Criticism of the DSM-IV

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), offers a common language and standard criteria for the classification of mental disorders. It is used, or relied upon, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, the legal system, and policy makers together with alternatives such as the International Statistical Classification of Diseases and Related Health Problems (ICD), produced by the World Health Organization (WHO). The DSM is now in its fifth edition, DSM-5, published on May 18, 2013. It evaluated the patient on five axes or dimensions rather than just one broad aspect of 'mental disorder'. These dimensions relate to biological, psychological, social and other aspects. The DSM evolved from systems for collecting census and psychiatric hospital statistics, and from a United States Army manual. Revisions since its first publication in 1952 have incrementally added to the total number of mental disorders, although also removing those no longer considered to be mental disorders.

The ICD is the other commonly used manual for mental disorders. It is distinguished from the DSM in that it covers health as a whole. While the DSM is the official diagnostic system for mental disorders in the US, the ICD is used more widely in Europe and other parts of the world. The DSM-IV-TR (4th. ed.) contains, in Appendix G, an "ICD-9-CM Codes for Selected General Medical Conditions and Medication-Induced Disorders" that allows for comparisons between the DSM and the ICD manuals, which may not systematically match because revisions are not simultaneously coordinated.

While the DSM has been praised for standardizing psychiatric diagnostic categories and criteria, it has also generated controversy and criticism. Critics, including the National Institute of Mental Health, argue that the DSM represents an unscientific and subjective system. There are ongoing issues concerning the validity and reliability of the diagnostic categories; the reliance on superficial symptoms; the use of artificial dividing lines between categories and from "normality"; possible cultural bias; and medicalization of human distress. The publication of the DSM, with tightly guarded copyrights, now makes APA over $5 million a year, historically totaling over $100 million.

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