Talk:Diagnostic and Statistical Manual of Mental Disorders/Archive 1

DSM-IV-TR Permissions Controversy
[This discussion might be interesting to anybody interested in,or knowledgable about, DSM-IV-TR:

http://en.wikipedia.org/wiki/Wikipedia:Administrators%27_noticeboard/Incidents#DSM-IV-TR_Copyright_question --82.195.137.125 19:13, 20 December 2005 (UTC)]

Link Update: http://en.wikipedia.org/wiki/Wikipedia:Administrators%27_noticeboard/IncidentArchive57#DSM-IV-TR_Copyright_question

is the diagnostic and scinetific manual a science or pseudo science?

Old comments that lacked headers
It is a terrible shame to waste much energy whining about disclaimers. I would prefer a more critical approach consisting of the implications of using such a diagnostic i.e the overlap between disorders. Also links to relevent advocates and challegeners of the DSM would be ideal.

--- I made some changes, what do you think? I would like make more. What speically would people like? Some of the article appears to be POV, I tried to make it more objectiveExpo512 08:43, 6 March 2006 (UTC)

--

Isn't it like IVr or some upgrade of the original IV?

I think something needs to be said about the changes between III-R and IV, like the introduction of five different axes to differentiate mental, social and physical functioning. That whole system could be put in the introduction, since it's the current standard. -- Kimiko 19:03, 17 Mar 2004 (UTC)

I have added a link to a list of DSM Codes to the See Also section of this page. I'm new here, so I hope that I have remained within the proper codes of conduct or etiquette. Cool? Erikpatt 06:15, 11 Jan 2005 (UTC)

I have added some criticism of DSM IV, this may be a personal opinion but I think it's justified. See what you think.

Cautionary statement
Can anyone explain the purpose of the "cautionary statement" section? The first sentence sort of makes it sound like it is about a "DSM cautionary statement" that is part of the DSM, or is something related to it, but as I read the section it sounds more like the caution is being advised by an author of the article itself. If this is the case, something needs to be done -- no matter how well-intentioned a warning to the reader may be, it is not NPOV to say, "You should know that X is a bad idea" instead of providing facts. (It kind of runs afoul of the "avoid self-references" guideline as well.) This is why Wikipedia has a medical disclaimer. It would certainly be appropriate to have some text in the article describing how and why the DSM is not intended to be used by amateurs, but an entire section that positions itself as a caution from the article to the reader needs to be rewritten so that it only describes the subject from a neutral stance.

If anyone else understands whether the "DSM cautionary statement" is supposed to describe some external statement in the world, or whether it is meant to itself be a caution to the reader, please edit the article as needed. Thank you. –Sommers (Talk) 17:29, 24 January 2006 (UTC)


 * I've rewritten the section so that it only provides information, not advice, as described above. I think it's much more concise and neutral this way, and the section still gets it across quite clearly that the DSM isn't meant to be used by amateurs, so I don't anticipate any problems with the new draft. If anyone can replace the "Experts generally advise..." with a real citation, though, that would be great. If anyone has any objections to the changes I made, I'm more than willing to discuss them. Thanks. –Sommers (Talk) 01:57, 25 January 2006 (UTC)


 * The original version was fairly neutral. It reminds me somewhat of the standard disclaimer before introductory abnormal psychology classes (The kind they claim they shouldn't be teaching because the information could be mis-used, but which they teach anyway). Probably more than a generic DSM disclaimer, there should be a statement that diagnoses should be left to experts.--Limegreen 21:28, 6 March 2006 (UTC)


 * I agree. However, I feel I should clarify: the point I was trying to make above (and below) is that the statement you mention should be one of fact and not of advice. Any competent encyclopedia article on the DSM should provide facts indicating that the diagnoses should be left to experts, without having to actually come out and state it to the reader. –Sommers (Talk) 04:22, 23 March 2006 (UTC)

Outdated links to cautionary statement
Upon further examination of which pages link to what used to be the dedicated "DSM cautionary statement" page, it appears that a lot of psychology-related articles were formerly referring to a page which contained a much larger and widespread description of problems perceived with the DSM. This is a problem, since most of those links now refer to a statement that has not properly existed since it was merged into this article. (A lot of it was moved into the "Development" section even before I did the most recent revision of what remained of the "cautionary statement" section.)

I think the best thing to do would be to remove (or at least rewrite) all direct references in other articles to the former cautionary statement. It was an explicitly POV (although well-intentioned) piece that, by its own title, existed only to make a statement about the weaknesses of the DSM (presumably to warn the reader against trusting it too much). It would be much better to describe these possible weaknesses, carefully in line with the NPOV policy, in a section of this article ("Criticisms" or something similar; it seems weird to have this under "Development" anyway) like we would with any controversial subject, and the other articles can point to the relevant issues with the DSM if and when they apply instead of to a blanket statement.

However, because the use of this "cautionary statement" page and the links to it predate my involvement, I'd like to get some feedback on all of this before I take it upon myself to start making changes across a lot of different articles. If no one objects, I'll get started on working my way down this list. Of course I shouldn't be the only one doing this: beside the fact that it's a big task, there are probably plenty of instances where an article says "(See the DSM cautionary statement)" where it really needs something more specific to be added, and I'll likely lack the necessary expertise in most of those cases. So if you want to make the edits yourself, please do. Otherwise, any feedback or information would be appreciated (including explanations about the former use of the cautionary page). Thanks.

–Sommers (Talk) 05:00, 25 January 2006 (UTC)

(I've taken the liberty of moving several posts from here to the bottom of the page, so that they will be in chronological order. If Zeraeph or anyone else objects, please feel free to revert. Thanks. –Sommers (Talk) 22:13, 27 March 2006 (UTC) )

Done
After having set this task aside for some time, I saw that there were no objections and proceeded. All mention of the former DSM cautionary statement has now been excised from the main namespace. The articles that formerly linked to the statement are no longer visible at the "What links here" link above, so in case anyone would like to review the changes, here is the list of the articles:


 * Agoraphobia Without History of Panic Disorder
 * Asperger syndrome
 * Atypical depression
 * Autism
 * Body dysmorphic disorder
 * Borderline personality disorder
 * Children’s Global Assessment Scale
 * Clinical depression
 * Conduct disorder
 * Dependent personality disorder
 * Global Assessment of Functioning
 * Histrionic personality disorder
 * Malingering
 * Melancholic depression
 * Obsessive-compulsive personality disorder
 * Paranoid personality disorder
 * Personality disorder
 * Schizoid personality disorder
 * Taijin kyofusho

I hope this helps to improve the neutrality of Wikipedia's overall treatment of the DSM. Any remaining comments or questions about this matter are still, as always, welcome. Thanks again to Limegreen for the attention to my concerns. Happy editing! –Sommers (Talk) 04:10, 23 March 2006 (UTC)

--

While I agree that the cautionary statement presented a point of view and I understand the reasons for the merge (I merged them myself), I remain concerned that this particular point of view (a pov incorporated into and shared by the publishers of the DSM, the American Psychiatric Association) is rather significant. I perceive this particular information less as an opinion or editorial about the DSM and more like a "Mr. Yuk" for psychiatric diagnoses. I believe that sites such as this one, which draw individuals from outside of the mental health profession in search of clarification for diagnoses that they may have formally (or otherwise) received should have quick access to the pertinent and important information provided in a cuationary statement. So many of my clients are willing to blindly pursue treatment options that they believe are in accordance with a diagnosis that they may have arbitrarily received years and years ago. For this reason, I think a prominent sign saying "Stop and read this first!" that explains the limitations and purposes of diagnostic practices is important. I believe that it is the responsibility of the wiki community to acknowledge that the information available here is integrally linked with the treatment opportunities of those who access it. It seems that offering the reader easy access to a cautionary statement is part of this responsibility. I am a bit concerned that access to this information has been lost during the merge and revisions. There is a reason William Glasser refers to the DSM as "perhaps the most dangerous and harmful book ever created for mental health" and the cautionary statement is an industry accepted step toward recognizing the limitations and potential dangers of the DSM. It is naive to think that a layperson accessing basic encyclopedic information from this site will either acknowledge the limitations of this diagnostic toolbox or dig far enough as is currently necessary to access the warnings previously provided on the cautionary statement page. I was personally responsible for the merge as the community pointed out the limitations of the cautionary statement. However, I am concerned that the removal of this section from this entry removes the metaphoric Mr. Yuk and leaves readers less prepared to access objective information that may have significant impact on their lives. I hope that the wiki community can help with figuring out a way to prominently display this information in a wiki-appropriate format for readers. Erik 04:15, 22 March 2006 (UTC)


 * Thanks for your reply. First, I agree with everything you say about the DSM itself, and I'm glad you understand the POV problems with the original DSM cautionary statement. However, I believe what you are suggesting is also, for many of the same reasons, over the line with regard to NPOV. The central problem is that trying to caution the reader, even guide them toward or intentionally emphasize the relevant information with the metaphoric "Mr. Yuk" tag, is taking an instructional or persuasive stance; Wikipedia articles are allowed to do neither. Here are the details, as I see them. (Please forgive a very long post. This is a complicated matter and I wanted to make sure I didn't miss anything. Also, the suggestions you make are good ones, and the reasons that, in my opinion, we can't follow them are subtle but important.)
 * Wikipedia articles are supposed to be written so as to only provide information, from a neutral standpoint, with no authorial voice or stance. Trying to say "Stop and read this first!" is communicating something from author to reader, which is unacceptable. As I've said, the DSM article should carefully explain the book's limitations and describe the warnings experts have given against its improper use. However, it (and other pages) must not say to the reader "Hey, make sure you read this stuff about experts' warnings before you misuse the information". To do so would be unencylopedically POV, because—even if it isn't opinionated or editorial in tone—it's advancing the opinion that people need to be aware of a certain thing lest they make a harmful mistake. Much discussion has already taken place about giving special warnings to readers, and the decision has been not to do so (even without POV problems like this): as I said to Zeraeph above, please refer to No disclaimer templates.
 * Also, I appreciate that the DSM cautionary statement page itself, as it currently exists, does neutrally provide facts much in the way I'm recommending, but it still needs to be removed. By taking these facts about the DSM's limitations and corralling them into a separate page (or even a separate section in the regular DSM article) in such a way as to warn the reader, we're creating a textbook example of a POV fork, which is a very bad thing, more so because the information has been explicitly put there to make a "statement". As I've said, the information itself given in the cautionary statement can and should be present in the regular DSM article, but must not be arranged in a cautionary or persuasive manner.
 * As for your concerns about laypersons not digging deep enough to see that information, I agree that this is probably a real problem, but I think it's a symptom of the article not presenting those facts properly. Because the point of view is, as you say, so widespread, the facts in question could be presented quite prominently in line with the NPOV policy without actually highlighting them to the reader with special links or tags. It's my opinion that, if the article were improved to a sufficiently readable and balanced condition, any rational and fairly intelligent person who reads the article would walk away with an understanding of how the DSM should and shouldn't be taken. (By analogy, someone who reads the article on firearms and had never heard of a gun before will walk away with the understanding that a gun could kill them, without a cautionary statement coming out and explicitly guiding them toward the gun safety article.) The other articles that link to the cautionary statement should take a similar approach, treating the DSM as one source of opinion without implying it's an incontrovertible reference book; I think they already do a fairly good job of this and they can be further improved if necessary. If the problem with the main DSM article is serious enough, perhaps it could be listed for review. Finally, because of the policies that the cautionary statement violates as I describe above, I think it behooves us to remove it right away, rather than leave it as a stopgap measure until the other articles receive such improvements.
 * Thanks for discussing this matter and for the understanding you've already displayed. (Thanks also for putting up with my long-windedness.) Any replies or questions would be very welcome. Unless there is a good reason not to, I'd like to get the cautionary statement and the links to it removed as soon as possible. Thanks again, and happy editing!
 * –Sommers (Talk) 17:08, 25 March 2006 (UTC)

