

What's more, notes Heimberg, social phobia is generally more debilitating than phobias focused on singular circumstances, such as a fear of thunderstorms or animals. "If you are afraid of interacting with people, that can mess you up wherever you turn," he says. "It can have very broad mental health implications."

Heimberg also notes two subtypes of social phobia. For people with a "generalized" type, the social anxiety ranges across a broad number of social interactions for those with a "specific" type, the anxiety involves only one or a few social encounters, such as public speaking or eating in public.

Therapy's staying power

The trouble is, despite the proven efficacy of treatment, many social phobics shy away from it, according to Heimberg's research. For example, he found that 92 percent of people who were accessing information on social phobia on an anxiety clinic Web site met criteria for social anxiety disorder. Yet, only about 36 percent of the respondents reported receiving psychotherapy 35 percent reported taking medication for social anxiety disorder, according to a study by Heimberg and psychologists Brigette Erwin, PhD, Cynthia Turk, PhD, David Fresco, PhD, and Donald Hantula, PhD, in the 2004 issue of the Journal of Anxiety Disorders (Vol. 18, No. 5, pages 629-646).

But, with CBT treatment or antidepressant medication, about 80 percent of social phobics can alleviate their symptoms, Heimberg says. What's more, clients who receive CBT treatment remain improved five years later, whereas clients who receive only medication treatment are more likely to relapse than clients receiving CBT, according to Heimberg's 1998 study in the Archives of General Psychiatry (Vol. 55, No. 12, pages 1,133-1,141).

However, Heimberg suspects a combination of CBT and medication may prove most effective in preventing relapse--something he hopes to prove in his latest NIMH study with Michael Liebowitz, MD, of the New York State Psychiatric Institute, to be completed by 2007.

Heimberg is providing participants with a 28-week treatment program that includes medication--in this case, the antidepressant Paxil--and some patients then receive 16 sessions of CBT. Each session helps clients to evaluate their thought processes more critically, such as by filtering out automatic thoughts that others judge them negatively in social interactions. The client and therapist also role-play social interactions to provide the client with confidence they can take into real-world situations. In Heimberg's CBT, the therapist gradually exposes clients to their feared social situations in real life, perhaps assigning a client to initiate a conversation with a person they don't know, ask someone out on a date or go on a job interview.

"They start going into social situations that have made them tense a thousand times before, but the trick now is that they are doing it. with coping skills that will help them turn defeat into victory," Heimberg says.


The search terms for MEDLINE will be as follows:

exp personality disorders/

exp anankastic personality disorder

exp obsessive compulsive personality disorder/

exp compulsive personality disorder/

exp passive-aggressive personality disorder/

anal retentive or anal character

We will search MEDLINE in combination with the Cochrane Collaboration’s search strategy for identifying reports of controlled trials as detailed in Section 6.4.11 of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2008).

We will develop similar strategies to identify participants and controlled trials for the other databases.


  • 1950s: South African psychiatrist Joseph Wolpe paved the way for later advances in behavioral therapy for phobias through his work developing systematic desensitization techniques.
  • 1960s: British psychiatrist Isaac Marks proposed that social phobias be considered a distinct category separate from other simple phobias.
  • 1967: Barbra Streisand forgot the lyrics to a song while singing in Central Park, which she attributed to anxiety that she later received treatment for.
  • 1968: In the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II), published by the American Psychiatric Association, social fears were described as a specific phobia of social situations or excessive fear of being observed or scrutinized by others. At this point in history, the definition of social phobia was very narrow.
  • 1980: In the third edition of the DSM (DSM-III), social phobia was included as an official psychiatric diagnosis. In this edition, social phobia was described as a fear of performance situations and did not include fears of less formal situations such as casual conversations. People with such broad fears were more likely to be diagnosed with avoidant personality disorder (which could not be diagnosed at the same time as social phobia).
  • 1985: Psychiatrist Michael Liebowitz and clinical psychologist Richard Heimberg initiated a call to action for research on social phobia. Up to this point, research on the disorder had been lacking, leading some to refer to it as the "neglected anxiety disorder."
  • 1987: A revision to the DSM-III lead to changes in some of the diagnostic criteria. A diagnosis now required that the symptoms cause "interference or marked distress" rather than simply "significant distress." It was also now possible to diagnose social phobia and avoidant personality disorder in the same patient. Finally, the term "generalized social phobia," referring to a more severe and pervasive form of the disorder, was introduced.
  • 1990s: Donny Osmond suffered from severe stage fright while performing in Joseph and the Amazing Technicolor Dreamcoat.
  • 1994: The DSM-IV was published and the term social anxiety disorder (SAD) replaced social phobia. This new term was used to refer to how broad and generalized fears are in the disorder. In this new edition, the disorder was defined as a "marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others." The diagnostic criteria were only slightly modified from the DSM-III-R.

Day and month of 1980 DSM-III publication - Psychology

Development of the DSM-III and DSM-III-R

The DSM-III began being created in 1974 and was published in 1980( American Psychiatric Association), and it contained many drastic changes from the DSM-II, which made it a controversial topic among mental health professionals. You can imagine the surprise when the DSM-III came out with 494 pages, compared to the 134 pages in the DSM-II. While the DSM-III was taken critically by many professionals at the time, we will see how it had a long standing effect on the way we diagnose mental disorders today.

The purpose of the DSM-II was primarily to provide a way for psychologists to keep records of their patient’s diagnoses, and to provide the mental health professionals with brief descriptions of the 83 mental disorders that were listed within the DSM-II. In contrast, the DSM-III provided a multi-axial system which provided a more comprehensive method of diagnosing, as well as giving in-depth descriptions of disorders with detailed diagnostic criteria. Some people felt that this took away from the “art” of psychology, by forcing mental health professional’s focus on diagnostic criteria, rather than their gut instinct. With this new in depth system of diagnosing, the DSM-III broke away from using the same diagnostic criteria as the World Health Organization used in their ICD-9, which coded mental disorders. This break away from the ICD-9 allowed mental health professionals to better diagnose patients by providing clearer diagnostic criteria (Spitzer, 2001).

