DSM-IV

 

Janet Greider
DSM-IV Overview

The DSM-IV was published in 1994, with the DSM-IV-TR following 6 short years later. The DSM-IV-TR was a considered simply a ‘text revision’ to keep the terminology in vogue with the International Classification of Disorders-10 (ICD-10).  The DSM-IV was 886 pages long and covered 297 disorders across 5 Axis. It placed renewed emphasis on limiting cultural biases and limiting the influence of drug companies and medicalization on the production of the DSM-IV. (Frances, Widiger & Pincus, 1989; Zimmerman, 1986)

Who was involved in publication of the DSM-IV?

Task Force Chair: Allen Frances
The DSM-IV Task Force
:  27 members (mainly MD’s) but included 4 psychologists.
Work Groups: 13 total, (like the DSM-V) supported by 20 expert advisors.

In addition to setting up safeguards to prevent the exchange of nomenclature, terminology, and relevance of criterion between the ICD and the DSM-IV from becoming random, the Task Force increased the emphasis on conferences during the publication of the DSM-IV (Frances, Widiger & Pincus, 1989)

New Emphasis on International Conferences

At the conferences, the Work Groups systematically reviewed all comprehensive data regarding the Work Group-specific diagnoses. Through analysis of this data, the Work Groups determined if more research was necessary to confirm the criterion beyond reasonable doubt. The goal of the DSM-IV was to be extremely conservative with criterion. The Work Groups also drew data from requested field studies, and edited their diagnostic criterion appropriately. (Blashfield, Sprock and Fuller, 1990; Frances, Widiger & Pincus, 1989)

Reality Checks and Transparency during Development of the DSM-IV

Throughout the task, there were individuals questioning the methodology and motivation of the DSM-IV Task Force and Work Groups (Zimmerman, 1986 ). Mark Zimmerman wrote a particularly pointed article wherein he challenges the usefulness of the DSM-IV (Zimmerman, 1986). The concerns raised by Zimmerman and others in encouraged the editors of the DSM-IV , IV-TR, and DSM-V to create a more transparent process in which the rationale for each criteria change is available to the public, as well as the selection, methodology, and systematic review of the changes to the diagnostic criteria. (Frances, Widiger & Pincus, 1989)  (Zimmerman, 1986; )

Although the schedule of the development for the DSM-IV was not as lengthy as the DSM-III or DSM-5, it maintains validity and reliability by incorporating checks, encouraging strict and conservative modification of the DSM-III-R, and focusing on the necessity of scientific validation of diagnostic criterion before adding it to the DSM-IV, rather than the arbitrary changes made through group consensus of expert advisors.  The process of development for the DSM-IV incorporated all the  learning from the DSM-III and DSM-III-R, building on their methodology, as well as creating a platform that promoted transparency and clear methodology for the DSM-V. (Blashfield, Sprock, & Fuller, 1990)

 

Psychiatric Nosology

The DSM-IV, although it was abruptly published, it did provide one of the first opportunities to document psychiatric nosology (or the process of creating the DSM-IV). This in turn set the tone for the publication of the DSM-5, a process which began immediately after the publication of the DSM-IV in 1994.

Dr. Allen Frances, Chair of the DSM-IV Task Force aimed for the DSM-IV to straddle the  boundary between historically following the ICD(-10), and maintaining comprehensive reviews of scientific research and widely established expert consensus in order to establish clear and conservative diagnostic criteria. (Frances, Widiger & Pincus, 1989)

Frances, A., Widiger, T., Pincus, H.A. (1989). The Development of the DSM-IVArch Gen Psychiatry, 46, 373-375.

Blashfield, R.k., Sprock, J., Fuller, A.k. (1990). Suggestions for Guidlings including or Excluding Catagories in the DSM-IV. Comphrenisve Psychiatry, 31(1), 15-19

Janet Greider

 

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