Speaker 1: Welcome to Brainstuff, a production of iHeartRadio, Hey brain Stuff,
Speaker 1: Lauren Bogelbaum. Here in the United States, if you go
Speaker 1: to a medical professional looking for help with mental health,
Speaker 1: one of the guides they're going to turn to in
Speaker 1: helping you identify what's going on is the Diagnostic and
Speaker 1: Statistical Manual of Mental Disorders, or the DSM. The DSM
Speaker 1: is a living document. It's currently in its fifth edition,
Speaker 1: known appropriately as the DSM five, having been updated about
Speaker 1: once every fifteen years by its governing body, the American
Speaker 1: Psychiatric Association, since they first published it in nineteen fifty two.
Speaker 1: It's updated so often because our understanding of the human
Speaker 1: mind keeps updating based on science. For example, before the
Speaker 1: nineteen seventies, homosexuality was often considered to be a mental illness.
Speaker 1: The American Psychiatric Association, or APA, classified it as such
Speaker 1: in the first iteration of the DSM. This held with
Speaker 1: prevaill and cultural norms, but then activists started protesting at
Speaker 1: annual meetings of the APA and presented scientific evidence opposing
Speaker 1: those norms. In nineteen seventy three, it was put to
Speaker 1: the vote and a majority of APA members agreed that
Speaker 1: home sexuality should no longer be considered a mental disorder.
Speaker 1: Although it took baby steps to get there, this change
Speaker 1: was a huge leap for gay rights and helped shift
Speaker 1: sidal thinking on home sexuality. It also demonstrated the power
Speaker 1: of the DSM on public opinion. The DSM doesn't offer
Speaker 1: advice on medications or other treatments for the one hundred
Speaker 1: and fifty seven disorders currently described in its pages. Rather,
Speaker 1: it was designed to help healthcare professionals identify and diagnose
Speaker 1: mental health conditions, such as those that impact personality, cognition,
Speaker 1: and mood. The manual also provides uniform diagnostic codes for
Speaker 1: each issue, which are used to facilitate medical billing and
Speaker 1: data collection. Often, if a condition isn't listed in the
Speaker 1: DSM US, health and chure companies won't pay for the
Speaker 1: treatment of it. The manual is primarily used in the
Speaker 1: United States, with much of the rest of the world's
Speaker 1: health professionals turning instead to the World Health Organization's International
Speaker 1: Classification of Diseases or ICD, which covers all diseases, not
Speaker 1: only those psychological in nature. The APA encourages healthcare professionals
Speaker 1: to consider the DSM five and the ICD as companion
Speaker 1: publications designed to be compatible with each other. The ICD
Speaker 1: is currently in its eleventh edition, having started up in
Speaker 1: the eighteen nineties and been updated about every ten years.
Speaker 1: The history of the DSM goes back way further than
Speaker 1: the nineteen fifties. It was developed in response to an
Speaker 1: obvious need for systems by which to classify mental health.
Speaker 1: The US Census of eighteen forty took small steps toward
Speaker 1: the eventual development of the manual by adding a question
Speaker 1: about incidents of what they called idiocy or insanity to
Speaker 1: their survey. This was possibly the first attempt statistical information
Speaker 1: gathering related to mental health. In eighteen eighty, the Census
Speaker 1: flushed out the mental health category to include issues like dementia, melancholia, epilepsy,
Speaker 1: and mania. In nineteen seventeen, the American Medico Psychological Association,
Speaker 1: the forerunner of the APA, and the National Commission on
Speaker 1: Mental Hygiene came up with a plan for gathering uniform
Speaker 1: health statistics and mental hospitals, which was then adopted by
Speaker 1: the Census Bureau in nineteen twenty one. The APA started
Speaker 1: to develop psychiatric classifications for various severe psychiatric disorders. After
Speaker 1: World War Two. They shifted to a bigger classification system
Speaker 1: developed by the US Army as it was treating veterans
Speaker 1: with these systems as guides. They released the first official
Speaker 1: version of the DSM in nineteen fifty two. Each update
Speaker 1: is the result of years of task force meetings, discussion
Speaker 1: by work groups, and input by many psychiatric experts around
Speaker 1: the world. Each listing the manual includes diagnostic criteria including
Speaker 1: a disorder symptoms and their duration necessary for a diagnosis,
Speaker 1: plus any other disorders to screen, four with common symptoms,
Speaker 1: and any antithetical symptoms that can help rule a diagnosis out.
