The APA first published a predecessor of DSM in 1844, as a statistical classification of in- stitutionalized mental patients. It was designed to improve communication about the types of patients cared for in these hospitals. This forerunner to DSM also was used as a component of the full U.S. census. After World War II, DSM evolved through four major editions into a diagnostic classification system for psychiatrists, other physicians, and other mental health professionals that described the essential features of the full range of mental disorders. The current edition, DSM-5, builds on the goal of its predecessors (most recently, DSM-IV-TR, or Text Revision, published in 2000) of providing guidelines for di- agnoses that can inform treatment and management decisions.
In 1999, the APA launched an evaluation of the strengths and weaknesses of DSM based on emerging research that did not support the boundaries established for some mental disor- ders. This effort was coordinated with the World Health Organization (WHO) Division of
Mental Health, the World Psychiatric Association, and the National Institute of Mental
Health (NIMH) in the form of several conferences, the proceedings of which were published in 2002 in a monograph entitled A Research Agenda for DSM—V. Thereafter, from 2003 to 2008, a cooperative agreement with the APA and the WHO was supported by the NIMH, the Na- tional Institute on Drug Abuse (NTDA), and the National Institute on Alcoholism and Alco- hol Abuse (NIAAA) to convene 13 international DSM-S research planning conferences, involving 400 participants from 39 countries, to review the world literature in specific diag- nostic areas to prepare for revisions in developing both DSM-S and the International Classi— fication of Diseases, 11th Revision (ICD—11). Reports from these conferences formed the basis for future DSM-5 Task Force reviews and set the stage for the new edition of DSM.
In 2006, the APA named David I. Kupfer, M.D., as Chair and Darrel A. Regier, M.D.,
M.P.H., as Vice-Chair of the DSM-S Task Force. They were charged with recommending chairs for the 13 diagnostic work groups and additional task force members with a multi- disciplinary range of expertise who would oversee the development of DSM-5. An addi- tional vetting process was initiated by the APA Board of Trustees to disclose sources of income and thus avoid conﬂicts of interest by task force and work group members. The full disclosure of all income and research grants from commercial sources, including the phar- maceutical industry, in the previous 3 years, the imposition of an income cap from all com- mercial sources, and the publication of disclosures on a Web site set a new standard for the field. Thereafter, the task force of 28 members was approved in 2007, and appointments of work group advisors with no voting authority were also approved to participate in the pro- cess. A clear concept of the next evolutionary stage for the classification of mental disorders was central to the efforts of the task force and the work groups. This vision emerged as the task force and work groups recounted the history of DSM-IV’s classification, its current strengths and limitations, and strategic directions for its revision. An intensive 6—year pro- cess involved conducting literature reviews and secondary analyses, publishing research reports in scientific journals, developing draft diagnostic Criteria, posting preliminary drafts on the DSM-S Web site for public comment, presenting preliminary findings at pro- fessional meetings, performing field trials, and revising criteria and text.
Proposals for the revision of DSM-5 diagnostic criteria were developed by members of the work groups on the basis of rationale, scope of change, expected impact on clinical man- agement and public health, strength of the supporting research evidence, overall clarity, and clinical utility. Proposals encompassed changes to diagnostic criteria; the addition of new disorders, subtypes, and specifiers; and the deletion of existing disorders.