For now, I have restored the last, brief, basic version of a "Cautionary Statement" that existed on this article as DSM cautionary statement. This seems to be some kind of legal requirement and, as a whole we are skating on such thin ice we are swimming, already with DSM and the APA, doesn't do to poke THAT particular tiger with too many sticks. I'm restoring the links as fast as I can. My only POV on this is FEAR OF THE APA ;o) --Zeraeph 13:17, 23 March 2006 (UTC)


 * Would you care to elaborate? I can see an argument for it being an ethical requirement, but under which countries laws is it a legal requirement? Also, wouldn't it be more appropriate to have a one sentence spoiler on each page. Perhaps if there is some consensus, a template could be created, similar to the plot spoiler warning :

Spoiler warning: Plot and/or ending details follow.
 * --Limegreen 23:07, 23 March 2006 (UTC)


 * There is no such legal requirement, and (while we should be as responsible as possible) the APA has no power to do anything to Wikipedia, unless they wanted to bring a groundless lawsuit. It is more or less the stated position of Wikipedia that its normal disclaimers (including the medical disclaimer, which applies here) are sufficient to be responsible to the readers and to protect Wikipedia from any liability, and it has already been decided at No disclaimer templates that there is no need for additional warning messages like the DSM cautionary statement and what Limegreen suggests. If you think that the little "disclaimer" link at the bottom of every page isn't sufficient to warn readers, you probably aren't alone, but the thing to do is bring it up at the Village Pump, not create new protective measures on the fly. Thank you, however, for your concern and boldness regarding this matter.
 * Unless a consensus decision dictates otherwise, I believe that, under existing guidelines, your edits will need to be reverted soon. Please also see my remarks below (in response to Erik's post) about the unacceptability of the DSM cautionary statement in its current form. Any additional questions and discussion are most welcome. –Sommers (Talk) 17:08, 25 March 2006 (UTC)

The DSM contains it's own cautionary statement see. HOWEVER the APA specifically refuses permission to use ANY content from the DSM IV TR including criteria. Strictly speaking all criteria should exist only as links to sites for which permission has been given.

All DSM criteria and transcriptions of same should be deleted. Now I am certainly not going to DO that deleting, but that is their position. When articles link to criteria on behavenet, the criteria already contain links the warning statement, as they are required to do. It's all a very dodgey area, but where the criteria still appear as part of an article it is simply wise to link the cautionary statement as would be required by the APA to avoid stirring them up. It would probably be best to just link their own disclaimer on behavenet.

And, I am afraid, if they take a mind to it, the APA most certainly CAN sue the bejaysus out of Wikipedia for copyright violation at any time, not least because permission fort use of criteria has been sought and refused...what on earth makes you think they can't? --Zeraeph 17:28, 25 March 2006 (UTC)


 * Wikipedia has the right to quote the DSM in line with our fair-use rights under copyright law. Sommers (Talk) 15:31, 27 March 2006 (UTC)


 * No it doesn't. "Fair use" isn't a right, it's a complex legal principle that must be proven through the courts to stand if someone wants to contest it. The APA contest that principle regarding wikipedia in specific (if you don't believe me, mail them for permission "Chad Thompson"  and explain about "fair use") and they have the lawyers and funding to back it up literally any time they feel like it, the trick is, trying to avoid them "feeling like it". This particular "storm in a teacup" is JUST the kind of thing to set them off at last.


 * Just for the record, while I personally feel the APA should concede "fair use" and that it would be to the advantage of all that they do so, sadly they do not agree. However, I cannot think of any counter argument to one of the arguments they put forward, which is that they cannot allow "fair use" for criteria where the text can be altered at any time. --Zeraeph 14:18, 28 March 2006 (UTC)

Reprinting entire sections of the DSM (or perhaps even individual criteria, word-for-word) would of course be copyright infringement, but if an article discusses a particular disorder and we want to give the fact, "The DSM lists X as a diagnostic criterion for this disorder", I don't believe the APA can legally prohibit us from doing so (because facts aren't copyrightable). Now, when Wikipedia articles do go beyond this point and infringe on the DSM, we should treat it like any other copyvio problem. (I agree that the problem does indeed exist for some articles.) But as you seem to be aware, there are two problems with using the cautionary statement to address the copyright matter: (1) Wikipedia hasn't been given the same permission as, for example, BehaveNet, so linking to a cautionary statement is a requirement that doesn't apply to us; and (2) as I've pointed out, Wikipedia's DSM cautionary statement is not the same thing as the DSM's own, so there is no point in linking to it anyway, except for a blind guess that it will somehow appease the APA.

If the purpose of the DSM cautionary statement is what you tell me, then what we're doing is bending the NPOV policy to meet an arbitrarily made-up standard in order to mimic a condition of a permission that we haven't been given. There's no legitimate reason to violate the NPOV policy and this isn't even a particularly good one. The cautionary statement is a POV fork, the links to it imply a critical opinion of the DSM, and they need to go now. That said, I understand your opinion and I'm glad you're paying attention to these matters. Thanks again for continuing to discuss this civilly. I look forward to your response. –Sommers (Talk) 15:31, 27 March 2006 (UTC)


 * I think you are getting a bit too far away from the point here, which is the PURPOSE of the DSM cautionary statement, which is, simply to explain what the DSM IS intended to be and what it is NOT, on behalf of the APA, to avoid misunderstanding or misuse. Like an "inflammable" or "dry clean only" label on a garment.


 * There are three ways to achieve that:


 * A Template
 * A link to a paraphrased article
 * A link to verbatum reproduction such as on behavenet


 * I would also very much like to see you qualify your statement that the existing article is POV by showing exactly which words and phrases you believe to be POV and why, because I honestly believe "POV" is a total misnomer for the point you are trying to make.


 * I am not saying that you shouldn't make your point, but if it is worth making at all it is worth making accurately.--Zeraeph 14:27, 28 March 2006 (UTC)


 * Please pardon the delay in my responding. As you know, I've addressed the "POV" thing at Talk:DSM cautionary statement. As for the top paragraph of your last post, I can respond to that with two of the points I've been trying to make all along. I apologize if these points weren't previously made too concisely or clearly, since this is (as I've said) a complicated matter and I can see how they may have gotten lost in the details. So, regarding the purpose of the statement:
 * The title of the DSM cautionary statement makes it brazenly clear that it is, in fact, a statement. Any such statement from the article to the reader can't be NPOV, because, no matter how impartial the statement itself may be, it reflects the point of view of the person or people who think readers ought to hear the statement. The central point here—which I think you also may be getting away from—is that it's just plain unencyclopedic to try to make a statement of any kind (let alone one with a cautionary purpose) in the main namespace, where we're only supposed to be providing information.
 * Sub-point: You say yourself that the cautionary statement is meant to be "on behalf of the APA". But "on behalf of the APA" is a point of view.
 * Also, to avoid misunderstanding, I do agree that we must "explain what the DSM IS intended to be and what it is NOT [...] to avoid misunderstanding or misuse", but we are bound by NPOV to do it in the article. Collecting facts from the article into a special statement off to the side is unencyclopedic.
 * The links that currently follow every citation of the DSM, which read "(See the DSM cautionary statement)", carry an implication something like: "The DSM says this, but you can't always take it at face value." If this were strictly a fact, then the links would indeed be as simple as a "dry clean only" label or the metaphoric "Mr. Yuk" advocated above. Unfortunately, it's not a fact; it's an opinion—an exceedingly widely-held and well-supported professional assessment, but an opinion nonetheless. The NPOV policy prohibits us from echoing that opinion, and taking special measures to urge readers to "see the DSM cautionary statement" comes far too close to doing exactly that.
 * I hope that does make my position a bit clearer. Thanks for your continued interest in hearing my points. –Sommers (Talk) 15:54, 30 March 2006 (UTC)

DSM, CBT and psychopharmacology
What about the claims that DSM was designed to (or is used to) promote cognitive behavior therapy (rather than, for instance, psychoanalysis) and the use of psychoactive drugs (e.g. methylphenidate)? Apokrif 16:54, 2 April 2006 (UTC)

Re. merging brief 'axis ii' into DSM:Multiaxial...
I would prefer not to merge, but to keep that article as a very brief one focused on that subject (like the other axis n articles). "Axis n" are mentioned frequently in other articles, usually without explanation (except of course in the main DSM article). A person who clicks on those references more likely wants a quick explanation, rather than finding themselves in the midst of the large and complex DSM article (if they're that interested in the DSM as a whole, they probably know what the axes are already; and if they become interested in dsm via the axes, it's only one click further). Just my $0.02. —The preceding unsigned comment was added by Sderose (talk • contribs) 12:56, 8 January 2007 (UTC).

NPOV and vague words
Impotence, premature ejaculation, jet lag, caffeine addiction, and bruxism are examples of surprising inclusions

Who finds them surprising?

and are but only several that non-psychiatrists might not consider to be mental illnesses "non-psychiatrists"? And what do psychiatrists (and psychologists, butchers, bartenders...) consider? Apokrif 16:48, 2 April 2006 (UTC)

Only a group of psychiatrists (and psychologists, too if they'd be invited), apparently drunk on their own power, would hold a vote (and a majority vote of those in the inner sanctum is exactly how entries are made) that would deem the above to be "mental diseases." That is, after all what we are talking about here. It is a valid criticism and more than a few psychiatrists note that the DSM now includes damned near anything that anyone might possibly complain about.Homebuilding 03:05, 12 September 2006 (UTC)

I totally agree, a good amount of criticism of the percieved "medical authority" of DSM-IV is right on it's place on this page. Let's face it, the overwhelming majority of "diagnoses" in the DSM are nothing else but a collection of subjective POV's of a bunch of wealthy and influential psychiatrists, who define behaviors outside the scope of currently socially acceptable limits as "diseases" (a.k.a. "we don't like it, so it must be a disease"). It has about as much objective validity as The Dianetics or the infamous Malleus Maleficarum. The insiders are very much aware of these facts; a considerable amount of psychiatrists, with several decades of practice, have been outspoken against the practical limitations of DSM and it's validity. F. inst. the prominent and influential psychiatrist Loren Mosher stated in his resignation letter to APA that "Finally, why must the APA pretend to know more than it does? DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general.", whilst the former APA president Robert Spitzer echoed him in an interivew, admitting "The DSM is not a scientific document.. very few of the categories have an empirical base". Unless the DSM openly states that it's labelings are unscientific/philosophical/religious and to be taken as purely subjective guidelines/alternatives in response to "troubles of daily life", it deserves to be publicly and ruthlessly exposed to the scrutiny of professional criticism. 193.217.56.24 17:29, 3 October 2006 (UTC)