The DSM- III contained 265 diagnoses, many of which were new to the DSM-III (http://kadi.myweb.uga.edu/The_Development_of_the_DSM.html). Many mental health professionals were starting to be frustrated by the fact that many of the disorders that they saw and treated were not actually listed as disorders in the DSM-II. Things such a Borderline Personality Disorder (BPD) and Post Traumatic Stress Disorder (PTSD) were not yet recognized as legitimate, diagnosable mental disorders. The developers of the DSM-III took these concerns into account, and had mental health professionals provide what they considered to be symptoms of these disorders, and looked to see if a reliable and valid diagnosis could be made for these disorders that were being requested to be put in. Disorders such as PTSD and BPD made it into the DSM-III, while other suggestions, such as the Atypical Child, did not. Another significant change to the DSM-III was the removal of homosexuality as a mental illness, which was a very controversial topic as well. (Spitzer, 2001).

Due to the many problems and critical reviews that the DSM-III received, a revised edition, the DSM-III-R was released only seven years after the DSM-III in 1987. Initially, the idea behind the DSM-III-R was for it to be a follow up guide to the DSM-III to assist it’s users in properly diagnosing patients. However, the DSM-III-R ended up being so different from the DSM-III, and contained 32 new disorders that it could easily be considered a whole new DSM edition. ( University of Georgia).


A Historical Timeline of Modern Psychology

Emily is a fact checker, editor, and writer who has expertise in psychology content.

The timeline of psychology spans centuries, with the earliest known mention of clinical depression in 1500 BCE on an ancient Egyptian manuscript known as the Ebers Papyrus.   However, it was not until the 11th century that the Persian physician Avicenna attributed a connection between emotions and physical responses in a practice roughly dubbed "physiological psychology."

Some consider the 17th and 18th centuries the birth of modern psychology (largely characterized by the publication of William Battie's "Treatise on Madness" in 1758).   Others consider the mid-19th century experiments done in Hermann von Helmholtz's lab to be the start of modern psychology.

Many say that 1879, when Wilhelm Wundt established the first experimental psychology lab, was the true beginning of psychology as we know it. From that moment forward, the study of psychology would continue to evolve as it does today. Highlighting that transformation were a number of important, landmark events.


The Past, Present, and Future of the DSM

At nearly a thousand pages long and weighing more than 3 lb, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, otherwise known as the DSM-5, is by most estimations a considerable tome. Yet the weight of the DSM transcends its mere dimensions. Since first published in 1952, psychiatry's "bible," as it's often called, has been both a boon and a bust to its publisher, the American Psychiatric Association (APA). It's provided guidance to mental health professionals ― not to mention plenty of revenue to the country's leading psychiatry association ― yet has also served as a whipping post for those who see the book as outdated, unscientific, and dogmatic.

"It's easy to criticize the DSM," said Jeffrey A. Lieberman, MD, professor and chair of psychiatry at Columbia University College of Physicians and Surgeons in New York City. "But at this point, it represents a system that is as good as we can have, given our current state of knowledge.

"Is it ideal?" asked Lieberman, who served as APA president from May 2013 to May 2014. "By no means. But there's no better alternative. Hopefully, research will soon enable modifications that will lead to pathologic diagnostic assessments, like every other field of medicine has."

Others take a more cynical view of the manual. "What the DSM does successfully is provide a cultural anthropology of mental suffering," said Gary Greenberg, PhD, a Connecticut-based psychologist and author of The Book of Woe: The DSM And The Unmaking Of Psychiatry.

Yet, it's this provision that also makes Greenberg uncomfortable with the book. The way he sees it, the DSM is as much the product of politics, history, and society as it is of science.

"The categories into which the DSM sorts disorders and the criteria it provides for them are themselves artifacts of society," he told Medscape Medical News. "The APA is part of that social organization."

The origins of the DSM date to the 1800s, when the United States began collecting statistical information on its citizens. Reflecting a growing concern at the time for the mentally ill and a desire to classify mental disorders, the 1849 census incorporated a category for "idiocy/insanity." Yet, the US marshals who performed the census counts were given no instructions on how to make such classifications. Nevertheless, enumerations of the mentally ill and the "mentally retarded" were included in the six US censuses between 1840 and 1890.

With time, classifications of mental illness evolved. In 1888, the Report on the Defective, Dependent, and Delinquent Classes of the Population of the United States, as Returned at the Tenth Census was published. The report defined seven categories of mental illness: dementia, dipsomania, epilepsy, mania, melancholia, monomania, and paresis. These definitions were soon adopted by the fledgling American Medico-Psychological Association (AMPA), which in 1921 would change its name to the American Psychiatric Association.

The number of diagnoses grew to 22 in 1917, when the AMPA, in conjunction with the National Commission on Mental Hygiene, published the so-called Statistical Manual for the Use of Institutions for the Insane . During World War II, the US Army developed its own classification system, Medical 203 , which addressed the needs of service members with symptoms of mental illness.

Medical 203 was one of the first classification systems to embrace the concept that life circumstances and stressful events could lead to mental illness. The document, issued in 1943 under the auspices of the Office of the Surgeon General, ultimately comprised 52 disorders, categorized into five main categories.

A Modern Manual

The first iteration of the DSM, DSM-I, was published in 1952 after the APA Committee on Nomenclature and Statistics was charged with developing a version of Medical 203 that would standardize the usage of its predecessors. To do so, the APA implemented a process that has resonated through subsequent versions of the document and that led to much of its criticisms: it circulated its proposed changes to approximately 10% of the association's members for their approval or disapproval and listed 106 mental disorders, including several categories of "personality disturbance" and "neurosis."

"One of the strangely unscientific aspects of the DSM is that it's largely the product of horse trading," explained Edward Shorter, PhD, Jason A. Hannah Professor of the History of Medicine and professor of psychiatry at the University of Toronto, Toronto, Canada. "People sit down around a big table and say, 'I'll give you your diagnosis if you give me mine.'

"This is a totally unscientific way of doing business," he continued. "We didn't come up with the speed of light by having a consensus conference, and it's not how psychiatric science should be conducted, either. To think that this is responsible for the official psychiatry diagnostic manual is just gob smacking."

"The consensus diagnosis issue is a legitimate concern, but I don't think it's a fatal flaw," Lieberman noted. "Knowing the process intimately, the consensus method is only used in the absence of data, when you have to use clinical judgment. Because if there's no data, then what methods do you use?"

It would be 16 years before the APA released a second version, DSM-II, which was published in 1968. Although the document expanded the number of disorders to 182, it was otherwise similar to its predecessor.

