Psychotherapy Diagnostic and Statistical Manual (DSM) Overview By Kendra Cherry facebook twitter Kendra Cherry, MS, is an author, educational consultant, and speaker focused on helping students learn about psychology. Learn about our editorial process Kendra Cherry Fact checked by Fact checked by Adah Chung on December 12, 2020 linkedin Adah Chung is a fact checker, writer, researcher, and occupational therapist. Learn about our editorial process Adah Chung Updated on December 12, 2020 Print F.J. Jimenez / Getty Images The Diagnostic and Statistical Manual of Mental Disorders is the handbook widely used by clinicians and psychiatrists in the United States to diagnose psychiatric illnesses. Published by the American Psychiatric Association (APA), the DSM covers all categories of mental health disorders for both adults and children. It contains descriptions, symptoms, and other criteria necessary for diagnosing mental health disorders. It also contains statistics concerning which gender is most affected by the illness, the typical age of onset, the effects of treatment, and common treatment approaches. Just as with other medical conditions, the government and many insurance carriers require a specific diagnosis in order to approve payment for treatment. Therefore, in addition to being used for psychiatric diagnosis and treatment recommendations, mental health professionals also use the DSM to classify patients for billing purposes. Verywell / JR Bee DSM History The Diagnostic and Statistical Manual has been updated seven times since it was first published in 1952. Version Year Number of diagnoses DSM-I 1952 106 DSM-II 1968 182 DSM-III 1980 265 DSM-III-R 1987 292 DSM-IV 1994 297 DSM-IV-TR 2000 365 The newest version of the DSM, the DSM-5, was published in May of 2013. This latest revision was met with considerable discussion and some controversy. A major issue with the DSM has been around validity. In response to this, the National Institute of Mental Health (NIMH) launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system they feel will be more biologically based. Later, NIMH Director Thomas Insel, and APA President-elect Jeffrey Lieberman, issued a joint statement saying that the DSM-5 "represents the best information currently available for clinical diagnosis of mental disorders." They went on to say that both the DSM-5 and RDoC represent "complementary, not competing, frameworks" for the classification and treatment of mental disorders. DSM-IV-TR Multiaxial System The DSM-IV was originally published in 1994 and listed more than 250 mental disorders. An updated version, called the DSM-IV-TR, was published in 2000. This version utilized a multiaxial or multidimensional approach for diagnosing mental disorders. The multiaxial approach was intended to help clinicians and psychiatrists make comprehensive evaluations of a client's level of functioning because mental illnesses often impact many different life areas. It described disorders using five DSM "axes" or dimensions to ensure that all factors—psychological, biological, and environmental—were considered when making a mental health diagnosis. Using the Axes of DSM-IV Multi-Axial System for Diagnosing Disorders Axis I – Clinical Syndromes Axis I consisted of mental health and substance use disorders that cause significant impairment. Disorders were grouped into different categories such as mood disorders, anxiety disorders, or eating disorders. Axis II – Personality Disorders and Mental Retardation Axis II was reserved for mental retardation and personality disorders, such as antisocial personality disorder and histrionic personality disorder. Personality disorders cause significant problems in how a person relates to the world, while mental retardation is characterized by intellectual impairment and deficits in other areas such as self-care and interpersonal skills. Axis III – General Medical Conditions Axis III was used for coding medical conditions that influence or worsen Axis 1 and Axis II disorders. Some examples include HIV/AIDS and brain injuries. Axis IV – Psychosocial and Environmental Problems Any social or environmental problems that may impact Axis I or Axis II disorders were accounted for in this axis. These include such things as unemployment, relocation, divorce, or the death of a loved one. Axis V – Global Assessment of Functioning Axis V is where the clinician gives their impression of the client's overall level of functioning. Based on this assessment, clinicians could better understand how the other four axes interacted and the effect on the individual's life. Changes in the DSM-5 The DSM-5 contains a number of significant changes from the earlier DSM-IV. The most immediately obvious change is the shift from using Roman numerals to Arabic numbers. Perhaps most notably, the DSM-5 eliminated the multiaxial system. Instead the DSM-5 lists categories of disorders along with a number of different related disorders. Example categories in the DSM-5 include anxiety disorders, bipolar and related disorders, depressive disorders, feeding and eating disorders, obsessive-compulsive and related disorders, and personality disorders. A few other changes in the DSM-5: Asperger's disorder was removed and incorporated under the category of autism spectrum disorders.Disruptive mood dysregulation disorder was added, in part to decrease over-diagnosis of childhood bipolar disorders.Several diagnoses were officially added to the manual including binge eating disorder, hoarding disorder, and premenstrual dysphoric disorder While the DSM is an important tool, only those who have received specialized training and possess sufficient experience are qualified to diagnose and treat mental illnesses. Was this page helpful? Thanks for your feedback! Ever wonder what your personality type means? Sign up to find out more in our Healthy Mind newsletter. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC; 2013. National Institute of Mental Health. Research Domain Criteria (RDoC). New York State Psychiatric Institute. DSM-5 and RDoC: Shared Interests. Updated May 14, 2013. American Psychiatric Association. Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Publishing. 2013. Additional Reading Insel T. Post by Former NIMH Director Thomas Insel: Transforming Diagnosis. National Institute of Mental Health. April 29, 2013.