Please note that Robert Spitzer, quoted just above, was and has been the driving force of the DSM--and has "founding father" status. He appointed the entirety of the initial committess and boards of the DSM. He has been the final editor of all DSM versions, up to and including the DSM IV. Once it's off his desk it is ready for the vote, up or down. He has tremendous power over how health insurance money is spent on "mental health" services as this book defines what mental health is.207.178.98.48 02:17, 12 October 2006 (UTC)

I would like to repeat that there is much more to it then finding a behavior a disease etc. as I have stated within the discrimination section of this talk article. I would like to add that there are many philosophical POVs in various forms that gave birth to the different ideas of what causes mental distress. Also, as I have said before very few disorders do NOT have the tag that it must give the individual trouble in either social, work, or liesure activity. Saying that, caffeinism is the physiological addiction as well as the psychological addiction in which the individual has withdrawal symptoms such as headaches etc that interfere with their normal functioning in which they need to consume more caffeine based products to allieviate and even act normally. Jet lag is defined as repeatedly moving from time zone to time zone in such a way which renders an insomniatic state that interferes with the individuals social, occupation, or leisure activities. Also, the comment about naming everything a disease is not truly the case. A disease has a specific definition as taken from dictionary.com for this debate "a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment." There have been links to genetic contributors for many mental disorders including schizophrenia, alcohol abuse, opiate abuse, one particular form of insomnia etc. Though there are what are called disorders as well in which there may be a cognitive impairment that leads to an individual suffering social, occupational, or leisure activities. Finally, there are even psychologists and psychiatrists that reject the medical model and use a phenomenological approach to helping individuals with problems that are not biologically based. —Preceding unsigned comment added by UNache (talk • contribs)


 * Who wrote the above paragraph? EverSince 10:18, 24 January 2007 (UTC)


 * That would be me. Sry I haven't been around lately to show my 2-cents. UNache 5:19, 5 Feburary 2007

DSM-IV Sourcebooks
The DSM-IV doesn't specifically cite its sources, but there are several "sourcebooks" intended to be APA's documentation of the guideline development process, including literature reviews, data analyses and field trials. Funnily enough these key source materials for the major psychiatric "bible" of our time seem to be rarely referred to, or stocked even in major libraries, let alone read. I thought I'd post a mixture of available sources about them here before just trying to edit, since there's so much detail and perspective that somehow needs to be summarised in a balanced way.

Widiger TA, Frances AJ, Pincus Haet al. DSM-IV sourcebook. Vols 1–4. Washington, DC: American Psychiatric Association, 1997.

Volume 1 Volume 2 Volume 3 Volume 4 (possibly not even in print any longer)

The DSM-IV Classification and Psychopharmacology by authors including the guy who directed the process

A Participant's Observations: Preparing DSM-IV

Critical reviews of vol 1 (appears twice) and Vol 2 by mental health professional author on reputable site.

Other articles covering the sourcebooks and DSM development:

Whither psychiatric diagnosis

PSYCHOPATHOLOGY: Description and Classification

Diagnosis and Classification of Psychopathology: Challenges to the Current System and Future Directions

EverSince 13:48, 24 January 2007 (UTC)

Delete Citation Needed lines
I would suggest that if references and citations cannot be provided for the lines marked, then those statements are POV and also do not meet the Wikipedia standard of being verifiable and should be deleted. DPeterson talk 14:38, 14 January 2007 (UTC)

Removal of article unreferenced tag

 * I removed the "unreferenced" tag at the top of the article because User:EverSince has done a wonderful job of adding sources and citations. DPeterson talk 20:01, 28 February 2007 (UTC)


 * I was thinking of removing the tag also, thanks. I'm also thinking of removing the unverified tag from the history section, as generally covered by the sources I think, e.g. the number of pages/disorders in each version is tabulated in the Mayes, R. & Horwitz, AV. (2005) article. EverSince 09:47, 1 March 2007 (UTC)
 * Yes, that tag should also be removed. regards.  DPeterson talk 00:21, 2 March 2007 (UTC)

DSM and Politics section
I addded the information that I removed from the History section. I am not sure if I have put this new section in the best place, but I think the information is important as it demonstrates how the community interpretation of a "condition" can effect how the mental health community thinks about a condition.LCP 22:15, 24 May 2007 (UTC)
 * Thank you for continuing to include that information; I think that it is important as well. I happened upon this page while looking for information on the removal of homosexuality from the DSM for a school project I'm working on... Just thought I'd let you know that "This American Life" (which is on NPR) recently had a show on this. I just listened to the podcast, and found it interesting, so I thought that the information might be of use here. You can find the website for that show with a quick search, and then listen to the episode from the website, if you want. The title of that episode is "81 Words". I would edit the page myself, but I don't wish to step on anyone's toes, I haven't done much editing around here in the past, and I ought to get back to writing my assignment! Anyways, I hope you find that useful, or at least interesting. Ciao! --ChatOmbre 02:45, 31 May 2007 (UTC)
 * Please feel free to step in. Wikipedia is a community project, and fiefdoms are contrary to the Wikipedia ethos. If you are uncomfortable publishing live, post a sample of what you want to include here, and others will comment on it.LCP 15:21, 31 May 2007 (UTC)

Criticisms
It's worth noting, as an illustration of just how potentially subjective and socially constructed the various diagnoses in the DSM-IV are, that Homosexuality was listed as a disorder until 1973.

It's also VERY MUCH worth noting that the authors have been shown to have links to the Pharmaceutical Industry: http://www.washingtonpost.com/wp-dyn/content/article/2006/04/19/AR2006041902560.html — Preceding unsigned comment added by 24.49.244.243 (talk) 23:41, 11 June 2006


 * Just a few thoughts:


 * 1) You can't judge the objectivity of the DSM based on the example of homosexuality being listed as a disorder over 30 years ago. The field of psychology/psychiatry is a relatively young field, and in the past it was much more attached to negative social and cultural forces than it is now, as it was more dominated by "old world" doctors. It's a different situation now.
 * 2) Nothing can be taken from that Washington Post article. LOTS of doctors act as consultants for pharmaceutical companies. That on its own means absolutely nothing for their objectivity. If the study bringing this out is included in the article (which it was until somebody blanked it), no inference of influence can be stated.
 * 3) That being said, there needs to be a good section comparing the positives and negatives of the DSM-IV, but in an NPOV way.
 * -- Tim D 17:01, 18 November 2006 (UTC)

Will someone please provide a page on Wikipedia detailing the destructiveness of this DSM document, and the many lives it has destroyed? there are websites devoted to anti-psychiatry you might want to link to. I beg of someone! please help people who have been destroyed by this process of labelling and those in the future who will be. This document is nothing more than a political and cultural means of control. It dehumanizes the wide range of human behavior. For the love of God I wish the DSM would be discredited as the voodoo it is. Psychiatry is a huge business and most lost souls primarily need to be held and loved because of horrible things that have happened, instead are villified and ridiculed and marginalized. If anyone wants to contact me they can, at contesta@comcast.net Its not that I'm against the people who perform these jobs (I think most approach the profession with a certain desire to help), but the whole method of treating people with problems has to change. A new paradigm! 71.206.44.177 01:40, 2 January 2007 (UTC)


 * Why can't we just say that homosexuality might be a mental disorder, like many other things in the manual? If it was right "thirty years ago" then we haven't made any progress at all in understanding the mind if we ignore evidence because it makes us uncomfortable. I do not imagine that many people are comfortable thinking that they have a mental disorder, but hey, plenty do. It is worth noting that other explanations for homosexuality may be even less palatable. 72.144.198.53 08:50, 31 March 2007 (UTC)


 * For the user seeking "A new paradigm!": The page you want is called anti-psychiatry. WhatamIdoing 03:03, 10 July 2007 (UTC)

Discrimination and future of DSM

 * Are you serious?! And to think that homosexuality itself was considered a "mental illness" until 1973. Such a move would show to the wider world that the DSM has no basis in objective scientific reality at all, but is just pseudoscience which slavishly follows social trends. I for one find it quite chilling that a person could be classified as mentally "ill" simply because of their political views or sexual tastes. You could envisage that sort of thing happening in the former Soviet Union, or in the "People's" Republic of China. 217.155.20.163 00:10, 15 October 2006 (UTC)

We must try to keep in mind that most of the concepts presented in the DSM can be viewed on a continuum and that almost all diagnoses require that there be significant impairment in work, social, or leisure activity that can be documented before the diagnosis is presented. Also, for most diagnosis there is a prevalence rate in which it can help us determine how rare the particular disorder should be within given samples. I do not have the research but if there was an addition of that calibar then it would be based on a rare impairing form of what is being referred to as 'bigotry'. Also, psychological testing uses the idea of clinical as opposed to statistical significance. Clinical significance can be usually seen in which those only scoring 2.5+ standard deviations are usually considered ill which is less than 10% of the population that it was standardized with. That is usually viewed rare enough to warrant further investigation. For this above example, the ideation of bigotry can be very over-simplified and become a belief in trend then what could conceivably be a detremental thought 'disorder' since I lack a better word at this moment. I will try to stress that clinicians use multiple resources besides just the DSM in order to make a diagnostic decision including lab and physician findings and psychological scores etc. UNache 23:26, 5 February 2007 (UTC)


 * No: Creating a specific diagnosis for extreme racism doesn't seem to be in contemplation.  The usual reasons for not including it are:
 * Other, existing categories are typically sufficient (paranoia, delusions, obsessions) and often much more descriptive of the whole situation. (It's likely that more mental health professionals need to recognize racism as a presenting symptom of these other conditions, but that doesn't make racism itself be the disease.)
 * Race is a culturally constructed identity, and racism can be a societal norm. Until the entire world (remember that this book gets used worldwide) is dramatically less racist than it is now, racism by itself can legitimately be considered a variation on culturally normative behavior.  You can really only call racism a "disease" (a personality disorder?) if the client's society is normatively non-racist.
 * There don't seem to be any published cases of people who are pathologically racist (under the usual clinical standards: your ideations significantly interfere with your own everyday life) unless they also have other, significant mental disturbances.  For example, I met a man last year whose severe paranoid schizophrenia prompted him to make an enormous number of anti-gay and anti-Jew remarks (averaging every fourth sentence, no matter the subject matter).  However, in the context of the whole picture of his life, his racism was really a small symptom.
 * This is an issue that highlights the complexity of the DSM's broad subject matter. Some psychological problems are socially constructed instead of biologically determined.  Some psychological "problems" are also perfectly normal (e.g., transient situational depression).  The DSM covers all of the above.  WhatamIdoing 03:57, 10 July 2007 (UTC)

DSM-IV Codes
You know, I've been watching this page for a few weeks, and what I can only describe as its slow-motion revert war is getting on my nerves. Some people clearly think that it's appropriate for the DSM page to link to the DSM-IV Codes page. Some people clearly disagree. Not one of these people has bothered to do get a discussion going on the subject. Although I'm generally inclusionist, I don't really care one way or another. But I'd really appreciate it if you'd type a little note here before you make that change again, okay? Something approaching a consensus would be nice. WhatamIdoing 15:32, 23 July 2007 (UTC)

Description of the DSM-V Task Force members
"The APA has entrusted the revision of the DSM to world-renowned scientists who have vast experience in research, clinical care, biology, genetics, statistics, epidemiology, public health and consumer advocacy. They have interests ranging from cross-cultural medicine and genetics to geriatric issues, ethics and addiction. As a group, task force members have authored over 2,500 research reports, books, chapters, white papers and journal articles." This (particularly the first and third sentences) clearly consists of a positive evaluation of the membership of the task force, and not a neutral description of its composition. What is the informational value of the word "vast" here? Is there any reason for an encyclopedia to mention the number of articles published by members of this task force? Presumably someone with an interest in the DSM edited this in. —The preceding unsigned comment was added by Special:Contributions/ (talk) This clearly consists of a positive evaluation of the membership of the task force, and not a description of its composition. Presumably someone with an interest in the DSM edited this in?
 * Edit the entry as you see fit; due to lack of telepathy, I wasn't sure why you added the tag (I don't think you need it though, be bold and make the necessary changes; although I'm wandering... maybe they are world-renowned scientists &mdash; I have no opinion either way). Thx. El_C 22:41, 21 August 2007 (UTC)

More disease names doesn't mean more sick people
I've pulled this change:
 * Each subsequent revision of the DSM contains additional entries. It is difficult to justify the claim that there are ever-increasing numbers persons defined as mentally ill during a time when the numbers of "therapists" has exploded and the numbers and types of medications used has comensurately increased.

primarily because it's unsourced, but also because it contains a logical error. The number of newly described subtypes of mental illness doesn't say anything about the number of people who have mental illnesses. This is like saying that the world produces a billion pounds of apples each year, and if you replace the "red apples" category with the names of twenty specific kinds of red apples, that somehow the world suddenly produces twenty billion pounds of apples.