Although from 1952 to 1968, the DSM had come to assume a more important role in the practice of psychiatry, the document was still little more than a reference guide during its first two decades. That all changed in the early 1970s, when the manual crossed paths with Robert Spitzer, MD, who, through his work with the DSM, would go on to become one of the most influential psychiatrists of the 20th century.

In 1974, Spitzer, along with Joseph L. Fleiss, PhD, wrote an article asserting that DSM-II was an unreliable diagnostic tool. Among other things, the authors found that practitioners who used DSM-II rarely agreed when diagnosing patients who had similar symptoms, a phenomenon the military had recognized years before. During World War II, for example, military officials observed that rejection rates for would-be soldiers varied widely between states. Upon closer examination, it was found that psychiatrists responsible for making these decisions used widely divergent diagnostic criteria.

Several years later, in 1949, a study demonstrated that three psychiatrists could offer widely disparate diagnoses of the same patient. These findings were corroborated in a 1962 article by Beck and colleagues, who found very low rates of diagnostic agreement among clinicians.

So when Spitzer was appointed to chair the task force charged with revising DSM-II in 1974, it came as little surprise that one of his primary goals would be to improve the document's reliability. Among other things, Spitzer sought to bolster the uniformity and validity of psychiatric diagnoses.

Spitzer was not alone in his beliefs. As part of the revision, he established 25 committees to tackle the process, a vast cadre of people who believed psychiatry could be improved through science. Yet, despite their ideals, Spitzer and his colleagues were hamstrung by a relative lack of systematic research in the field. That, however, did not stop them from meeting regularly to devise more specific and comprehensive descriptions of mental disorders.

"American psychiatry was dominated by the analysts right up until the 1970s," Shorter explained. "DSM-III was a real game changer. It was produced by a task force that had no interest in psychoanalysis at all. They claimed to be ideology free, though in fact they were quite committed to biological concepts of illness and drug treatment.

"And the disease classification they came up with was a striking departure from what had gone before," Shorter told Medscape Medical News.

"DSM-III was a pivotal transition point for psychiatry, where it moved from an arbitrary theory- and opinion-driven discipline to something that was regimented, systematized, and meticulously defined," Lieberman added.

Revolution or Rehash?

Although DSM-III would be heralded as constituting a revolution in the field of psychiatry, its development was not without controversy. Chief among the issues was the proposed deletion of the concept of neurosis, which had been a mainstream of psychoanalytic therapy for generations and was cited frequently in both DSM-I and DSM-II.

Nevertheless, Spitzer and his colleagues saw the concept as vague and unscientific. After significant pressure and months of debate, they eventually reached a compromise ― the word "neurosis" appeared parenthetically, and only a handful of times. Importantly, the manual also addressed the concept of homosexuality. The DSM-II category "sexual orientation disturbance" was changed to "ego-dystonic homosexuality." This change was largely the result of protests by gay rights activists against the APA, which began in 1970.

When it was finally published in 1980, the DSM-III was nearly 500 pages long and boasted 265 diagnostic categories, a vast departure from its predecessors. Yet, Spitzer's efforts did much more than increase the DSM's girth. For the first time, the manual was deemed scientifically sound, a development that led to worldwide acceptance by psychiatrists and psychiatric institutions and, importantly, many insurers.

"DSM-III was very popular at the time, because psychiatry was moving from a psychoanalytic orientation to drug treatment," said S. Nassir Ghaemi, MD, MPH, author and psychiatrist at Harvard University and Tufts University in Boston, Massachusetts. "The psychoanalytic approach didn't really need rigorous diagnosis you were dealing more with emotions and psychological constructs. But for drugs, people felt a need for more than just symptoms."

That may not have been the official rationale for the massive changes in DSM-III, but Ghaemi says it was one of the main reasons the manual was so quickly adopted by clinicians and insurers. Nevertheless, he sees the manual as a victim of its own success.

"It was so popular that it became a bible," he told Medscape Medical News. "We've created a bunch of terms ― most of which were created out of the blue with no scientific rationale ― but just because we would all agree on the definitions. And now we act as if they were handed down by God himself and can never be changed. And that's essentially what's happened in the last 40 years."

Spitzer, who died in 2016, may not have agreed. Both he and the APA truly believed DSM-III was a more scientifically sound, reliable version of its former self. Nevertheless, these beliefs could not withstand rigorous scientific analysis. In a notable 1992 study of DSM-III's test-retest reliability, Janet B. Williams, DSW, and colleagues (Spitzer was also an author of the article) found that for the latest edition, the kappa values ― which express the extent of agreement between two clinicians diagnosing the same patient ― were not much different from those reported in the pre-DSM-III studies.

In 1987, under Spitzer's guidance, a revised version of the document (DSM-III-R) was published. Among its many changes was the removal of "ego-dystonic homosexuality," a diagnosis largely subsumed under "sexual disorder not otherwise specified."

But when the APA decided to publish DSM-IV, it was not Spitzer who chaired the task force but rather renowned psychiatrist Allen Frances, MD, chairman of the Department of Psychiatry at Duke University, Durham, North Carolina. Although Frances sought to rein in the addition of new mental disorders, the DSM nevertheless continued to expand. Published in 1994, the DSM-IV boasted 886 pages and 410 disorders. Such an expansion required considerable effort. The task force was overseen by a steering committee of 27 people, which created 13 work groups with from five to 16 members, plus as many as 20 advisers. Six years later, a so-called "text revision" of DSM-IV was published ― DSM-IV-TR.

Almost 20 years later, in 2013, the latest version of the DSM ― DSM-5 ― was published. Although this edition is characterized by several notable clinical changes, including deletion of the five subtypes of schizophrenia and autistic spectrum disorder, it was the political and social climate surrounding its publication that underscored its significance.

In a blog post, Thomas R. Insel, MD, who was then director of the National Institute of Mental Health (NIMH), was critical of the manual and called for the NIMH to stop funding research projects that relied exclusively on DSM-5 criteria, citing the manual's "lack of validity." Two weeks later, he backed away from those comments and issued a joint statement with Lieberman ― who was APA's president-elect at the time ― that the DSM "represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care."

"We never stopped funding DSM-based research," said Bruce N. Cuthbert, PhD, who heads the Research Domain Criteria (RDoC) unit at the NIMH. "In fact, about 50% of our grant applications that get funded are pure DSM disorders, like they always were."

