The History of DSM



Psychiatric diagnosis has proven far more complicated than anyone believed 50 years ago when the first edition of the Diagnostic and Statistical Manual saw the light of day. Psychiatry has always had a nosology, or classification of diseases, beginning with the rough categories established in the early nineteenth century. Between the late nineteenth and mid-twentieth centuries, psychiatric classification was shaped by individual authorities, in particular by the great German nosologist Emil Kraepelin.

The DSM series of the American Psychiatric Association grew out of a desire to create an American system in line with the International Classification of Diseases series issued by the World Health Organization. In some ways its evolution represents progress towards a genuine medical model of classification. Yet in other respects the series has been hijacked by consensus and horse-trading, becoming a political rather than scientific document. Despite enormous investments of time, thought and academic firepower, the process of establishing a reliable nosology of psychiatric illness continues to elude our grasp.


Bipolar Disorder Seasonal Affective Disorder York State Psychiatric Institute Dissociative Disorder Schizotypal Personality Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



For comments on an earlier version, I am grateful to Bernard Carroll and Max Fink.


  1. 1.
    American College of Neuropsychopharmacology. In the beginning.... The origin of the American College of Neuropsychopharmacology. Brentwood, TN: ACNP; 1990.Google Scholar
  2. 2.
    Pinel P. Traité médico-philosophique sur l’aliénation mentale. 2nd ed. Paris: Brosson; 1809.Google Scholar
  3. 3.
    Heinroth FCA. Lehrbuch der Störungen des Seelenlebens. Leipzig: Vogel; 1818.Google Scholar
  4. 4.
    Bell LV. On a form of disease resembling some advanced stages of mania and fever, but so contradistinguished from any ordinarily observed or described combination of symptoms, as to render it probable that it may be an overlooked and hitherto unrecorded malady. Am J Insanity. 1849;6(2):97–127, 99.Google Scholar
  5. 5.
    Delasiauve L. Du diagnostic différentiel de la lypémanie. Ann Méd Psychol. 1851;(3):380–442, 380.Google Scholar
  6. 6.
    Kraepelin E. Compendium der Psychiatrie. Leipzig: Abel; 1883.Google Scholar
  7. 7.
    Kraepelin E. Psychiatrie: ein kurzes Lehrbuch für Studierende und Ärzte. 8th ed. Leipzig: Barth; 1909–1915.Google Scholar
  8. 8.
    Gaupp R. Die Frage der kombinierten Psychosen. Zeits Neurol Psychiatry. 1926;76(1):73–80, 77–8.Google Scholar
  9. 9.
    Bleuler E, Jung CG. Komplexe und Krankheitsursachen bei Dementia praecox. Zentralbl Nervenheilk Psychiatr. 1908;19:220–7.Google Scholar
  10. 10.
    Kraepelin E. Psychiatrie: ein kurzes Lehrbuch für Studierende und Ärzte. 6th ed. Leipzig: Barth; 1899.Google Scholar
  11. 11.
    Kraepelin E. Die Abgrenzung der Paranoia. Allg Zeits Psychiatr. 1894;50:1080–1.Google Scholar
  12. 12.
    Lewis A. “Endogenous” and “exogenous”: a useful dichotomy? Psychol Med. 1971;1(3):191–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Stengel E. Classification of mental disorders. Bull World Health Organ. 1959;21(4–5):601–63.PubMedGoogle Scholar
  14. 14.
    Menninger WC. Psychiatric nomenclature. J Nerv Ment Dis. 1946;104(2):180–99.CrossRefGoogle Scholar
  15. 15.
    Fink M. Interview. In: Ban TA, editor. An oral history of neuropsychopharmacology: the first fifty years; peer interviews, vol. 9. Brentwood, TN: ACNP; 2011. p. 76.Google Scholar
  16. 16.
    World Health Organization. Manual of the international statistical classification of diseases, injuries and causes of death. 6th revision [later known as ICD-6] 2 volumes. Geneva: WHO; 1948–49.Google Scholar
  17. 17.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, DC: APA; 1952.Google Scholar
  18. 18.
    Klein DF, Fink M. Psychiatric reaction patterns to imipramine. Am J Psychiatry. 1962; 119(5):432–8.PubMedGoogle Scholar
  19. 19.
    Müller C. Lexikon der Psychiatrie. Berlin: Springer; 1973. p. 409–15.CrossRefGoogle Scholar
  20. 20.
    Lambert P. Discussion. In: Bradley PB, Deniker P, Raduoco-Thomas C, editors. Neuro-­psychopharmacology: proceedings of the first international congress of neuro-­psychopharmacology, Rome, September 1958. Amsterdam: Elsevier; 1959. p. 212.Google Scholar
  21. 21.
    American Psychiatric Association. DSM-II: diagnostic and statistical manual of mental disorders. 2nd ed. Washington, DC: APA; 1968.Google Scholar
  22. 22.
    Kendell RE, Cooper JE, Gourlay AJ, Copeland JRM, Sharpe L, Gurland BJ. Diagnostic criteria of American and British psychiatrists. Arch Gen Psychiatry. 1971;25(2):123–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Frank J. Discussion comment. In: Zubin J, Freyhan F, editors. Disorders of mood. Baltimore: Johns Hopkins Press; 1972. p. 30.Google Scholar
  24. 24.
    Katz M, Williams TA, Shield JA. Recent advances in the psychobiology of the depressive illnesses. Proceedings of a workshop hosted by the College of William and Mary in Virginia, April 30 through May 2, 1969. National Institute of Mental Health, Division of Extramural Research Programs, Clinical Research branch. Washington, DC: Superintendent of Documents, US Government Printing Office; 1972.Google Scholar