This mental error has come up before on this page. The DSM describes kinds of mental illnesses (and a few not-really-illnesses). It does not make anyone be sick or change the number of people who are sick. WhatamIdoing 21:39, 13 October 2007 (UTC)

Confusing, blathering article
Needs:
 * 1) clear statement of what the DSM is
 * 2) some discussion (pref. in layman's terms) of how professionals use it
 * 3) section of criticism

Currently, a critique is buried in the "brief history" section. Here's some more criticism:


 * The use of the DSM, as Herb Kutchins and Stuart Kirk have said, reflects ‘a growing tendency in our society to medicalize problems that are not medical, to find pathology where there is only pathos, and to pretend to understand phenomena by merely giving them a label and a code number.’

Others have criticized DSM for permitting pressure groups to put in or take out things - instead of disorders being added strictly on the basis of scientific evidence. The exclusion of homosexuality was heralded by gay rights groups as proof that homosexuality is normal - yet it was only their political pressure on the APA that made it remove homosexuality. Uncle Ed 17:27, 9 November 2005 (UTC)

Added statement about how professional use it, by request aboveExpo512 (talk) 05:37, 30 November 2007 (UTC)

Wartime origin of the DSM
The main article does not make it clear that the postwar DSM grew out of a clash between psychiatric practice and the requirements of the armed forces and Veterans Administration during the second world war. Previously the American Medico-Psychological Association (later the American Psychiatric association) had produced, in conjunction with other bodies, a Statistical Manual which attempted to replace the diagnostic schemes used in the different state hospital systems and academic centres. This went through at least eight editions. However, it was common for a psychiatric consultation, especially with an office patient, not to lead to any clear and explicit diagnosis. Often the standard diagnoses, when applied to abnormal behaviour appearing in the extra-ordinary circumstances of the war, appeared to be wrong, in that the course of symptoms and the long-term outlook was not as expected. Many conditions that would not receive medical intervention in civilian life had to be labelled and managed, whether as diseases, crimes or breaches of discipline. The military and its hospitals found it necessary to label and tabulate many such encounters, and a couple of schemes were developed in the course of the war which returning medical officers found to be of use in civilian practice also. The introduction to the first edition of the DSM gives a brief account of that situation. The DSM-I was devised to reconcile these schemes in the days before the insurance companies acquired hegemony over American medical practice. NRPanikker (talk) 16:36, 2 January 2008 (UTC)
 * Is this WP:V? Can you provide reliable sources to back up this explanation?  WhatamIdoing (talk) 19:11, 2 January 2008 (UTC)
 * My reference for the above is the first edition of the DSM, which was reprinted by the APA to mark its 50th anniversary a few years ago (2002?). I don't have it at hand right now, but will get hold of the bibliographical details soon. Presumably all this would have been discussed in the (APA's) American Journal of Psychiatry at the time, but scientific and medical libraries nowadays throw everything out after ten years, so the details may not be easy to find. NRPanikker (talk) 17:01, 3 January 2008 (UTC)
 * The full reference: The Committee on Nomenclature and Statistics of the American Psychiatric Association, Mental Disorders, Diagnostic and Statistical Manual Washington: American Psychiatric Association 1952 - reprinted for the APA Sesquicentennial, May 1994. NRPanikker (talk) 03:53, 4 January 2008 (UTC)

Referencing the DSM in APA Format
Why do we have this section on "Referencing the DSM in APA Format"? Is this normal for book pages? If you look up Catch-22 or Green Eggs and Ham, is there a section on how to cite it in a bibliograph? I understand that it might be useful, but is it encyclopedic? WhatamIdoing 23:01, 18 October 2007 (UTC)

This section, I agree, is silly. I moved it to the bottom for now. I would be happy to just delete it. Perhaps it is the APA (that is american psychiatric assoc..) 'party line' on how they want their book referred to. Maybe not. However, it probably should be up to the author to choose.Expo512 (talk) 05:42, 30 November 2007 (UTC)

The "APA Format" refers to the "APA style," from the Publication Manual of the American Psychological Association, not the American Psychiatric Association. This style guide is used by a wide range of scientific publications. There are other schemes, e.g. that of the MLA (Modern Languages Association), used in other academic fields. As students are increasingly using Wikipedia as a source for essays and academic presentations, it would be a kindness to provide them with references in the form appropriate to their subject. NRPanikker (talk) 02:41, 5 February 2008 (UTC)


 * I understand that it might be useful, but is it encyclopedic? WhatamIdoing (talk) 17:43, 5 February 2008 (UTC)


 * More importantly, it's not even there now, as Athing removed it on 30/11/07 for being "unencyclopedic." It was not accurate to include the claim that DSM IV is the standard reference text for psychiatric diagnosis, since that description applies better to ICD 10. NRPanikker (talk) 16:55, 8 February 2008 (UTC)

Globalization tag
I have removed the globalization tag because it is unexplained. I had a conversation a while ago with the editor who added the tag; as I recall, the editor seemed to think that:
 * the article needed to further emphasize the fact that the DSM is not the only such book/system in the entire world, so that readers would not confuse the fact that it is very widely used with the reality that other options exist;
 * the article, which is about an American book, should include more references which have absolutely no American connection (e.g., it's not good enough to be a Spanish researcher if you publish in an American journal); and
 * the sloppy statement about DSM-based diagnosis being required should be labeled as being specifically American (and IMO the editor is absolutely right on this point).

If you think that a globalization tag will result in the improvement of this article, then please restore it and explain your concerns, in detail, right here on this talk page. This will help other editors figure out how to address your concerns. Thanks, WhatamIdoing (talk) 20:47, 4 March 2008 (UTC)

Mental retardation on the axis system
Beginning with the 1987 Diagnostic and Statistical Manual (DSM-III-R), mental retardation is classified as an Axis II disorder. See and about a half a million other webpages. Interestingly, this change was apparently (ultimately) the result of a lawsuit, City of Cleburne v. Cleburne Living Center. WhatamIdoing (talk) 19:10, 2 April 2008 (UTC)

Some &Clarify
http://www.motherjones.com/news/feature/2002/07/disorders.html later —Preceding unsigned comment added by Ben Meijer (talk • contribs) 22:33, 18 May 2008 (UTC)

On-line petitions as WP:RS
WP policy requires that the person putting the text on the page carries the burden of proof that the claim is verifiable by a reliable source. On-line petitions do not meet that standard. I can recommend only that you employ some of the available venues, such as the RS noticeboard, to ascertain whether your source has a reputation for accuracy and fact-checking. Until then, reverting this page to reinstate text that has no RS behind it violates WP:V. I am amenable to this discussion being moved to our mediation discussion. —MarionTheLibrarian (talk) 23:50, 13 June 2008 (UTC)


 * Sometimes the person putting the text doesn't do a good job of sourcing, that's true. Any editor can help; since it's easy to find sources for this, why not just add them, instead of remove stuff that's easily verifiable?  See for example these news items. Dicklyon (talk) 05:58, 14 June 2008 (UTC)


 * I went ahead and added a couple of those sources, restoring the brief mention of the petition. There's a lot more from those that could be said, but I didn't work on that, other than using their names instead of titles, and linking the journal that Zucker edits.  I agree the second half seemed unverifiable WP:OR; though some of its refs may have been reliable, I didn't see anything about the petition in them. Dicklyon (talk) 06:23, 14 June 2008 (UTC)


 * It's unclear why "Marion" has again removed the link to the petition, given that the material is sourced and doesn't seem to be at issue. And the only reason she "attributed" the news to one of the two two sources was apparently to link it to a marginalized group.  This is bullshit.  News is news; if there's a particular point that that article makes, in the way of interpretation or opinion, then attribution makes sense.  I'll try to fix it. Dicklyon (talk) 03:29, 15 June 2008 (UTC)

—MarionTheLibrarian (talk) 13:52, 15 June 2008 (UTC)
 * Please use language appropriate to WP rather than statements such as "this is bullshit." That is the second time Dicklyon has used that expression in a discussion with me.
 * I removed the petition because it does not beem WP:RS, as I said here. This is my third request that other opinion be sought, such as a third opinion or other WP venue.  WP policy is that the burden of proof belongs to the person putting the statement onto the WP page.
 * The text Dicklyon inserted here violates WP:NPOV. It quotes the negative statements reported by the newspaper article while omitting the positive ones in the same article, regarding a controversial topic.

Removal claiming RS problem
This paragraph keeps getting removed by MarionTheLibrarian:

The appointment, in May 2008, of two of the taskforce members, Kenneth Zucker (editor of the Archives of Sexual Behavior) and Ray Blanchard, has led to an internet petition to remove them. Accoring to Brian Alexander of MSNBC, "The petition accuses Zucker of having engaged in 'junk science' and promoting 'hurtful theories' during his career. According to Duncan Osborne of The Gay City News, "Dr. Ray Blanchard, a psychiatry professor at the University of Toronto, is deemed offensive for his theories that some types of transsexuality are paraphilias, or sexual urges. In this model, transsexuality is not an essential aspect of the individual, but a misdirected sexual impulse.".

Please, if there's a problem with it, tag the relevant statement with citation needed, or take out any part that you believe is not sufficiently referenced. Don't take out the whole thing with no explanation. Dicklyon (talk) 05:57, 16 June 2008 (UTC)

Consensus
We have reached consensus that reference to homosexuality as a mental disorder should be integrated into the article in a relevant section and, to the extent that such additions refer to contemporary (i.e., in 2013) assertions that homosexuality is a mental disorder, such additions should be made in a manner that does not accord the viewpoint undue emphasis (WP:UNDUE), i.e., space and prominence in the article that is out of proportion with its:


 * > small number of adherents


 * > lack of acceptance by any major mental health or medical professional association


 * > little, if any, empirical basis

 Mark D Worthen PsyD  05:03, 24 May 2013 (UTC)

Adding Back the "Political Controversies" subsection and its contents
If you believe that the "Political Controversies" subsection should be restored with some or all of the material that had been included, please first discuss your proposal here before editing the page.

