DSM I and DSM II

[JackD]

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I stumbled upon something that i found interesting and if you haven't seen this yet, perhaps you will too. I remember talking about the early DSMs awhile ago and most people here had never seen them, so here is your opportunity. Here is a copy of the DSM I and II

DSM I

http://www.psychiatryonline.com/DSMPDF/dsm-i.pdf

DSM II

http://www.psychiatryonline.com/DSMPDF/dsm-ii.pdf

and far less interesting

DSM III

http://www.psychiatryonline.com/DSMPDF/dsm-iii.pdf

 

[nononora]

Hopefully in another 50 years, we will look at the DSM-IV-TR and scoff!

 

[JackD]

Hopefully in another 50 years, we will look at the DSM-IV-TR and scoff!

I think most already do.

 

[erg923]

I think I must be the only person here who likes the DSM-IV. It has alot of problems, but this has to do with an issue that is for the most part, beyond its control; specifically, the nosoloy and taxometics of placing dimensional constructs that exist on a continuum (because overt behavior is the only critieria we can utilize at the moment) into categoriies. Of couse there will be problems.

However, I think working with the SCID (or similar semi-structured interviews) really allows developing clinician a chance to put the criteria into real life and develope a better understanding of why the criteria are set as they are. Just looking at them, they may seem silly and even arbitrary, I admit it. But when you have to put them to use using the SCID, one starts to develop a better undersatanding of what the criteria mean, what they truely tell us about the underlying condition, and they theory behind why the were placed there.

 

[PrisonPsych]

I think I must be the only person here who likes the DSM-IV. It has alot of problems, but this has to do with an issue that is for the most part, beyond its control; specifically, the nosoloy and taxometics of placing dimensional constructs that exist on a continuum (because overt behavior is the only critieria we can utilize at the moment) into categoriies. Of couse there will be problems.

However, I think working with the SCID (or similar semi-structured interviews) really allows developing clinician a chance to put the criteria into real life and develope a better understanding of why the criteria are set as they are. Just looking at them, they may seem silly and even arbitrary, I admit it. But when you have to put them to use using the SCID, one starts to develop a better undersatanding of what the criteria mean, what they truely tell us about the underlying condition, and they theory behind why the were placed there.

Agreed. Also, if you're a good clinician, you don't assume that the diagnosis tells you *everything* - diagnoses just allow us a common classification scheme from which to work, they don't negate individual differences. I think a lot of people's problem with diagnoses is the feeling that they pigeonhole people. If you look at them as a starting point for dialogue rather than a pigeonhole they work just fine.

 

[Ollie123]

My view is that the DSM is pragmatic. I disagree that it is "beyond its control" that it categorizes things on a continuum, and that is my major issue with it. As a clinical tool I understand why that is necessary just because of our insurance system, health model, etc. However, I think it changes how we (and the public) think about psychological disorders and its slowing us down, since we are so reliant on an archaic and frankly, incorrect diagnostic system. Failure to adequately account for severity, co-morbidity, not to mention the disorders that are just a diagnostic mess.

That said, I'm not sure we're at a point where I would be comfortable moving to a fully dimensional model. The research just isn't there at this point. I think it will be eventually, but I hesitate to jump the gun on this. So for now, I am arbitrarily categoring the DSM as a "Necessary evil" along the good-evil continuum😉

 

[JackD]

I think one other thing that is important to keep in mind is the DSM IV is probably pretty good considering this field hasn't been around very long. If we had the DSM IV after 500 years of real research then it might be more alarming. However, it has only been about 100 and that is if you want to be generous.

It is quite astonishing to look at that first DSM and compare it to what we have now. That was only 40 years and look at the difference. Progress does take time. The field isn't going to be perfected after just a few decades.

 

[JockNerd]

Also, if you're a good clinician

Therein, the problem. The other, related problem is that the reason that DSM diagnoses are included in insurance reimbursements has much, much more to do with the political involvement of the other APA and much much much less to do with any actual research or evidence on conditions. A huge number of the disorders have essentially no good evidence behind them, and were grandfathered in based on the fact that psychiatrists treated people with the disorder, so, ipso facto, the conditions were disorders worthy of inclusion (for really no other reason than to not include them would reduce the scope of psychiatry).

The DSM is more a problem to me because of the weak research, weak reliability, and weak validity that go into the categories. To me, this makes inappropriate use all the much worse, and appropriate use more difficult. For this reason, I really consider the DSM to be more of a hinderance than a flawed step in the right direction. There are proposals for alternative diagnostic systems. Meehl had interesting ideas.

 

[PrisonPsych]

Therein, the problem. The other, related problem is that the reason that DSM diagnoses are included in insurance reimbursements has much, much more to do with the political involvement of the other APA and much much much less to do with any actual research or evidence on conditions. A huge number of the disorders have essentially no good evidence behind them, and were grandfathered in based on the fact that psychiatrists treated people with the disorder, so, ipso facto, the conditions were disorders worthy of inclusion (for really no other reason than to not include them would reduce the scope of psychiatry).

The DSM is more a problem to me because of the weak research, weak reliability, and weak validity that go into the categories. To me, this makes inappropriate use all the much worse, and appropriate use more difficult. For this reason, I really consider the DSM to be more of a hinderance than a flawed step in the right direction. There are proposals for alternative diagnostic systems. Meehl had interesting ideas.

Out of curiousity, which diagnoses/categories do you feel are the more problematic under the current system?

 

[JockNerd]

Out of curiousity, which diagnoses/categories do you feel are the more problematic under the current system?

Well, not to put too fine a point on it, but first off I essentially agree with Szasz that there are no "mental illnesses," and that there are only (a) brain diseases and (b) unpopular behaviors that aren't essentially different from sins.

If I can adopt the other epistemological position as an intellectual exercise, though, I still have a lot of problems with the DSM. So, a few of the diagnosis appear to me to be simply wrong. Gender identity disorder is my prime example of this. I don't see how this is a "mental illness" in any way. In fact, the idea that it is seems laughably ridiculous. Many of the sexual diagnoses also seem similarly off to me (Masochism, sadism, transvestic fetishism, fetishism). I also have a lot of problems with many of the childhood behavior/conduct disorders. The reasons for this trouble are so trivially obvious that it's probably not necessary for me to expand on them (I can, if it's not obvious to anyone, though). I think many other disorders simply have too little literature about them, much less any literature about gender/age/cultural factors, to be useful in classification. I have less of a problem with some other things (e.g. I think schizophrenia is probably a mostly genetic/biological disorder, so I'm reserving judgment on that one and think it will probably be lined up more with things like Alzheimer's in the future).

I also think the DSM is inappropriately focused on North American/UK culture given its mission as a unversal clasification system. For example, the culture-bound diagnoses have been called an anthropological field trip (or, worse, freak show), and the Counseling Psychologist in me is puzzled about whether that section is laughable or depressing. The decision to exclude anorexia, chronic fatigue syndrome, and DID from this section (they were all proposed for inclusion) emphasizes this point to me. Again, an example to me of the DSM being not a "step in the right direction," but a flawed start to what could be a useful project.

 

[psychmama]

I'd especially like to see personality disorders (Axis II) described on a continuum. I think this just makes much more sense than the current categories the DSM IV uses.

 

[PrisonPsych]

I'd especially like to see personality disorders (Axis II) described on a continuum. I think this just makes much more sense than the current categories the DSM IV uses.

Definitely agreed. I hate ending up calling so many people PDNOS with XYZ traits/features. Continuums would be much nicer.