Speaker 1: The listing also includes information about the prevalence, development, and
Speaker 1: course of the disorder, the risk, the prognostic factors, and
Speaker 1: other relevant information. Finally, each disorder has that diagnostic code
Speaker 1: in common with the ICDs codes, which is helpful for
Speaker 1: the collection of data as well as streamlining the billing
Speaker 1: process for care providers and insurance agencies. It's no small
Speaker 1: feat for a mental health issue to be added to
Speaker 1: the DSM. The DSM four wasn't all that different from
Speaker 1: the DSM five, but the changes that did make the
Speaker 1: cut were thoroughly reviewed and discussed by some of the
Speaker 1: foremost minds in the psychiatric field. The DSM four was
Speaker 1: published in nineteen ninety four, so the DSM five Task
Speaker 1: Force had to review all scientific studies published on psychiatric
Speaker 1: disord orders since then. Since the DSM five wasn't published
Speaker 1: until twenty thirteen, that's nearly twenty years worth of ongoing
Speaker 1: research to look at. Following comprehensive review, proposals to modify
Speaker 1: existing diagnoses were made, which required vigorous discussion and debate
Speaker 1: among the committee members plus input from outside experts. All
Speaker 1: proposals were examined by the Task Force, as well as
Speaker 1: two additional committees created for a more independent opinion, being
Speaker 1: the Scientific Review Committee and a Clinical and Public Health Committee. However,
Speaker 1: since then, new changes to the process have streamlined it.
Speaker 1: Rather than waiting decades between issues, experts can now submit
Speaker 1: changes online, helping to make the manual more timely and current.
Speaker 1: Once approved by the APA Board of Trustees, clinicians and
Speaker 1: other DSM users are notified about the edit. Users can
Speaker 1: hover over the change in the online version to find
Speaker 1: out the pertinent details, what the previous material was, and
Speaker 1: the support arding scientific evidence that inspired the edit. For
Speaker 1: the article this episode is based on has to work,
Speaker 1: spoke doctor Philip Wang, director of the APA's Research Division,
Speaker 1: which supervises the DSM. He said, this has been a
Speaker 1: major advance. Let's say there is enough scientific evidence, and
Speaker 1: let's say there is a valid change. To have to
Speaker 1: wait fifteen or twenty years for clinicians and patients to
Speaker 1: benefit from that change is unconscionable. The new system is
Speaker 1: completely transparent, continuous, and at the end of the day,
Speaker 1: it hopefully is good for clinicians and benefits patients. The
Speaker 1: changes from the fourth edition to the fifth edition were
Speaker 1: small but significant to address advances in scientific research and
Speaker 1: issues with diagnoses that clinicians had been reporting. The DSM
Speaker 1: five combined nearly thirty disorders, eliminated two diagnoses entirely, and
Speaker 1: added fifteen. The DSM five has also revamped disorders into
Speaker 1: a lifespan approach. Instead of classifying certain issues as solely
Speaker 1: childhood disorders, it discusses how they change and manifest at
Speaker 1: all stages, and the DSM five emphasizes the importance of
Speaker 1: parents in diagnosis and treatment. This new version also introduced
Speaker 1: Section three, which is for conditions where there's not enough
Speaker 1: scientific data yet to determine whether they should be classified
Speaker 1: as psychiatric disorders. Among these conditions are things like Internet
Speaker 1: gaming disorder and caffeine use disorder. Section three also contains
Speaker 1: cross cutting measures and models that have potential to help
Speaker 1: clinicians better evaluate patients when they show symptoms that could
Speaker 1: be indicative of multiple disorders, and it also includes a
Speaker 1: Cultural Formulation Interview guide with questions to help clinicians identify
Speaker 1: how a patient's cultural background affects their perception and presentation
Speaker 1: of psychiatric symptoms, treatment, and diagnosis. The APA's fact sheet
Speaker 1: about it explains a quote the interview provides, it's an
Speaker 1: opportunity for individuals to define their distress in their own
Speaker 1: words and then relate this to how others who may
Speaker 1: not share their culture see their problems. This gives the
Speaker 1: clinician a more complete foundation on which to base both
Speaker 1: diagnosis and care. Some key about faces that occurred in
Speaker 1: this update are proof that the DSM isn't opposed to
Speaker 1: changing with the times. Here's some examples of major turnarounds.