In your discussion, please explain why restoring that subsection, including all or most of its content, is important in light of:


 * The information I presented above;


 * The additions made between 01:29 and 02:28 UTC on 24 May 2013 by Johnfos;


 * The many problems with the subsection as it was written (please see the article as of 11:04 UTC on 23 May 2013).

 Mark D Worthen PsyD  04:59, 24 May 2013 (UTC)

Article needs much work
It strikes me that there are particular problems with POV, for two reasons: the Criticisms are pushed to the end of the article instead of being integrated in a balanced way throughout the text. Authors such as Prof Stuart A. Kirk (UCLA), who have said a lot about the DSM over many decades, are not mentioned. Kirk wrote The Selling of the DSM in 1992, and his most recent book Mad Science (2013) also extensively reviews DSM history. I don't plan to get involved in editing this article in a major way, but will add a few paragraphs in the first half of the article that might help to balance it and make it a little more comprehensive. Johnfos (talk) 00:52, 24 May 2013 (UTC)


 * I agree wholeheartedly and I very much appreciate your additions, Johnfos. IMHO, they are well-placed, pithy, pertinent, balanced, and nicely referenced.  Mark D Worthen PsyD  04:03, 24 May 2013 (UTC)


 * Many thanks, Mark, good to work with you... Johnfos (talk) 09:16, 24 May 2013 (UTC)

The criticism section is really bad
I'm going to point out some of the problems with the criticism section. It's really bad and needs a lot of work. I would suggest deleting it or cutting it down until it is fixed.

Reliability and Validity Concerns[edit]

The revisions of the DSM from the 3rd Edition forward have been mainly concerned with diagnostic reliability--the degree to which different diagnosticians agree on a diagnosis. (no source)

It was argued that a science of psychiatry can only advance if diagnosis is reliable. (by who?)

If clinicians and researchers frequently disagree about a diagnosis with a patient, then research into the causes and effective treatments of those disorders cannot advance. (no source - who said this? - it doesn't even really make sense because research specifically lists the inclusion criteria. This is true for all medical research.)

Hence, diagnostic reliability was a major concern of DSM-III. (Who was concerned?)

When the diagnostic reliability problem was thought to be solved, subsequent editions of the DSM were concerned mainly with "tweaking" the diagnostic criteria. (source?)

Unfortunately, neither the issue of reliability (accurate measurement) or validity (do these disorders really exist) was settled. (source? Also reliability is and validity are not correctly defined)

However, most psychiatric education post DSM-III focused on issues of treatment--especially drug treatment--and less on diagnostic concerns. (source?)

In fact, Thomas R. Insel, M.D., Director of the NIMH, has recently stated the agency would no longer fund research projects that rely exclusively on DSM criteria due to its lack of validity. (In fact? Is that meant to be proof?)

Superficial symptoms[

By design, the DSM is primarily concerned with the signs and symptoms of mental disorders, rather than the underlying causes. It claims to collect them together based on statistical or clinical patterns. As such, it has been compared to a naturalist’s field guide to birds, with similar advantages and disadvantages.[43] The lack of a causative or explanatory basis, however, is not specific to the DSM, but rather reflects a general lack of pathophysiological understanding of psychiatric disorders. As DSM-III chief architect Robert Spitzer and DSM-IV editor Michael First outlined in 2005, "little progress has been made toward understanding the pathophysiological processes and etiology of mental disorders. If anything, the research has shown the situation is even more complex than initially imagined, and we believe not enough is known to structure the classification of psychiatric disorders according to etiology."[44] (can you use letters to the editor as a source?)

The DSM's focus on superficial symptoms is claimed to be largely a result of necessity (assuming such a manual is nevertheless produced), since there is no agreement on a more explanatory classification system.[citation needed]

Reviewers note, however, that this approach is undermining research, including in genetics, because it results in the grouping of individuals who have very little in common except superficial criteria as per DSM or ICD diagnosis.[3](where does the source say this?)

Despite the lack of consensus on underlying causation, advocates for specific psychopathological paradigms have nonetheless faulted the current diagnostic scheme for not incorporating evidence-based models or findings from other areas of science. (source?)

A recent example is evolutionary psychologists' criticism that the DSM does not differentiate between genuine cognitive malfunctions and those induced by psychological adaptations, a key distinction within evolutionary psychology, but one widely challenged within general psychology.[45][46][47] Another example is a strong operationalist viewpoint, which contends that reliance on operational definitions, as purported by the DSM, necessitates that intuitive concepts such as depression be replaced by specific measurable concepts before they are scientifically meaningful. One critic states of psychologists that "Instead of replacing 'metaphysical' terms such as 'desire' and 'purpose', they used it to legitimize them by giving them operational definitions...the initial, quite radical operationalist ideas eventually came to serve as little more than a 'reassurance fetish' (Koch 1992) for mainstream methodological practice."[48]

Dividing lines

Despite caveats in the introduction to the DSM, it has long been argued (by who?)

that its system of classification makes unjustified categorical distinctions between disorders, and uses arbitrary cut-offs between normal and abnormal. A 2009 psychiatric review noted that attempts to demonstrate natural boundaries between related DSM syndromes, or between a common DSM syndrome and normality, have failed.[3] Some argue that rather than a categorical approach, a fully dimensional, spectrum or complaint-oriented approach would better reflect the evidence.[49][50][51][52]

In addition, it is argued (by who?)

that the current approach based on exceeding a threshold of symptoms does not adequately take into account the context in which a person is living, and to what extent there is internal disorder of an individual versus a psychological response to adverse situations.[53][54] The DSM does include a step ("Axis IV") for outlining "Psychosocial and environmental factors contributing to the disorder" once someone is diagnosed with that particular disorder.

Because an individual's degree of impairment is often not correlated with symptom counts, and can stem from various individual and social factors, the DSM's standard of distress or disability can often produce false positives.[55] On the other hand, individuals who do not meet symptom counts may nevertheless experience comparable distress or disability in their life. (Every test in medicine has false positives and false negatives. What's the point of this section?)

Cultural bias

Some psychiatrists also argue that current diagnostic standards rely on an exaggerated interpretation of neurophysiological findings and so understate the scientific importance of social-psychological variables.[56] Advocating a more culturally sensitive approach to psychology, critics such as Carl Bell and Marcello Maviglia contend that the cultural and ethnic diversity of individuals is often discounted by researchers and service providers.[57] In addition, current diagnostic guidelines have been criticized as having a fundamentally Euro-American outlook. Although these guidelines have been widely implemented, opponents argue that even when a diagnostic criteria set is accepted across different cultures, it does not necessarily indicate that the underlying constructs have any validity within those cultures; even reliable application can only demonstrate consistency, not legitimacy.[56] Cross-cultural psychiatrist Arthur Kleinman contends that the Western bias is ironically illustrated in the introduction of cultural factors to the DSM-IV: the fact that disorders or concepts from non-Western or non-mainstream cultures are described as "culture-bound", whereas standard psychiatric diagnoses are given no cultural qualification whatsoever, is to Kleinman revelatory of an underlying assumption that Western cultural phenomena are universal.[58] Kleinman's negative view towards the culture-bound syndrome is largely shared by other cross-cultural critics, common responses included both disappointment over the large number of documented non-Western mental disorders still left out, and frustration that even those included were often misinterpreted or misrepresented.[59] Many mainstream psychiatrists have also been dissatisfied with these new culture-bound diagnoses, although not for the same reasons. Robert Spitzer, a lead architect of the DSM-III, has held the opinion that the addition of cultural formulations was an attempt to placate cultural critics, and that they lack any scientific motivation or support. Spitzer also posits that the new culture-bound diagnoses are rarely used in practice, maintaining that the standard diagnoses apply regardless of the culture involved. In general, the mainstream psychiatric opinion remains that if a diagnostic category is valid, cross-cultural factors are either irrelevant or are only significant to specific symptom presentations.[56]

Medicalization and financial conflicts of interest

It has also been alleged (by who?) that the way the categories of the DSM are structured, as well as the substantial expansion of the number of categories, are representative of an increasing medicalization of human nature, which may be attributed (by who?) to disease mongering by psychiatrists and pharmaceutical companies, the power and influence of the latter having grown dramatically in recent decades (according to who?).[60]

Of the authors who selected and defined the DSM-IV psychiatric disorders, roughly half had had financial relationships with the pharmaceutical industry at one time, raising the prospect of a direct conflict of interest.[61] The same article concludes that the connections between panel members and the drug companies were particularly strong in those diagnoses where drugs are the first line of treatment, such as schizophrenia and mood disorders, where 100% of the panel members had financial ties with the pharmaceutical industry.[61] In 2005, then American Psychiatric Association President Steven Sharfstein released a statement in which he conceded that psychiatrists had "allowed the biopsychosocial model to become the bio-bio-bio model".[62]  (It seems that if we're going to have a section questioning the use of prescription drugs then we should have a discussion about all the research that is preformed to balance out what is really an ad hominem attack)

However, although the number of identified diagnoses has increased by more than 200% (from 106 in DSM-I to 365 in DSM-IV-TR), psychiatrists such as Zimmerman and Spitzer argue it almost entirely represents greater specification of the forms of pathology, thereby allowing better grouping of more similar patients.[3] William Glasser, however, refers to the DSM as "phony diagnostic categories", arguing that "it was developed to help psychiatrists – to help them make money".[63]

In addition, the publishing of the DSM, with tightly guarded copyrights, has in itself earned over $100 million for the American Psychiatric Association.[64] (What is the purpose of this line?  It appears to be to question the motives of the APA.  If that's going to be done, then do it, and back it up with something.  Instead this line makes it seem like it's somehow immoral to publish books.)

Consumers and survivors

A consumer is a person who accesses psychiatric services and may have been given a diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, while a survivor self-identifies as having survived psychiatric intervention and the mental health system (which may have involved involuntary commitment and involuntary treatment). (According to who - these are not commonly used descriptions in psychiatry - seems 100% POV)

Some are relieved to find that they have a recognized condition to which they can give a name. Indeed, many people self-diagnose. Others, however, feel they have been given a "label" that invites social stigma and discrimination (i.e. mentalism), or one that they simply do not feel is accurate. Diagnoses can become internalized and affect an individual's self-identity, and some psychotherapists find that this can worsen symptoms and inhibit the healing process.[65]

Some in the Psychiatric survivors movement (more broadly the consumer/survivor/ex-patient movement) actively campaign against their diagnosis, or its assumed implications, and/or against the DSM system in general.