Even before its 2013 publication, there was a flood of criticism of DSM-5. In 2011, for instance, a vocal group of psychologists decried its proposed revisions, saying it would create a culture in which otherwise healthy people would be overdiagnosed and overtreated. The Society for Humanistic Psychology ― a division of the American Psychological Association ― collected thousands of signatures on a petition in response to what it claimed was a dangerous broadening of the definition of many mental disorders, a phenomenon it believed could lead to overtreatment with pharmaceuticals.

Some criticism came from unexpected sources, including DSM-IV's chair, Frances. In a December 2012 blog post in Psychology Today, Frances said the APA's approval of DSM-5 was the "saddest moment" in his lengthy career of studying, practicing, and teaching psychiatry. He went on to note that the revision was "deeply flawed" and contained a number of changes that seemed "clearly unsafe and scientifically unsound."

In highlighting several DSM-5 changes that he said "make no sense," Frances advised clinicians to cast a critical eye toward the book and use it as a guide rather than a bible.

Interestingly, this approach is espoused by John Talbott, MD, professor emeritus of psychiatry at the University of Maryland School of Medicine, Baltimore, and former president of the APA. Talbott, who has practiced for more than 50 years, said, "If you let the specifics of the DSM tie you down, it prevents you from practicing the art of medicine. So I would hope people would not be bound by it but be flexible and use their clinical judgment instead."

The Future of Psychiatric Diagnosis

So what does the future hold for the DSM? If the past is any predictor, then the answer could be more of the same, particularly with respect to how the APA determines diagnoses. Nevertheless, the association says some aspects of the book will be different going forward. Observers noted that with DSM-5, the edition number was indicated by an Arabic number rather than a Roman numeral. The APA says that that will facilitate more frequent revisions of the DSM. So it's possible there will be a DSM-5.1 before there is a DSM-6.

"After publication of DSM-5, the APA decided to shift the model of revision that had existed until that point in time," said Paul S. Appelbaum, MD, professor of psychiatry at the New York State Psychiatric Institute, New York City, who is a former APA president. "Previously, revisions took place periodically, when the entire manual was put into play at the same time.

"Now the model is one of ongoing iterative revision, as warranted by the advances in the field for a particular diagnosis." As chair of the DSM Steering Committee, Appelbaum oversees that process, one that he intends to make more rapid, efficient ― and inclusive ― than previous revisions have been.

"Anybody who has an interest in psychiatric diagnosis and believes that they have data to support a change can submit a proposal," he told Medscape. "These proposals are initially reviewed by the steering committee. If they pass the first level of screening, they will be sent to one of five review committees, which undertakes a more detailed review and makes a recommendation for approval or disapproval." After going back to the steering committee for approval or disapproval, the proposed change will be made available for public input. The proposed changes will go back to the steering committee and will go through the APA's traditional approval process via the APA assembly and, finally, the APA board.

In contrast to previous iterations of the DSM, these changes will be made immediately to the online version, which Appelbaum said will be the "canonical version" at any point in time. "And the further out you get from any hardcopy edition, the more important it is to consult the online version to ensure that there have not been substantial changes." he added.

In the meantime, potential alternatives to the DSM are being explored, including the Research Domain Criteria. When created in 2009, the RDoC ― a research framework for investigating mental disorders ― was largely the basis for Insel's passionate criticism of the DSM. Now, however, the NIMH makes it clear that RDoC is not intended to be a diagnostic guide or to replace current diagnostic systems. Instead, the website states the goal of the RDoC "is to understand the nature of mental health and illness in terms of varying degrees of dysfunction in general psychological/biological systems."

"There's an increasing amount of enthusiasm for this approach, both in the United States and internationally," said Cuthbert. "And it's useful to know that we're not the only group working on alternatives to the DSM."

RDoC's current focus is on research, not diagnosis. "In 2020, we still use that same system," said Cuthbert. "What's different is that people are now looking at different research efforts. And we like to think that one of the real contributions of RDoC has been to really open up the field just as we hoped for: looking at the study of mental disorders in different ways. So even though there's a lot of research going on and we're talking about different ways we can move forward, for the moment in 2020, the DSM is still the manual."

Creators of other tools seem more open about the desire to address the perceived shortcomings of the DSM. In 2017, an international team of 33 authors wrote an article describing the Hierarchical Taxonomy of Psychopathology (HiTOP). HiTOP proposes to address the reliability and validity problems of traditional taxonomies in several ways, including viewing mental health as a spectrum between pathology and normality. Importantly, HiTOP simplifies its classifications by clarifying psychopathology dimensions at multiple levels of hierarchy. Perhaps most importantly, HiTOP aims to adhere to the latest scientific evidence rather than rely on expert opinion.

Although for many of DSM's critics, HiTOP might represent a step ahead, some clinicians still think the best strategy is to start from scratch.

Count among these Ghaemi, who has been one of the DSM's most vocal opponents. "I think the alternative would be to simply base diagnostic criteria on our best research, end of story, no further discussion," he said.

"So if our best research shows that a 2-month-old should get diagnosed with bipolar disorder, then we should do it, even if we don't like it," he said.

One of Ghaemi's suggestions for replacing DSM is to go back to the diagnostic criteria popularized in the 1970s. "Back then, there were about 20 diagnoses with enough scientific research to back them up. DSM-III took those 20 and it added about another 270 others to it, most of which were just based on clinical belief.

"So my view would be to get rid of the ones that are based on clinical belief and leave the ones that are based on research criteria," he says.

Another option, Ghaemi added, is to simply use nothing. "No other specialty in medicine has its professional organization defining the criteria for every single diagnosis in that specialty. Psychiatry is the only one," he said.

Shorter agrees. "I think nosology should be taken out of the hands of the APA ― which is a professional guild, not a scientific organization ― and given to a scientific organization, such as the Karolinska Institute or the NIMH, and start again from the ground up.

"In other words, there should not be a DSM," Shorter added. "The whole concept of how we classify illness needs an entirely new goal, with entirely new people at the helm."

Not surprisingly, Lieberman takes a more tempered view of the issue. "If somebody has something better, please publish it or bring it forward," he said. "But to say, 'This is terrible and we're not going to use it,' well, that's just self-defeating."

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Cite this: The Past, Present, and Future of the DSM - Medscape - Dec 15, 2020.