Speaker 1: Consenting adults who enjoy relatively unconventional BDSM fetishes or cross
Speaker 1: dressing need not fear being diagnosed with mental illness anymore.
Speaker 1: The DSM five update depathologized kinky sex. They're now just
Speaker 1: people with a preference. It also removed the diagnosis of
Speaker 1: Asperger's syndrome and classified the symptoms associated with it and
Speaker 1: three other previous diagnoses under the umbrella autism spectrum disorder,
Speaker 1: and it codifies medical acceptance of transgender people. The DSM
Speaker 1: five replaced the diagnosis of gender identity disorder with gender dysphoria,
Speaker 1: so those who don't identify with their assigned sex at
Speaker 1: birth are no longer considered to have a mental disorder.
Speaker 1: The new diagnosis spells out some of the challenges of
Speaker 1: living with gender dysphoria and the paths that people may
Speaker 1: choose to resolve it. One complaint about the DSM is
Speaker 1: that once a condition is included in the manual, it
Speaker 1: may turn what once was considered normal behavior into a
Speaker 1: pathological illness that must be treated, often with medication. But
Speaker 1: Wang pointed out that the DSM five has incorporated an
Speaker 1: acuity measure to help with that. Since so many disorders
Speaker 1: range widely in their severity, these scales help clinicians better
Speaker 1: evaluate symptoms and levels of impairment. For example, let's say
Speaker 1: you're grieving the death of a loved one, are you
Speaker 1: still able to cope with life? Or are you barely
Speaker 1: able to get out of bed? Once assessed, clinicians will
Speaker 1: be better able to land on the appropriate treatment, whether
Speaker 1: that's medication, watchful waiting, talk, therapy, or a combination of these.
Speaker 1: After all, the human mind is a marvelous thing, but
Speaker 1: mental wellness doesn't come automatically or easily for all of us.
Speaker 1: People dealing with that, and not to mention the loved
Speaker 1: ones who support them deserve and up to date and
Speaker 1: fully vetted guide to help them and their care providers
Speaker 1: find the best treatments. The value in the decades of
Speaker 1: research and intense consideration that have gone into the DSM
Speaker 1: is one of the many reasons why the gold standard
Speaker 1: advice for anyone who's concerned about the mental health of
Speaker 1: themselves or a loved one is to reach out to
Speaker 1: a healthcare professional. Access to tools like the DSM helps
Speaker 1: those professionals help us on a path towards having a
Speaker 1: better time in this sometimes difficult world. Today's episode is
Speaker 1: based on the article how the Diagnostic and Statistical Manual
Speaker 1: of Mental Disorders Works on how stufforks dot com, written
Speaker 1: by A. Leah Hoyt brain Stuff is production by heart
Speaker 1: Radio in partnership with HowStuffWorks dot Com and is produced
Speaker 1: by Tyler Klang. Four more podcasts by heart Radio, visit
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Speaker 1: to your favorite shows.