It has been noted that the DSM often uses definitions and terminology that are inconsistent with a recovery model, and that can erroneously imply excess psychopathology (e.g. multiple "comorbid" diagnoses) or chronicity.[66] (This line makes no sense. It's saying that people who disagree with psychiatry disagree with what psychiatrists do - not really needed)

DSM-5 Critiques

Psychiatrist Allen Frances has been critical of proposed revisions to the DSM-5. In a 2012 article, Frances warned that if this DSM version is issued unamended by the APA, it will "medicalize normality and result in a glut of unnecessary and harmful drug prescription."[67] In a December 2, 2012 blog post in Psychology Today, Frances lists the ten "most potentially harmful changes" to DSM-5:[68] Disruptive Mood Dysregulation Disorder, for temper tantrums Major Depressive Disorder, includes normal grief Minor Neurocognitive Disorder, for normal forgetting in old age Adult Attention Deficit Disorder, encouraging psychiatric prescriptions of stimulants Binge Eating Disorder, for excessive eating Autism change, reducing the numbers diagnosed First time drug users will be lumped in with addicts Behavioral Addictions, making a "mental disorder of everything we like to do a lot." Generalized Anxiety Disorder, includes everyday worries Post-traumatic stress disorder, changes opening "the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings." (This is deceptively worded - it makes it sound like the DSM-5 is including temper tantrums under disruptive mood dysregulation disorder [and so on]. This is not an established fact, but one guys opinion of what would happen)

Frances and others have published debates on what they see as the six most essential questions in psychiatric diagnosis:[69] are they more like theoretical constructs or more like diseases how to reach an agreed definition whether the DSM-5 should take a cautious or conservative approach the role of practical rather than scientific considerations the issue of use by clinicians or researchers whether an entirely different diagnostic system is required. (This would be good in an article about Frances)

In 2011, psychologist Brent Robbins co-authored a national letter for the Society for Humanistic Psychology that has brought thousands into the public debate about the DSM. Approximately 14,000 individuals and mental health professionals have signed a petition in support of the letter. Thirteen other American Psychological Association divisions have endorsed the petition.[70] Robbins has noted that under the new guidelines, certain responses to grief could be labeled as pathological disorders, instead of being recognized as being normal human experiences.[71] (I'm not sure if this is a specific enough criticism to be included. Any diagnostic criteria for anything will have false positives and/or false negatives - also this ignores the role of the physician as any decent physician would get a history)

I think the section should be taken out or pruned until someone has a chance to go through and fix it. Whoever does should ask themselves if this is the right article for each bit of information, if it represents a POV, and if it's properly sourced.


 * You make some valid points but you lose some credibility by not signing your post and not registering for the site. I see lots of 'fly by' editors with these characteristics. Since I'll often never see such ediotrs again, I don't want to waste time engaging in a dialogue. So, please register for the site and let us know if this was a one-time contribution or if you plan to stick around and work on this issue in a collaborative manner. If you plan to stick around, please read the introductory material for editors on the site - it is very helplful. Then you can make some of the changes you propose yourself. :) Best Regards -  Mark D Worthen PsyD  20:26, 2 August 2013 (UTC)

Why the repeated focus on sexuality?
The sections on the first two editions on the DSM seem to pick out homosexuality in particular as a focus. The section of the second edition's seventh printing is written in such a way as to suggest that homosexuality was removed purely due to political pressure. And the section on DSM-III-R also picks out sexual orientation. It seems that the focus on sexuality throughout these sections and the misleading account of homosexuality being removed are driven by a conservative agenda. — Preceding unsigned comment added by 82.20.19.182 (talk) 14:10, 21 September 2013 (UTC)

Difference between Axis I and II
I believe that this is a really good topic for discussion, as there is a logic behind it that is not obvious. My view is that Axis II is derived from traits that are life-long, and Axis I is about disorders that are affective (not necessarily, but including depression). I am posing this suggestion as a question, as sources are hard to find concerning this.--John Bessa (talk) 17:19, 15 February 2011 (UTC)
 * You will find the best description of this in the introduction to The Diagnostic and Statistical Manual of the American Psychiatric Association. Basically they were trying to separate up different aspects of the biopsychosocial-developmental aspects of the diagnosis. Also Axis I is not just 'affective', but all the major disorders. Also, the book itself clearly says if you don't like the multiaxial system, dont use it, and it provides several helpful alternative formats you might like to use. Main problem here is that I bet the minority contributing have the book or have ever read it. Egmason (talk) 05:53, 13 February 2014 (UTC)

Edit request on 18 December 2011 (note to administrators - this belongs in the Critique section, thanks!)
Dr. Ofer Zur and Nola Nordmarken (2010) describe how the DSM pathologizes healthy groups, such as autistics, women, the elderly, and people with strong expressed emotions. Full article here.

Azziaz (talk) 06:57, 18 December 2011 (UTC)
 * ❌ - as it stands its not something I can add to the criticism section. I though about adding it to a created further reading section? But it seems a primary article written by two people that as yet don't have en wikipedia articles. IMO to include this content will need a bit tweaking and or discussion. Youreallycan (talk) 12:52, 21 December 2011 (UTC)

--- (Note: Just wanted to add a request - I've recently found out that the "belief in supernatural beings, such as ghosts, spirits, angels and demons" was considered a sign of mental illness and incompetency before DSM-IV 1994. Could the experts please confirm this fact and report it in this article?) — Preceding unsigned comment added by Philosopher3000 (talk • contribs) 23:55, 9 March 2012 (UTC)
 * If that is a delusion, then yes it still is. If you have enough persons who believe, then no, it is religion and obviously not a mental disorder. Egmason (talk) 05:53, 13 February 2014 (UTC)

DSM-IV-TR for free
Hi. How can I get DSM-IV-TR and get it for free? — Preceding unsigned comment added by Mustafa Bakacak (talk • contribs) 11:07, 27 September 2012 (UTC)


 * I don't know how you can get the whole book for free, but here you can read about all the diagnoses:   Lova Falk     talk   19:03, 27 September 2012 (UTC)
 * Search through second-hand or charity stores in a University town. Go to a library. Ask a psychiatrist if you can have their old copy. Write to the APA and ask. Pirate Bay might have a copy but you might get Digital Millennium Copyright Act-ed. Advertise on e-bay or Craigslist. Ask your local hospital or health provider if they have one they're not using. Egmason (talk) 05:53, 13 February 2014 (UTC)

Consumers (term)
The section Consumers says: "A Consumer is a person who has accessed psychiatric services and been given a diagnosis from the DSM." Is consumer really the best, most standard term? Isn't client or user more common?? Lova Falk    talk   17:26, 18 June 2010 (UTC)


 * client, consumer and service user are all used. I dont think there is a standard term, as the concept seems to be a product of the social and poltical climate of the time.  The term client is no longer used in my service - as it is thought to be a product of the 1980s.  Earlypsychosis (talk) 08:28, 6 July 2010 (UTC)


 * Consumer is a horrible word probably of human capital origin; it appears nowhere in the DSM IV TR; if there is no compelling reason to use it, it should soon be changed to the more standard "client."--John Bessa (talk) 18:33, 27 January 2011 (UTC)


 * Why is this necessary in a discussion about the DSM? I don't see any link. Put this in a general article about Psychiatry. Egmason (talk) 05:53, 13 February 2014 (UTC)
 * Egmason, the talk page is not a discussion about the DSM but about our article. In the article, the term consumer is used. That is how this is a relevant discussion.  Lova Falk     talk   08:33, 14 May 2014 (UTC)
 * I now changed from consumer to client.  Lova Falk     talk   08:36, 14 May 2014 (UTC)

Asperger's and Diagnostic and Statistical Manuel of Mental Disorders
I believe it is necessary to mention that Aspergers was first recognized by the DSM-IV. It is a popular topic amongst society and its origination should be noted. Here is my hopeful addition: The DSM-IV was also the first to recognize Asperger's Syndrome as one of the five disorders listed under the category of pervasive developmental disorder. Here is the citation to the book where I found this information: Grandin, Temple, and Richard Panek. The Autistic Brain: Thinking across the Spectrum. Boston: Houghton Mifflin Harcourt, 2013. Print.

Let me know what you think! --Rzelmano1221 (talk) 23:24, 18 April 2014 (UTC)
 * Hi Rzelmano1221! Thank you for your suggestion, but personally I think this is too detailed information about one single diagnosis for this article. There are many more diagnoses that have started in one edition of the DSM and that were abandonned in the next edition.  Lova Falk     talk   08:39, 14 May 2014 (UTC)

Blacklisted Links Found on Diagnostic and Statistical Manual of Mental Disorders
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OOBE
is out of body experience is a disorder? — Preceding unsigned comment added by 14.142.41.30 (talk) 09:56, 20 August 2015 (UTC)
 * It can either be a spiritual experience, a symptom of a mental disorder, or if chronic and severe enough, Depersonalization-derealization disorder, which is included in DSM-5 (ICD-9-CM 300.6; ICD-10-CM F48.1). The Wikipedia article, Depersonalization, provides a good introduction IMHO.  Mark D Worthen PsyD  16:25, 24 August 2015 (UTC)

Inconsistencies in description of number of mental disorders listed in each DSM version
I want to find the number of mental disorders listed in each DSM version.

At present there are some inconsistencies in the way this is described:
 * DSM-I: "106 mental disorders"
 * DSM-II: "182 disorders"
 * DSM-III: "265 diagnostic categories"
 * DSM-IIIR: "292 diagnoses"
 * DSM-IV: "297 disorders"
 * DSM-IV-TR: "The diagnostic categories ... were unchanged." but later in the article: "the number of identified diagnoses ... 365 in DSM-IV-TR"
 * DSM-V: Not specified

I'd like the article to:
 * Use consistent terminology (are they mental disorders, disorders, diagnostic categories, or diagnoses?) in each case.
 * Be specific and consistent about how many mental disorders are listed in the DSM-IV-TR (is it 297 or 365?).
 * Include the number of mental disorders in DSM-V.
 * Summarize this information in a table and/or graph.

--Grahamstoney (talk) 03:22, 24 July 2015 (UTC)


 * You make some good, valid points. Be bold and make some edits to the article yourself. Your contributions are appreciated. :O)  Mark D Worthen PsyD  16:28, 24 August 2015 (UTC)

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Criticisms - #2
I find this article disappointing. I have only a layman's knowledge of psychiatry and psychology, but have some hopefully constructive criticisms. First, and most obvious is why are all five editions (as well as supplementary publications which are generally included) treated the same? There has been enormous changes in the DSM's content and uses; is it USEFUL or INFORMATIVE to discuss them as being parts of a single thing? Second, it would be useful to discuss the major alternatives to the Euro-centric? DSM (including the ICD, Ch. V) used by mental health practitioners the world over. (Does China use the DSM? India? Indonesia? Brazil? Pakistan? (those countries and the USA comprise ½ of the world population. How about (other) Islamic, Arabic, or African countries?) Third, the section titled "DSM-5 critiques" was written PRIOR to it being published (May 2013) and should be revised. Any claims before that time were speculative predictions; and are of limited relevance, imho. NOWHERE in that section is mention of the petition (Oct 2013) for outside review mentioned, for example. Lastly, the section titled "Reliability and validity concerns" should be rewritten. Here is my suggested revision:"The DSM's diagnostic reliability — the degree to which different diagnosticians agree on a diagnosis - continues to be a major source of concern.[55] If clinicians often differ in their diagnosis of a patient, or of the criteria which they use to categorize mental disorders, then treatment may not be optimum. Misdiagnosis can lead to both sub-optimal treatment as well as limiting insurance reimbursements for (hence access to) care. In 2013, Thomas R. Insel, M.D., Director of the NIMH, stated that the agency would no longer fund research projects that rely exclusively on DSM criteria due to its lack of validity.[56] NIMH has proposed use of the RDoC classification system as an alternative."216.96.113.99 (talk) 07:01, 29 June 2016 (UTC)

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Undue POV
Just my 2 cents that the section I've tagged might be giving undue weight to one person's opinion - more citations that comment about the opinions (ideally, not self-written sources) would be required to demonstrate the importance of said opinions. 69.165.196.103 (talk) 05:23, 12 March 2017 (UTC)


 * If the Frances critiques were integrated with the other critiques, some of which have their own subsection, it might balance out the overall tenor of the article, along the lines of this Wikipedia essay: Criticism ("In most cases separate sections devoted to criticism, controversies, or the like should be avoided in an article because these sections call undue attention to negative viewpoints").  - Mark D Worthen PsyD   (talk)  09:14, 16 May 2017 (UTC)

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Italicized or not?
Is the title of this publication properly italicized or not? There seems to not be a consensus, and I feel as though there should be one. Michipedian (talk) 10:41, 31 July 2017 (UTC)
 * It should be italicized. Kaldari (talk) 10:36, 21 July 2018 (UTC)

Fact checking & Change of reference
Hello,

Very first contribution to WP.