  • 1950s: South African psychiatrist Joseph Wolpe paved the way for later advances in behavioral therapy for phobias through his work developing systematic desensitization techniques.
  • 1960s: British psychiatrist Isaac Marks proposed that social phobias be considered a distinct category separate from other simple phobias.
  • 1967: Barbra Streisand forgot the lyrics to a song while singing in Central Park, which she attributed to anxiety that she later received treatment for.
  • 1968: In the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II), published by the American Psychiatric Association, social fears were described as a specific phobia of social situations or excessive fear of being observed or scrutinized by others. At this point in history, the definition of social phobia was very narrow.
  • 1980: In the third edition of the DSM (DSM-III), social phobia was included as an official psychiatric diagnosis. In this edition, social phobia was described as a fear of performance situations and did not include fears of less formal situations such as casual conversations. People with such broad fears were more likely to be diagnosed with avoidant personality disorder (which could not be diagnosed at the same time as social phobia).
  • 1985: Psychiatrist Michael Liebowitz and clinical psychologist Richard Heimberg initiated a call to action for research on social phobia. Up to this point, research on the disorder had been lacking, leading some to refer to it as the "neglected anxiety disorder."
  • 1987: A revision to the DSM-III lead to changes in some of the diagnostic criteria. A diagnosis now required that the symptoms cause "interference or marked distress" rather than simply "significant distress." It was also now possible to diagnose social phobia and avoidant personality disorder in the same patient. Finally, the term "generalized social phobia," referring to a more severe and pervasive form of the disorder, was introduced.
  • 1990s: Donny Osmond suffered from severe stage fright while performing in Joseph and the Amazing Technicolor Dreamcoat.
  • 1994: The DSM-IV was published and the term social anxiety disorder (SAD) replaced social phobia. This new term was used to refer to how broad and generalized fears are in the disorder. In this new edition, the disorder was defined as a "marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others." The diagnostic criteria were only slightly modified from the DSM-III-R.

Day and month of 1980 DSM-III publication - Psychology

Timeline of Psychology (387BC to Present)

387 BC Plato suggested that the brain is the mechanism of mental processes.

335 BC Aristotle suggested that the heart is the mechanism of mental processes.

1774 AD Franz Mesmer detailed his cure for some mental illness, originally called mesmerism and now known as hypnosis.

1793 Philippe Pinel released the first mental patients from confinement in the first massive movement for more humane treatment of the mentally ill.

1808 Franz Gall wrote about phrenology (the idea that a person's skull shape and placement of bumps on the head can reveal personality traits.

1834 Ernst Heinrich Weber published his perception theory of 'Just Noticeable Difference,' now known as Weber's Law.

1848 Phineas Gage suffered brain damage when an iron pole pierces his brain. His personality was changed but his intellect remained intact suggesting that an area of the brain plays a role in personality.

1859 Charles Darwin published the On the Origin of Species, detailing his view of evolution and expanding on the theory of 'Survival of the fittest.'

1861 French physician Paul Broca discovered an area in the left frontal lobe that plays a key role in language development.

1869 Sir Francis Galton, Influenced by Charles Darwin's 'Origin of the Species,' publishes 'Hereditary Genius,' and argues that intellectual abilities are biological in nature.

1874 Carl Wernicke published his work on the frontal lobe, detailing that damage to a specific area damages the ability to understand or produce language

1878 G. Stanley Hall received the first American Ph.D. in psychology. He later founded the American Psychological Association.

1879 Wilhelm Wundt founded the first formal laboratory of Psychology at the University of Leipzig, marking the formal beginning of the study of human emotions, behaviors, and cognitions.

1883 The first laboratory of psychology in America is established at Johns Hopkins University.

1885 Herman Ebbinghaus introduced the nonsense syllable as a means to study memory processes.

1886 Sigmund Freud began performing therapy in Vienna, marking the beginning of personality theory.

1890 The term "Mental Tests" was coined by James Cattell, beginning the specialization in psychology now known as psychological assessment.

1890 Sir Francis Galton developed the technique known as the correlation to better understand the interrelationships in his intelligence studies.

1890 William James published 'Principles of Psychology,' that later became the foundation for functionalism.

1890 New York State passed the State Care Act, ordering indigent mentally ill patients out of poor-houses and into state hospitals for treatment and developing the first institution in the U.S. for psychiatric research.

1892 Foundation of the American Psychological Association (APA) headed by G. Stanley Hall, with an initial membership of 42.

1895 Alfred Binet founded the first laboratory of psychodiagnosis.

1896 Writings by John Dewey began the school of thought known as functionalism.

1896 The first psychological clinic was developed at the University of Pennsylvania marking the birth of clinical psychology.

1898 Edward Thorndike developed the 'Law of Effect,' arguing that "a stimulus-response chain is strengthened if the outcome of that chain is positive."

1900 Sigmund Freud published 'Interpretation of Dreams' marking the beginning of Psychoanalytic Thought.

1901 The British Psychological Society was founded.

1905 Alfred Binet's Intelligence Test was published in France.

1906 The Journal of Abnormal Psychology was founded by Morton Prince.

1906 Ivan Pavlov published the first studies on Classical Conditioning.

1911 Alfred Adler left Freud's Psychoanalytic Group to form his own school of thought, accusing Freud of overemphasizing sexuality and basing his theory on his own childhood.

1911 Edward Thorndike published first article on animal intelligence leading to the theory of Operant Conditioning.

1912 William Stern developed the original formula for the Intelligence Quotient (IQ) after studying the scores on Binet's intelligence test. The formula is

1912 Max Wertheimer published research on the perception of movement, marking the beginnings of Gestalt Psychology.

1913 John E. Watson published 'Psychology as a Behaviorist Views It' marking the beginnings of Behavioral Psychology.

1913 Carl G. Jung departed from Freudian views and developed his own theories citing Freud's inability to acknowledge religion and spirituality. His new school of thought became known as Analytical Psychology.

1916 Stanford-Binet intelligence test was published in the United States.

1917 Robert Yerkes (President of APA at the time) developed the Army Alpha and Beta Tests to measure intelligence in a group format. The tests were adopted for use with all new recruits in the U.S. military a year later.

1920 John B. Watson and Rosalie Rayner published the Little Albert experiments, demonstrating that fear could be classically conditioned.

1921 Psychological Corporation launched the first psychological test development company, not only commercializing psychological testing, but allowing testing to take place at offices and clinics rather than only at universities and research facilities.

1925 Wolfgang Kohler published 'The Mentality of Apes' which became a major component of Gestalt Psychology.

1927 Anna Freud, daughter of Sigmund Freud, published her first book expanding her father's ideas in the treatment of children.

