Table of ContentsView AllTable of ContentsWhat Is the DSM-5?DSM-5 HistoryThe Multiaxial SystemChanges in the DSM-5Changes in the DSM-5-TR

Table of ContentsView All

View All

Table of Contents

What Is the DSM-5?

DSM-5 History

The Multiaxial System

Changes in the DSM-5

Changes in the DSM-5-TR

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It contains descriptions, symptoms, and other criteria for diagnosing mental health disorders. It also contains statistics such as a condition’s typical age of onset, the development and course of the disorder, risks and prognostic factors, and other related diagnostic issues.

Some government agencies and manyinsurance carriersrequire a specific diagnosis to approve payment for support or treatment of mental health conditions. Mental health professionals use the DSM-5 to classify patients for billing purposes.

This article discusses the history of the DSM-5 and how the most recent edition compares to past editions.

The Diagnostic and Statistical Manual was first published in 1952.Since then, there have been several updates issued. In the DSM-I, there were 102 categories of diagnoses, increasing to 182 in the DSM-II, 265 in the DSM-III, and 297 in the DSM-IV.

In 2013, then-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.

The National Institute on Mental Health also notes that the RDoC is not meant to be a diagnostic tool and should not be used to replace other diagnostic systems (such as the DSM). Instead, its goal is to serve as a framework for research on mental disorders in order to better understand mental health.

RecapThe DSM has gone through many changes since it was first published in the early 1950s.

Recap

The DSM has gone through many changes since it was first published in the early 1950s.

The DSM-III introduced a multiaxial or multidimensional approach for diagnosing mental disorders.

Themultiaxial approachwas 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.

The Multi-Axial System in the DSM-IV

Axis I – Clinical Syndromes

Axis Iconsisted of mental health and substance use disorders that cause significant impairment. Disorders were grouped into different categories such asmood disorders,anxiety disorders, andeating disorders.

Axis II – Personality Disorders and Mental Retardation

Axis III – General Medical Conditions

Axis III was used for medical conditions that influence or worsen Axis I 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 asunemployment, relocation,divorce, or thedeath 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.

RecapUp to and including the DSM-IV-TR, the multiaxial system was used to help clinicians fully evaluate the biological, environmental, and psychological factors that can play a role in a mental health condition.

Up to and including the DSM-IV-TR, the multiaxial system was used to help clinicians fully evaluate the biological, environmental, and psychological factors that can play a role in a mental health condition.

DSM-V includes significant changes from tDSM-IV and DSM-IV-TR.The most obvious change is the shift from using Roman numerals to Arabic numbers in the name (i.e., DSM-5, not DSM-V).

Perhaps most notably, the DSM-5 eliminated the multiaxial system. Instead, the DSM-5 lists categories of disorders along with related disorders. Example categories in the DSM-5 include anxiety disorders, bipolar and related disorders,depressive disorders,feedingand eating disorders,obsessive-compulsiveand related disorders, and personality disorders.

A few other changes that came with the DSM-5 included:

While the DSM-5 is an important tool, only those who have received specialized training and possess sufficient experience are qualified to diagnose and treat mental illnesses.

RecapWhile the DSM-5 is still used, a number of significant changes were made in the DSM-5 compared to previous editions. The DSM-5 eliminated the multiaxial system. Some disorders were eliminated or changed, while several new conditions were added.

While the DSM-5 is still used, a number of significant changes were made in the DSM-5 compared to previous editions. The DSM-5 eliminated the multiaxial system. Some disorders were eliminated or changed, while several new conditions were added.

DSM-5-TRcontains revised criteria for more than 70 disorders, includingprolonged grief disorder.

There are new codes added to the DSM-5-TR that allow clinicians to documentsuicidal behaviorand nonsuicidalself-injuryin patients without any other psychiatric diagnosis.

The DSM-5-TR uses more specific language to avoid reader confusion. For example:

Used in DSM-5Desired genderCross-sex medical procedureNatal maleNatal femaleUsed in DSM-5-TRExperienced genderGender affirming medical procedureIndividual assigned male at birthIndividual assigned female at birth

Used in DSM-5Desired genderCross-sex medical procedureNatal maleNatal female

Desired gender

Cross-sex medical procedure

Natal male

Natal female

Used in DSM-5-TRExperienced genderGender affirming medical procedureIndividual assigned male at birthIndividual assigned female at birth

Experienced gender

Gender affirming medical procedure

Individual assigned male at birth

Individual assigned female at birth

The DSM-5-TR also addressed racial and cultural biases. These revisions include:

The DSM-5-TR also notes how symptoms of certain conditions manifest differently in people from varying demographic groups.

RecapThe DSM-5-TR revised criteria for 70 disorders as well as added a new diagnosis, prolonged grief disorder. This new edition of the DSM also revised language surrounding gender dysphoria and race.

The DSM-5-TR revised criteria for 70 disorders as well as added a new diagnosis, prolonged grief disorder. This new edition of the DSM also revised language surrounding gender dysphoria and race.

Takeaways

Mental healthcare providers rely on many information sources such as interviews, screening tools, psychological assessments, lab tests, physical exams, and research to learn about your symptoms and how they are affecting you. They will then use this information to make a diagnosis based on DSM criteria.

What to Know About the DSM-5-TR

8 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto 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.Kawa S, Giordano J.A brief historicity of theDiagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice.Philos Ethics Humanit Med. 2012;7:2. doi:10.1186/1747-5341-7-2Kawa, S., Giordano, J.A brief historicity of theDiagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice.Philos Ethics Humanit Med.2012;7:2. doi:10.1186/1747-5341-7-2National Institute of Mental Health.Research Domain Criteria (RDoC).New York State Psychiatric Institute.DSM-5 and RDoC: Shared interests.National Institute of Mental Health.About RDoC.American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Publishing. 2013.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC; 2013.

Kawa S, Giordano J.A brief historicity of theDiagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice.Philos Ethics Humanit Med. 2012;7:2. doi:10.1186/1747-5341-7-2

Kawa, S., Giordano, J.A brief historicity of theDiagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice.Philos Ethics Humanit Med.2012;7:2. doi:10.1186/1747-5341-7-2

National Institute of Mental Health.Research Domain Criteria (RDoC).

New York State Psychiatric Institute.DSM-5 and RDoC: Shared interests.

National Institute of Mental Health.About RDoC.

American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Publishing. 2013.

American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

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