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Glossary / History of psychiatry

DSM-III

The third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, published in 1980. It gave each disorder a list of diagnostic criteria, so that different clinicians would be more likely to reach the same diagnosis.

In the field trials reported in 1979 (281 adults), kappa for major diagnoses overall was 0.78 when two clinicians judged the same interview together and 0.66 when they interviewed separately[1].

The 1980 edition ran to 494 pages; its predecessor had 134[3]. It has been described as moving the centre of psychiatry from a broad clinical outlook, informed by psychoanalysis, to a research-based medical model and a return to descriptive psychiatry, while greatly narrowing its clinical scope[2].

The report of the DSM-5 field trials of 2013 notes that in the DSM-III trials a third of patients were judged by two clinicians from the same interview, and many diagnoses had few patients[4].

Related terms

  • Research Diagnostic CriteriaDiagnostic criteria for research in psychiatry, built by Spitzer and colleagues on the Feighner criteria. They became central to DSM-III in 1980.
  • Feighner criteriaDiagnostic criteria for research published in 1972 by psychiatrists at Washington University in St Louis, Missouri. They spelled out which symptoms, how many and for how long, had to be present for a diagnosis, and which cases were excluded.
  • KappaA measure of how far two raters agree, after removing the agreement expected by chance: 1 means perfect agreement and 0 means no better than chance. It was used to measure how often psychiatrists agree on a diagnosis.

Sources

  1. R. L. Spitzer, J. B. Forman, J. Nee, “DSM-III Field Trials: I. Initial Interrater Diagnostic Reliability,” American Journal of Psychiatry 136(6), 815–817 (1979).
  2. M. Wilson, “DSM-III and the Transformation of American Psychiatry: A History,” American Journal of Psychiatry 150(3), 399–410 (1993).
  3. A. Scull, “Rosenhan revisited: successful scientific fraud,” History of Psychiatry 34(2), 180–195 (2023).
  4. D. A. Regier, W. E. Narrow, D. E. Clarke, H. C. Kraemer, S. J. Kuramoto, E. A. Kuhl, D. J. Kupfer, “DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses,” American Journal of Psychiatry 170(1), 59–70 (2013).