1929 Wolfgang Kohler criticizes behaviorism in his publication on Gestalt Psychology.
1932 Jean Piaget published 'The Moral Judgment of Children' beginning his popularity as the leading theorist in cognitive development.

1932 Walter B. Cannon coined the term homeostasis and began research on the fight or flight phenomenon.

1935 Thematic Apperception Test (TAT) was published by Henry Murray.

1936 Egas Moniz published his work on frontal lobotomies as a treatment for mental illness.
1938 Electroshock therapy was first used on a human patient.

1939 Wechsler-Bellevue Intelligence Test was published which eventually became the most widely used intellectual assessment.

1939 The Canadian Psychological Associated was founded.

1942 Carl Rogers published 'Counseling and Psychotherapy' suggesting that respect and a non-judgmental approach to therapy is the foundation for effective treatment of mental health issues.

1942 Jean Piaget published 'Psychology of Intelligence' discussing his theories of cognitive development.

1942 Minnesota Multiphasic Personality Inventory (MMPI) was developed and fast became the most widely researched and widely accepted psychological assessment device.

1945 The state of Connecticut passed licensure legislation for psychologists, becoming the first state to recognize psychology as a protected practice oriented profession.
1945 The Journal of Clinical Psychology was founded.

1945 Karen Horney published her feministic views of psychoanalytic theory, marking the beginning of feminism.

1949 Boulder Conference outlines scientist-practitioner model of clinical psychology, looking at the M.D. versus Ph.D. used by medical providers and researchers, respectively.

1950 Erik Erikson published 'Childhood and Society,' where he expands Freud's Theory to include social aspects of personality development across the lifespan.

1952 A study on psychotherapy efficacy was published by Hans Eysenck suggesting that therapy is no more effective that no treatment at all. This prompted an onslaught of outcome studies which have since shown psychotherapy to be an effective treatment for mental illness.

1952 The Diagnostic and Statistical Manual of Mental Disorders (DSM) was published by The American Psychiatric Association marking the beginning of modern mental illness classification.

1952 Chlorpromazine (Thorazine) first used in the treatment of schizophrenia.

1953 B.F. Skinner outlined behavioral therapy, lending support for behavioral psychology via research in the literature.

1953 Code of Ethics for Psychologists was developed by the American Psychological Association.

1954 Abraham Maslow helped to found Humanistic Psychology and later developed his famous Hierarchy of Needs.

1957 Leon Festinger proposed his theory of 'Cognitive Dissonance' and later became an influence figure in Social Psychology.

1961 John Berry introduced the importance of cross-cultural research bringing diversity into the forefront of psychological research and application.

1961 Carl Rogers published 'On Becoming a Person,' marking a powerful change in how treatment for mental health issues is conducted.

1963 Alfred Bandura introduced the idea of Observational Learning on the development of personality.

1963 Lawrence Kolberg introduced his ideas for the sequencing of morality development.

1967 Aaron Beck published a psychological model of depression suggesting that thoughts play a significant role in the development and maintenance of depression.

1968 DSM II was published by the American Psychiatric Association.

1968 First Doctor of Psychology (Psy.D.) professional degree program in Clinical Psychology was established in the Department of Psychology at The University of Illinois - Urbana/Champaign.

1969 Joseph Wolpe published 'The Practice of Behavior Therapy.'

1971 First Doctorate in Psychology (Psy.D.) awarded (from The University of Illinois - Urbana/Champaign).

1973 APA endorsed the Psy.D. degree for professional practice in psychology.

1980 DSM III published by the American Psychiatric Association.

1983 Howard Gardner (professor at Harvard University) introduced his theory of multiple intelligence, arguing that intelligence is something to be used to improve lives not to measure and quantify human beings.

1988 American Psychological Society established.

1990 The emergence of managed care prompts the APA to become more political, leading to the idea of Prescribing Psychologists and equity in mental health coverage.

1994 DSM IV published by the American Psychiatric Association.

1995 First Psychologists prescribe medication through the U.S. military's psychopharmacology program.

1997 Deep Blue, the supercomputer at the time, beats the World's best chess player, Kasparov, marking a milestone in the development of artificial intelligence.

1998 Psychology advances to the technological age with the emergence of e-therapy.

1999 Psychologists in Guam gain prescription privileges for psychotropic medication.

2002 New Mexico becomes the first state to pass legislation allowing licensed psychologists to prescribe psychotropic medication.

2002 The push for mental health parity gets the attention of the White House as President George W. Bush promotes legislation that would guarantee comprehensive mental health coverage.


If you are working in any field that involves human behavior, sooner or later you will need to cite the Diagnostic and Statistical Manual of Mental Disorders (DSM). Published by the American Psychiatric Association (a.k.a. “the other APA”), the DSM provides a set of common criteria and language for talking about dysfunctions of the mind and emotions. From the beginning, the DSM has been widely used as a guide by state and federal agencies for the reporting of public health statistics and the fulfillment of legislative mandates, as well as its use as a classification guide for research and clinical psychologists. The DSM has gone through five revisions since it was first published in 1952, and each of those revisions has included substantial changes in structure and definitions. Some of these have been fairly controversial, such as the attempt to remove the term neurosis from DSM-III and the varying treatment of sexual disorders. A new edition (DSM-5) is in preparation, with a projected release date of May 2013, and major changes have been proposed for it as well. Because of these changes and their effects on areas as disparate as longitudinal research parameters and health insurance benefits, it’s important to be precise when citing the DSM. Below are some guidelines to use in citing the most recent edition.

Citation Examples

When a DOI is available, provide it after the publisher information. Individual chapters and other book parts are also assigned DOIs.

In text, cite the name of the association and the name of the manual in full at the first mention in the text thereafter, you may refer to the traditional DSM form (italicized) as follows:

After you have spelled out the name of the manual on first mention in the text, format the parenthetical citation as follows:

What About DSM-5?

The DSM-5 hasn’t been released yet, but there’s been much discussion of the proposed content. If necessary, refer to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. DSM-5) in text when you cite these discussions. We’ll be back in May 2013 with tips on how to cite the DSM-5 itself, so mark your calendar!

UPDATE: DSM-5 has arrived! Go here for information on how to cite it.

Comments

If you are working in any field that involves human behavior, sooner or later you will need to cite the Diagnostic and Statistical Manual of Mental Disorders (DSM). Published by the American Psychiatric Association (a.k.a. “the other APA”), the DSM provides a set of common criteria and language for talking about dysfunctions of the mind and emotions.