Under History/DSM-I (1952), ref 17[i] cannot be used to support the fact it is supposed to support, i.e. that "The manual was 130 pages long and listed 106 mental disorders". The information about number of pages and entries is nowhere to be found in this paper. I suggest citing this more recent paper[ii] which informs about both facts: "The DSM-I contained 128 categories and was published as a smallish (132 pages) paperback book that cost $3.", 'categories' meaning listed disorders from what I understand. I further suggest making the appropriate changes to the sentence.

[i] Grob, GN. (1991) Origins of DSM-I: a study in appearance and reality Am J Psychiatry. April;148(4):421–31.

[ii] Blashfield, R. K., Keeley, J. W., Flanagan, E. H., & Miles, S. R. (2014). The cycle of classification: DSM-I through DSM-5. Annual Review of Clinical Psychology, 10, 25–51. http://doi.org/10.1146/annurev-clinpsy-032813-153639

Regards,

Richard 176.159.24.144 (talk) 21:29, 25 October 2018 (UTC)

US Navy and US Army
Hi, I've tried to introduce a gentle historical record of the US Navy and US Army from DSM-1, combined with a UN WHO quote on the viral nature of mental diseases as expanded in numbers from 1952 to 2001 under UN inspection. It is part of the campaign the Israeli Mossad is managing against the phoenomenon of torture, as it is manifested in advanced scientific medical experiments tied to lifelong torture of human beings and animals. I was blocked by an Australian Wikipedia activist named David Gerard from even bringing the subject to the awareness of the community. Here are the sources which i tried to quote, DSM-1 page vii (1948 psychiatry history and forward) https://archive.org/details/dsm-1/page/n7 And here's the United Nation's World Health Organization's statement on the subject of people affected according to psychiatry/DSM https://www.who.int/whr/2001/media_centre/press_release/en/

Please see if you can process the original data into Wikipedia quality info, And ofcourse I'm available for any further info leaks I may be able to provide. War.technology (talk) 08:37, 15 December 2018 (UTC)


 * That WHO link doesn't even mention the DSM. And I've never blocked you - David Gerard (talk) 17:02, 15 December 2018 (UTC)

Lede re APA revenue stream (recent |editing efforts)
Yeah, Talk should help, Flyer22 Reborn!

Disclosure (of stance / bias: not of firm opinion): I’m very sympathetic to the aims and achievements of the DSM, in pulling together a reference platform out of the mental-health disaster of last century’s total war. To me, DSM is a worthwhile target for critics because it’s the only target. Its weaknesses are not APA self-indulgence, they’re the big issues in Anglophone culture’s ideas about mental health. And maybe in US healthcare delivery too, but that’s not my thing. (I’m a Brit.)

In particular, I’m impatient with criticism that DSM should be rejected as a mere muddle of symptomatology. So was eighteenth-century physical medicine; and the solution to that was to do the work and make the progress - not to complain tht medicine was unscientific and shouldn’t be attempted!

What I was originally tackling is the way the lede closes. I experienced it as a POV ambush, a bait-&-switch from encyclopaedic style, to push an undeclared agenda, leaving a nasty aftertaste.

At the close of the lede! I presume that’s the worst possible place in an article to do that - and this is an important article!

Looking again, it still seems clear to me tht there’s a problem tht needs solving.

( There are other minor problems with the sentence: the $100m figure in the source relates to DSM-IV, not to DSM’s whole history; and annualising the figure will mislead if in fact the revenue-stream is lumpy / cyclic. )

Rather than getting into the policy long grass. .  Maybe I took the wrong approach to reworking the text in the first place. How about moving the point to the opening paragraph? where it helps convey DSM’s established status?

( The following proposal includes other tweaks. )


 * 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 in established use by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, the legal system, and policy makers. The previous edition, DSM-IV, earned the APA over $100 million over its 19-year life.[1]  Outside the US the WHO’s ICD Chapter V, Classification of Mental and Behavioural Disorders, has greater reach.[2]


 * - SquisherDa (talk) 13:06, 19 February 2019 (UTC)
 * SquisherDa, the current lead states, "The publication of the DSM, with closely held copyrights, earns the APA over $5 million a year, totaling more than $100 million over its history." Your version states, "It has been observed that the fourth edition earned the APA more than $100 million, through closely held copyrights, during its 19-year currency period." I don't see how your version is any better. All "it has been observed" does is compel an editor to add a Template:By whom tag. I understand what you mean about the POV push of the statement; I addressed a similar matter at the DSM-5 article. After I took the matter to WP:Med (see Wikipedia talk:WikiProject Medicine/Archive 90), the material was moved to the lower part part of the article because the lead, per WP:Lead, is supposed to summarize the article, not include material not summarized lower first. The lead is supposed to summarize the article's most important points. Just like with the DSM-5 article, I don't see that this piece even needs to yet be in the lead of this article. How about moving it lower? We can ask for opinions on this at the WP:Neutral noticeboard and/or WP:Med. Flyer22 Reborn (talk) 04:00, 21 February 2019 (UTC)


 * On a side note: Since this article is on my watchlist, I prefer not to be pinged to this talk page. Flyer22 Reborn (talk) 04:04, 21 February 2019 (UTC)

Pinging: not sure how the system works: hope this is OK?

POV: great tht we’ve both felt uncomfortable! - it’s not just me! Also tht you’ve already sorted out rather the same issue elsewhere, as you describe.

Lede as summary: I had missed this, tht the point appears only in the lede. Really, that alone is decisive. That is, the first (?only) step is to transfer the point from lede to body.

You? or me? (Hint: I reckon you know the particular article better - and know what you’re doing generally rather better too!)

Other minor problems: I hope you agree with me tht annualising the revenue-stream is potentially misleading (and close to OR)? And of course the stated figure relates to just DSM-IV (presumably inc -TR)?

Policy points: what policy points apply to the new copy will become clear when it’s drafted; but if relevant. . I don’t share your qualms about By whom tags. It would help to locate the citation early in the sentence (as I did in my initial para-split attempt; forgot in my more recent effort moving the point to an earlier para). On that basis, I’d think anyone who adds that tag - while the answer to his/her question, last=, is staring right back from that exact point in the source code! - needs to be sat down in a quiet corner and listen while something is explained! And I doubt tht the suggested lede-limit of four paragraphs has a lot of weight, either, in application to an article of this length and importance.

In the body: *then* back in the lede again? Probably basically leave this until we have it in the body and we can judge how the whole thing looks. Thinking ahead, though, in case it helps with orientation / context. . I don’t fully trust my own ideas on this (because of my suspected bias in favor of DSM, + doubts tht I may be over-correcting); but my hunch is (i) there is an argument tht the APA is getting a little too comfortable with the revenue stream, and cozy with Big Pharma too; and (ii) it’s important enough for eventual mention in the lede.

Neutroboard / Med: I suppose we could? if we begin to feel doubts? But certainly at this stage it seems clear to me :-)

Lede discussion part 2

 * - SquisherDa (talk) 16:23, 23 February 2019 (UTC)
 * Pinging works by linking the editor's username with a fresh signature; see WP:Ping. That stated, I don't need to be pinged to this talk page since this talk page is on my watchlist. I prefer not to be pinged to articles I'm watching.


 * I'll move the content out of the lead.


 * If you feel that you can make the revenue-stream text more accurate, feel free to do so as long as you are sticking to what the source states. But it's best to avoid wording that can lead to a "by whom" tag. Yes, there are a lot of editors (especially less experienced ones) who will add the tag; this is because they have not read the template and they are keen on applying the WP:Words to watch guideline, often being strict with it. The template states, "Do not use this tag for material that is already supported by an inline citation. If you want to know who holds that view, all you have to do is look at the source named at the end of the sentence or paragraph. It is not necessary to inquire 'By whom?' in that circumstance." But despite what the template states, sometimes a source isn't clear about who stated what.


 * As for the WP:Lead guideline, it's an important guideline to follow. There's usually no need for a single-sentence paragraph in the lead, and this is definitely one of those cases since the content isn't even significantly covered lower in the article. And MOS:Paragraphs advises to generally avoid including single-sentence paragraphs.


 * As for whether some material on it should go in the lead once I put it lower. It's still currently a single-sentence paragraph. It's not one of the most important parts of that article that, per WP:Lead, should be in the lead. Flyer22 Reborn (talk) 16:42, 24 February 2019 (UTC)


 * Moved to the "History" section (followup edit here). Per WP:Due weight and MOS:Paragraphs, it shouldn't have its own subsection. Not yet, with it being the single-sentence paragraph (little material) that it is. Flyer22 Reborn (talk) 16:56, 24 February 2019 (UTC)

Pinging: mmm. Well, let me know if probs. (I did try looking at WP:Ping!)

I’ve now rewritten the moved copy to suit its new location - and to reflect its cited source(!) I’ve also taken care to avoid claiming to summarise the NYT article as a whole, rather than just this criticism.

As the point it makes is simply that, though - a criticism - should it really be in that section? rather than in History? (I would have said that earlier: but it wasn’t till I revisited the NYT piece, as part of this rewrite, tht I was reminded how fierce the criticism is. The piece ends with the words “laughing all the way to the bank”! - almost intemperate for the NYT?!)

Inexperienced editors: well, yes, and I’m much encouraged to see tht we’re seeing the basic issue in the same way. But shouldn’t we be pushing back? rather than surrendering the article space to contributors who need to attend to an explanation?

In this case, though, I’ve now simply mentioned the NYT in the running copy. I considered mentioning Gary Greenberg, instead of NYT. . it looks like he may be sufficiently notable to warrant mention? - but I’m not in a position to judge.

- SquisherDa (talk) 04:08, 25 February 2019 (UTC)

Lede discussion part 3

 * Good discussion y'all. :O) ... SquisherDa wrote: "In this case, though, I’ve now simply mentioned the NYT in the running copy." I like it, i.e., it seems to be the appropriate balance. The American Psychiatric Association runs a smart business. As a psychologist I could whine and complain or I could contribute to the scholarly discussion about the thorny problem of mental disorder nosology. I believe the later option ultimately moves the field forward and helps more people.