  25. 25.
    Weissman M. Interview. Gerald Klerman and psychopharmacology. In: Healy D, editor. The psychopharmacologists, vol. 2. London: Altman; 1998. p. 521–42, 530.Google Scholar
  26. 26.
    Clayton PJ. Interview. In: Ban TA, editor. An oral history of neuropsychopharmacology: the first fifty years; peer interviews, vol. 7. Brentwood, TN: ACNP; 2011. p. 99.Google Scholar
  27. 27.
    Henn FA. Interview. In: Ban TA, editor. An oral history of neuropsychopharmacology: the first fifty years; peer interviews, vol. 8. Brentwood, TN: ACNP; 2011. p. 154.Google Scholar
  28. 28.
    Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Muñoz R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry. 1972;26(1):57–63.PubMedCrossRefGoogle Scholar
  29. 29.
    Katz MM. Interview. In: Ban TA, editor. An oral history of neuropsychopharmacology: the first fifty years; peer interviews, vol. 9. Brentwood, TN: ACNP; 2011. p. 200.Google Scholar
  30. 30.
    Shorter E. Bipolar disorder in historical perspective. In: Parker G, editor. Bipolar II disorder: modeling, measuring and managing. 2nd ed. Cambridge, UK: Cambridge University Press; 2012. p. 1–9.CrossRefGoogle Scholar
  31. 31.
    Spitzer RL, Endicott J, Robins E, Kuriansky J, Gurland B. Preliminary report of the reliability of research diagnostic criteria applied to psychiatric case records. In: Sudilovsky A, Gershon S, Beer B, editors. Predictability in psychopharmacology: preclinical and clinical correlations. New York: Raven; 1975. p. 1–47.Google Scholar
  32. 32.
    Shorter E. How everyone became depressed: the rise and fall of the nervous breakdown. New York: Oxford University Press; 2013.Google Scholar
  33. 33.
    Spitzer RL, Endicott J, Robins E. Research diagnostic criteria. Arch Gen Psychiatry. 1978;35(6):773–82.PubMedCrossRefGoogle Scholar
  34. 34.
    Klein DF. Interview. In: Ban TA, editor. An oral history of neuropsychopharmacology: the first fifty years; peer interviews, vol. 9. Brentwood, TN: ACNP; 2011. p. 214.Google Scholar
  35. 35.
    Klerman GL, Endicott J, Spitzer R, Hirschfeld RMA. Neurotic depressions: a systematic analysis of multiple criteria and meanings. Am J Psychiatry. 1979;136(1):57–61.PubMedGoogle Scholar
  36. 36.
    Rudorfer MV, Clayton PJ. Depression, dementia and dexamethasone suppression [letter]. Am J Psychiatry. 1981;138(5):701.PubMedGoogle Scholar
  37. 37.
    Healy D, editor. The psychopharmacologists, vol. 2. London: Altman; 1998. p. 555.Google Scholar
  38. 38.
    Taylor MA, Vaidya NA. Descriptive psychopathology: the signs and symptoms of behavioral disorders. Cambridge, UK: Cambridge University Press; 2009.Google Scholar
  39. 39.
    McHugh PR, Slavney PR. Mental illness—comprehensive evaluation or checklist? N Engl J Med. 2012;366(20):1853–5, 1854.Google Scholar
  40. 40.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (third edition—revised): DSM-III-R. Washington, DC: APA; 1987.Google Scholar
  41. 41.
    Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, et al. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry. 1984;41(1):72–80.PubMedCrossRefGoogle Scholar
  42. 42.
    Frances A. Opening Pandora’s box: the 19 worst suggestions for DSM-5. Psychiatric Times, 11 Feb 2010.Google Scholar
  43. 43.
    Frances A, Cooper AM. Descriptive and dynamic psychiatry: a perspective on DSM-III. Am J Psychiatry. 1981;138(9):1198–202.PubMedGoogle Scholar
  44. 44.
    Frances A. Dr Frances responds to Dr Carpenter: a sharp difference of opinion. Psychiatric Times, 9 Jul 2009.Google Scholar
  45. 45.
    Kendell R, Jablensky A. Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003;160(1):4–12, 5, 11.Google Scholar
  46. 46.
    Clayton PJ, Guze SB, Cloninger CR, Martin RL. Unipolar depression: diagnostic inconsistency and its implications. J Affect Disord. 1992;26(2):111–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Taylor MA, Fink M. Melancholia: the diagnosis, pathophysiology, and treatment of depressive illness. Cambridge, UK: Cambridge University Press; 2006.CrossRefGoogle Scholar
  48. 48.
    Fink M, Taylor MA. Catatonia: a clinician’s guide to diagnosis and treatment. Cambridge, UK: Cambridge University Press; 2003.CrossRefGoogle Scholar
  49. 49.
    Craddock N, Owen MJ. Rethinking psychosis: the disadvantages of a dichotomous classification now outweigh the advantages. World Psychiatry. 2007;6(2):84–91.PubMedGoogle Scholar
  50. 50.
    Carroll B. Comment on: as precisely as possible. In: 1 Boring old man [Internet]. Accessed 5 Dec 2011.
  51. 51.
    Parker G, Hadzi-Pavlovic D, Wilhelm K, Hickie I, Brodaty H, Boyce P, et al. Defining melancholia: properties of a refined sign-based measure. Br J Psychiatry. 1994;164(3):316–26.PubMedCrossRefGoogle Scholar
  52. 52.
    Lewis AJ. Melancholia: a clinical survey of depressive states. J Ment Sci. 1934;80(329):277–378, 280.Google Scholar
  53. 53.
    Spitzer R. Interview. In: Healy D, editor. The psychopharmacologists, vol. 3. London: Altman; 1998. p. 427.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of TorontoTorontoCanada

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