From the beginning, the DSM has been widely used as a guide by state and federal agencies for the reporting of public health statistics and the fulfillment of legislative mandates, as well as its use as a classification guide for research and clinical psychologists.

The DSM has gone through five revisions since it was first published in 1952, and each of those revisions has included substantial changes in structure and definitions. Some of these have been fairly controversial, such as the attempt to remove the term neurosis from DSM-III and the varying treatment of sexual disorders. A new edition (DSM-5) is in preparation, with a projected release date of May 2013, and major changes have been proposed for it as well.

Because of these changes and their effects on areas as disparate as longitudinal research parameters and health insurance benefits, it’s important to be precise when citing the DSM. Below are some guidelines to use in citing the most recent edition.

Citation Examples

When a DOI is available, provide it after the publisher information. Individual chapters and other book parts are also assigned DOIs.

In text, cite the name of the association and the name of the manual in full at the first mention in the text thereafter, you may refer to the traditional DSM form (italicized) as follows:

After you have spelled out the name of the manual on first mention in the text, format the parenthetical citation as follows:

What About DSM-5?

The DSM-5 hasn’t been released yet, but there’s been much discussion of the proposed content. If necessary, refer to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. DSM-5) in text when you cite these discussions. We’ll be back in May 2013 with tips on how to cite the DSM-5 itself, so mark your calendar!

UPDATE: DSM-5 has arrived! Go here for information on how to cite it.


Theoretical Evaluation

Theoretical Evaluation

This caregiver sensitivity theory is supported by research from, Wolff and Van Ijzendoorn (1997) who conducted a Meta-analysis (a review) of research into attachment types.

They found that there is a relatively weak correlation of 0.24 between parental sensitivity and attachment type – generally more sensitive parents had securely attached children.

However, in evaluation, critics of this theory argue that the correlation between parental sensitivity and the child’s attachment type is only weak. This suggests that there are other reasons which may better explain why children develop different attachment types and that the maternal sensitivity theory places too much emphasis on the mother.

Focusing just on maternal sensitivity when trying to explain why children have different attachment types is, therefore, a reductionist approach.

An alternative theory proposed by Kagan (1984) suggests that the temperament of the child is actually what leads to the different attachment types. Children with different innate (inborn) temperaments will have different attachment types.

This theory is supported by research from Fox (1989) who found that babies with an ‘Easy’ temperament (those who eat and sleep regularly, and accept new experiences) are likely to develop secure attachments.

Babies with a ‘slow to warm up’ temperament (those who took a while to get used to new experiences) are likely to have insecure-avoidant attachments. Babies with a ‘Difficult’ temperament (those who eat and sleep irregularly and who reject new experiences) are likely to have insecure-ambivalent attachments.

In conclusion, the most complete explanation of why children develop different attachment types would be an interactionist theory. This would argue that a child’s attachment type is a result of a combination of factors – both the child’s innate temperament and their parent’s sensitivity towards their needs.

Belsky and Rovine (1987) propose an interesting interactionist theory to explain the different attachment types. They argue that the child’s attachment type is a result of both the child’s innate temperament and also how the parent responds to them (i.e., the parents’ sensitivity level).

Additionally, the child’s innate temperament may, in fact, influence the way their parent responds to them (i.e, the infants’ temperament influences the parental sensitivity shown to them). To develop a secure attachment, a ‘difficult’ child would need a caregiver who is sensitive and patient for a secure attachment to develop.


Stemming social phobia

Psychologist Richard Heimberg seeks to improve the staying power of social phobia treatments by combining therapy with medication.

July/August 2005, Vol 36, No. 7

As a graduate student at Florida State University, Richard Heimberg, PhD, was fascinated by the effects of people's intense social anxiety on their relationships. However, in the 1970s, no name existed for this type of anxiety, and Heimberg says many people wrote it off as shyness or a personality trait.

After all, many people get a little anxious when delivering a speech to a crowd. But it's the more severe cases that cause Heimberg concern--when those fears of being judged by others become so persistent and intense that they extend to almost all social situations, from informal conversations to eating in public. People diagnosed with the condition, social phobia--also known as social anxiety disorder--may avoid many social situations out of fear that others will notice something unusual about them, like their shaking hands or blushing, and that their actions will embarrass or humiliate them.

To help them overcome the condition, Heimberg, a Temple University psychology professor, has made studying the origins of and treatments for social phobia his life's work.

In 1983, he became the first researcher to receive National Institute of Mental Health (NIMH) funding to study psychosocial treatments for social phobia after the term first appeared in the third edition of the Diagnostic Statistical Manual of Mental Disorders in 1980 (DSM-III).

"Dr. Heimberg has made huge contributions to social phobia research, developing a cognitive-behavioral treatment for social phobia and carrying out numerous randomized controlled trials that have demonstrated its effectiveness," says psychologist Jacqueline Persons, PhD, a former president of the Association for Advancement of Behavior Therapy (AABT) who served with Heimberg on the AABT board. "He has made important contributions to alleviate a great deal of suffering."

Since Heimberg secured the first NIMH social phobia treatment research grant, such funding has been readily available because the condition is quite common: It's the third most prevalent mental disorder behind depression and alcoholism. About 5.3 million American adults have social phobia, which usually begins in childhood or adolescence, according to NIMH.

For many social phobics, preoccupation with what others think may interfere in their job, school, relationships or other social activities.

"Everyday interactions can become very problematic for people with social anxiety disorder," says Heimberg who, as director of Temple University's Adult Anxiety Clinic, helps people change their thought processes in such interactions using cognitive-behavioral therapy (CBT) and medication. The treatment also encourages clients to expose themselves gradually to feared events.

A debilitating disorder

Since 1983, Heimberg has conducted a series of NIMH-funded studies on social phobia. Most recently, he received a $1.2 million, four-year NIMH grant--which he's in the second year of--to investigate whether the addition of CBT to medication treatments can help prevent patients' relapse.

Through his 20-plus years of research, Heimberg has found that nearly everyone fears social situations to some degree.

"Some people just think they are shy--that it's a personality trait--and that's just the way they are," says Heimberg. "But. if a person starts fearing many social situations, [and as a result] lives alone or drops out of school, that's not shyness--that's an impairment."