 * SquisherDa also wrote: "I considered mentioning Gary Greenberg, instead of NYT . . it looks like he may be sufficiently notable to warrant mention?" I'd say 'no', but I don't have strong feelings about it.  - Mark D Worthen PsyD   (talk)  01:36, 26 February 2019 (UTC)
 * SquisherDa, regarding this, "remarked acidly" is an unencyclopedic tone. As for "should it really be in that section? rather than in History?", the content is in the History section. The General section is a subsection of the History section. And I included it in the History section because the text previously stated "over its history." It's partly about the history. As for "surrendering the article space to contributors who need to attend to an explanation," like I stated, it's best to avoid wording that can lead to a "by whom" tag and "despite what the template states, sometimes a source isn't clear about who stated what."


 * Markworthen, regarding this, this and this, I don't see why Insel should be mentioned in the lead. That is his opinion, and I don't see that he's even mentioned lower in the article. Criticism of the DSM should be summarized and not attributed to just one person. It's a WP:Due weight issue. If you reply, I ask that you don't ping me. Flyer22 Reborn (talk) 09:25, 27 February 2019 (UTC)


 * Insel was already quoted in the lede when I got here. But the quote was attributed to NIMH as a whole, which was imprecise. Therefore, I attributed the quote to Dr. Insel, and while I was at it, I re-wrote the sentence, hoping to improve the prose.


 * Your point about summarizing in the lede is well-taken, and since I was primarily just trying to help out with the issue regarding the APA’s DSM profits, I am perfectly fine with you editing that last paragraph as you deem it most appropriate.  - Mark D Worthen PsyD   (talk)  22:24, 27 February 2019 (UTC)


 * I owe you heartfelt apology, F22R, for (in essence) making you explain to me tht a subsection of the History section is part of the History section!! Thank you for your patience - and forbearance!


 * What I had *meant* to suggest is tht the material we’re working on should be in the *Criticism* section.


 * ( “Over its history”: well, yes, our original report did introduce that phrase - with misleading effect. That was one of the reasons I felt it needed rewriting.  Greenberg is entirely and clearly focussed, on “the current edition” - then (= 2016) still DSM-IV. )


 * And I think what Mark has been writing is sound in itself - just out-of-place (too detailed) in the lede.  (That is, it’s too detailed for the lede, which should just summarise: it needs to be in the body, in detail as Mark suggests; and then should probably be summarised in the lede.)


 * What do people think? about drawing this material together and relocating it in Criticism?


 * “Acidly” / unencyclopaedic: hard to argue with you there! I was a bit short of ideas at that point, on how to characterise the criticism without (i) appearing to overstate it, (ii) actually understating it (we would then be misrepresenting it), or (iii) seeming to criticise the critic (for, eg, being intemperate; or polemical).


 * Maybe take refuge in the facts? Describe the criticism simply as “sharp”? and then quote the NYT article’s closing words in the citation?  So, <ref (( cite  yadda yadda )) The article’s closing words: “it [the APA] will be laughing all the way to the bank.”<ref/


 * - SquisherDa (talk) 23:44, 27 February 2019 (UTC)


 * I moved the NIMH/Insel sentences to the body of the article as discussed here (diff). Thank you both for your insights and suggestions on this point. Good teamwork! :O)   - Mark D Worthen PsyD   (talk)  02:14, 28 February 2019 (UTC)


 * I don't feel strongly about the New York Times piece being moved to the Criticism section. Flyer22 Reborn (talk) 17:59, 28 February 2019 (UTC)

Consistency re: "U.S." instead of "US"
Another editor changed "US" to either "U.S." or "United States" (diff). I searched the article and found two instances of "US", which I changed to "U.S." for one, and "United States" for the other (diff) for consistency per MOS:US. Unless there is a compelling reason to change the way we abbreviate "United States" in this article, I am in favor using "U.S.". The article does not frequently mention other countries using abbreviations, e.g., UK, AUS, NZ, which is one reason to prefer "US" in some articles (see MOS:US). - Mark D Worthen PsyD  (talk)  (I am a man. The traditional male pronouns are fine.) 13:38, 30 September 2019 (UTC)

Creative work or factual description (Copyright issue)
Following the copyright issue (see top of this talk page), I'm surprised that the article does not state that this manual is a creative work, as even sated and claimed by the authors. Not so far from, for example, a novel or a personal report of a news or so on, differently form stating fact or "actual" definition of real things as "Water in rivers goes downstream ", "The Sun is a star", "The Sun rises in the East zone, set in the West zone", "New York is in Unite States", or for a medical example "Pharyngitis is every inflammation of the pharynx". We can hold to be sure that some other authors have written earlier than me, even word for word, but no one of such authors can claim a copyright stating that this wording are his/her own property and thinking tath he/sehe block anyone else to use the same sentence.

Amazing this book is introduced it this Wikipedia's article not as an authors' invention and imagination (as claimed by themself!) but as a "real thing". (Off course, we need to point out that someone actually use for the classification of mental disorders, but Iliad can not be introduced as a "real treasure map" not even if Heinrich Schliemann used it in that way). --95.239.2.134 (talk) 09:28, 21 October 2019 (UTC)

Multiple issues
I added a multiple issues tag (banner) to the article, specifying:


 * This article may need to be rewritten to comply with Wikipedia's quality standards.


 * This article may require copy editing for grammar, style, cohesion, tone, or spelling.


 * This article needs additional citations for verification.

Please discuss here. Thank you  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  17:00, 16 May 2020 (UTC)


 * Kudos to Dhtwiki and Guavabutter for their recent copy edits and other significant improvements to the article. I removed the Multiple Issues tag. :0)  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  08:34, 27 July 2020 (UTC)

International comparisons?
It would helpful to have in this article a comparison of the DSM with other serious non-US and non-Anglophone systems of diagnosing and describing mental health, if such exist. (I myself know absolutely nothing about this, but would love to read if other experts wrote it.) Acwilson9 (talk) 20:28, 14 September 2020 (UTC)


 * While the article doesn't make detailed comparisons, which don't necessarily belong here, the International Classification of Diseases, which is published by the World Health Organization, is mentioned. Dhtwiki (talk) 22:47, 14 September 2020 (UTC)

The opening paragraph made it sound as though the DSM is the default authority in all countries. As far as I know the DSM is only an authority in the USA. I have attempted to clarify this. Please improve if you think it can be improved. SpectrumDT (talk) 11:39, 8 April 2021 (UTC)

Wiki Education assignment: WikiMed Feb-Mar 2022 UCSF SOM
Hello Wikipedians! My name is Nicholas, and I am a fourth year medical student at UCSF going into psychiatry. I am going to work on the DSM page as part of an elective course. Hopefully I’ll be able to help!There are a few different parts of the page that look like they could use some work.

First I plan on improving the citations on the “Pre-DSM-1 (1840-1849)” section. I will update all of the citations and add citations wherever needed. I hope to have this accomplished by 3/10/2022.

I will then edit the “superficial symptoms” section as it is tagged for having too many/overly lengthy quotations. I will work to pare down the essential information to make it more readable as well as confirming citations and adding citations if needed. I hope to complete this by 3/15/2022.

Finally I will work on the section “Distinction from ICD” section to try to include more specific comparisons regarding the difference between the DSM and other widely used psychiatric diagnostic manuals. I hope to have this completed by 3/21/2022.

If anyone is interested in this page and wants to talk please reach out! Thanks!

Nicholas — Preceding unsigned comment added by Zeboman123 (talk • contribs) 07:03, 4 March 2022 (UTC)

Peer Review
Peer review of this article as part of the UCSF Spring 2022 Wikipedia Elective course.

Overall, the edits made to this article are outstanding and I believe they significantly improve upon the previous version of the article.

Two sections in particular that I believe had the most major improvements are the "distinction from ICD" and "superficial symptoms" sections.

The edits improve upon the article's readability, content, and flow and are appropriate for an encyclopedia audience at large.

Comments:


 * Specifically, the edits you made to the “superficial symptoms” section did an excellent job to improve the readability and flow of that section.
 * The edits you made to the “distinction from ICD” section greatly improve the reader’s ability to understand the differences between ICD versus DSM by expanding on the given descriptions of each.
 * References appear appropriate without primary literature cited.
 * All edits you have made have kept an appropriately neutral tone and minimized jargon all the while improving the content, readability, and flow of the article.

Suggestions:


 * One minor suggestion could be to include a reference for the ICD manual in the “Distinction from ICD” section where you talked about mental and behavioral disorders being included in chapter 5 of the ICD. For example, including a reference to chapter 5 of the latest or most commonly used version of the ICD manual might work well.

Really excellent job on improving this article! WikiUser950 (talk) 21:52, 17 March 2022 (UTC)


 * Thanks for the peer review! I'll definitely look into adding the citation. Thanks for the help! — Preceding unsigned comment added by Zeboman123 (talk • contribs) 18:58, 21 March 2022 (UTC)

DSM-II first printing to remove homosexuality as a mental disorder
On March 16, 2022, at 06:12, a subheading under DSM-II (1968) was changed from "Seventh printing of the DSM-II (1974)" to "Sixth printing. . . ." to indicate the first printing that removed homosexuality as a mental disorder. I own a copy of the DSM-II which first included a note about eliminating "Homosexuality" per se as a mental disorder. The printing is the seventh, not the sixth. The copyright page shows the Sixth printing as issued in October 1973, which is before the APA trustees voted to make the change. They voted in December 1973, and the decision was upheld in May 1974 in a referendum of the voting members of the association. The seventh printing, in July 1974, includes a page with "Special Note — Seventh Printing" and the announcement that since the last printing (6th) of the manual, the trustees voted to make the change.Rawars (talk) 15:11, 1 May 2022 (UTC)


 * You are, of course, correct. (There's nothing like owning the actual text, eh? ;o) Thank you for your very appropriate edit to the article. I added a reference and an explanatory note (diff) since this printing issue is confusing. Mark D Worthen PsyD (talk) [he/him] 17:26, 1 May 2022 (UTC)
 * Your explanatory note is an excellent addition and helps to resolve confusion.Rawars (talk) 18:08, 1 May 2022 (UTC)

ADHD
If you were diagnosed as a hyperactive child when you young and diagnosed with ADHD as an adult could you possibly get addicted to to medication prescribed for high ADHD as an adult? 174.240.50.138 (talk) 20:57, 12 June 2022 (UTC)


 * Interesting question, but probably not the type of call that would be appropriate to make on wikipedia. And even if it were, would likely belong on the ADHD or medications for ADHD page, not the DSM page HumetheHistorian (talk) 07:29, 3 July 2022 (UTC)


 * I agree with HumetheHistorian that this isn't the best place to ask such a question. The best place is the Reference Desk, as long as one is not seeking specific medical advice. Mark D Worthen PsyD (talk) [he/him] 22:19, 3 July 2022 (UTC)

"Bible" of Psychiatry
Currently the introduction calls it the "bible" of Psychiatry. There is no source for this, so it comes across like an opinion rather than verifiable information. I think it might qualify as WP:FLOWERY. I imagine people outside the US might consider something else to the "bible" of psychiatry, so it seems somewhat American-centric. I'm not planning to change it but thought I would leave my feedback. Pythagimedes (talk) 23:48, 21 July 2022 (UTC)

Actually, I looked at the edit history and this seems it was recent addition by an IP, so I'm going to go ahead and just remove it. Pythagimedes (talk) 23:56, 21 July 2022 (UTC)