What's more, notes Heimberg, social phobia is generally more debilitating than phobias focused on singular circumstances, such as a fear of thunderstorms or animals. "If you are afraid of interacting with people, that can mess you up wherever you turn," he says. "It can have very broad mental health implications."

Heimberg also notes two subtypes of social phobia. For people with a "generalized" type, the social anxiety ranges across a broad number of social interactions for those with a "specific" type, the anxiety involves only one or a few social encounters, such as public speaking or eating in public.

Therapy's staying power

The trouble is, despite the proven efficacy of treatment, many social phobics shy away from it, according to Heimberg's research. For example, he found that 92 percent of people who were accessing information on social phobia on an anxiety clinic Web site met criteria for social anxiety disorder. Yet, only about 36 percent of the respondents reported receiving psychotherapy 35 percent reported taking medication for social anxiety disorder, according to a study by Heimberg and psychologists Brigette Erwin, PhD, Cynthia Turk, PhD, David Fresco, PhD, and Donald Hantula, PhD, in the 2004 issue of the Journal of Anxiety Disorders (Vol. 18, No. 5, pages 629-646).

But, with CBT treatment or antidepressant medication, about 80 percent of social phobics can alleviate their symptoms, Heimberg says. What's more, clients who receive CBT treatment remain improved five years later, whereas clients who receive only medication treatment are more likely to relapse than clients receiving CBT, according to Heimberg's 1998 study in the Archives of General Psychiatry (Vol. 55, No. 12, pages 1,133-1,141).

However, Heimberg suspects a combination of CBT and medication may prove most effective in preventing relapse--something he hopes to prove in his latest NIMH study with Michael Liebowitz, MD, of the New York State Psychiatric Institute, to be completed by 2007.

Heimberg is providing participants with a 28-week treatment program that includes medication--in this case, the antidepressant Paxil--and some patients then receive 16 sessions of CBT. Each session helps clients to evaluate their thought processes more critically, such as by filtering out automatic thoughts that others judge them negatively in social interactions. The client and therapist also role-play social interactions to provide the client with confidence they can take into real-world situations. In Heimberg's CBT, the therapist gradually exposes clients to their feared social situations in real life, perhaps assigning a client to initiate a conversation with a person they don't know, ask someone out on a date or go on a job interview.

"They start going into social situations that have made them tense a thousand times before, but the trick now is that they are doing it. with coping skills that will help them turn defeat into victory," Heimberg says.


The search terms for MEDLINE will be as follows:

exp personality disorders/

exp anankastic personality disorder

exp obsessive compulsive personality disorder/

exp compulsive personality disorder/

exp passive-aggressive personality disorder/

anal retentive or anal character

We will search MEDLINE in combination with the Cochrane Collaboration’s search strategy for identifying reports of controlled trials as detailed in Section 6.4.11 of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2008).

We will develop similar strategies to identify participants and controlled trials for the other databases.


Day and month of 1980 DSM-III publication - Psychology

Development of the DSM-III and DSM-III-R

The DSM-III began being created in 1974 and was published in 1980( American Psychiatric Association), and it contained many drastic changes from the DSM-II, which made it a controversial topic among mental health professionals. You can imagine the surprise when the DSM-III came out with 494 pages, compared to the 134 pages in the DSM-II. While the DSM-III was taken critically by many professionals at the time, we will see how it had a long standing effect on the way we diagnose mental disorders today.

The purpose of the DSM-II was primarily to provide a way for psychologists to keep records of their patient’s diagnoses, and to provide the mental health professionals with brief descriptions of the 83 mental disorders that were listed within the DSM-II. In contrast, the DSM-III provided a multi-axial system which provided a more comprehensive method of diagnosing, as well as giving in-depth descriptions of disorders with detailed diagnostic criteria. Some people felt that this took away from the “art” of psychology, by forcing mental health professional’s focus on diagnostic criteria, rather than their gut instinct. With this new in depth system of diagnosing, the DSM-III broke away from using the same diagnostic criteria as the World Health Organization used in their ICD-9, which coded mental disorders. This break away from the ICD-9 allowed mental health professionals to better diagnose patients by providing clearer diagnostic criteria (Spitzer, 2001).

The DSM- III contained 265 diagnoses, many of which were new to the DSM-III (http://kadi.myweb.uga.edu/The_Development_of_the_DSM.html). Many mental health professionals were starting to be frustrated by the fact that many of the disorders that they saw and treated were not actually listed as disorders in the DSM-II. Things such a Borderline Personality Disorder (BPD) and Post Traumatic Stress Disorder (PTSD) were not yet recognized as legitimate, diagnosable mental disorders. The developers of the DSM-III took these concerns into account, and had mental health professionals provide what they considered to be symptoms of these disorders, and looked to see if a reliable and valid diagnosis could be made for these disorders that were being requested to be put in. Disorders such as PTSD and BPD made it into the DSM-III, while other suggestions, such as the Atypical Child, did not. Another significant change to the DSM-III was the removal of homosexuality as a mental illness, which was a very controversial topic as well. (Spitzer, 2001).

Due to the many problems and critical reviews that the DSM-III received, a revised edition, the DSM-III-R was released only seven years after the DSM-III in 1987. Initially, the idea behind the DSM-III-R was for it to be a follow up guide to the DSM-III to assist it’s users in properly diagnosing patients. However, the DSM-III-R ended up being so different from the DSM-III, and contained 32 new disorders that it could easily be considered a whole new DSM edition. ( University of Georgia).


A Historical Timeline of Modern Psychology

Emily is a fact checker, editor, and writer who has expertise in psychology content.

The timeline of psychology spans centuries, with the earliest known mention of clinical depression in 1500 BCE on an ancient Egyptian manuscript known as the Ebers Papyrus.   However, it was not until the 11th century that the Persian physician Avicenna attributed a connection between emotions and physical responses in a practice roughly dubbed "physiological psychology."

Some consider the 17th and 18th centuries the birth of modern psychology (largely characterized by the publication of William Battie's "Treatise on Madness" in 1758).   Others consider the mid-19th century experiments done in Hermann von Helmholtz's lab to be the start of modern psychology.

Many say that 1879, when Wilhelm Wundt established the first experimental psychology lab, was the true beginning of psychology as we know it. From that moment forward, the study of psychology would continue to evolve as it does today. Highlighting that transformation were a number of important, landmark events.


Watch the video: DSM 3 vs DSM 5 - SurvivorsVsSciencePt3 (August 2022).