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Diagnosing mental disorders can be complicated and challenging, as patients’ needs and symptoms can be constantly changing. The Diagnostic and Statistical Manual of Mental Disorders may be seen by some as the figurative “bible” for mental disorders, providing specific criteria for the complete range of formally diagnosed conditions. For others, however, its use remains under debate.

Known as the DSM, the resource was created in 1950 and is published by the American Psychiatric Association for the purpose of helping conduct research in the field of mental illness. Frequently modified, new conditions can be added to the manual and some disorders deleted altogether, reflecting advancements and research and cultural changes toward mental illness.

The APA suggests people have specific training on how to read and use the manual, and today, it is used for much broader purposes – including insurance reimbursements for mental disorders; to discuss cases among the mental health community; and to diagnose learning disabilities. To reach a diagnosis, a patient should state they are engaging in most of those specific behaviors listed in the manual for an illness, backed up by an expert or counselor. The mental illnesses included in the manual are categorized by five axes, such as personality disorders, developmental disorders or level of functioning as a whole.

Before a new version can be published, the APA creates expert congresses to review research and debate changes to mental health diagnoses. At times, changes to the manual can be socially-motivated. In 1973 homosexuality was removed as a diagnosable condition, due in part to pressure from social activists and groups.

The current version is DMS-IV-TR. The next revision of the DSM is underway within work groups, but these groups are being called into question by critics for including disorders such as addictions to video games or the Internet, for example.

Other skeptics say the diagnoses lack scientific evidence, but rather are included based on group discussion and voting. As the number of conditions grows, more illnesses can be endorsed by psychiatrists and require prescriptions – thus building profitability for the drug industry and creating socially-accepted “new” mental illnesses. Critics such as Dr. Irwin Savondnik, University of California psychiatry assistant clinical professor, suggest this allows the drug industry to control even the language used by mental health experts.

A 2006 study appearing in the Psychotherapy and Psychosomatics journal claims that many (more than half) of the members of the panel who critiqued the fourth edition of DSM have connections financially to the pharmaceutical industry. Critics go on to say that surveys conducted on mental health, using the DSM, are funded by major pharmaceutical companies – including a study conducted by Harvard Medical School professor Ronald Kessler that reports nearly half of Americans surveyed will suffer a mental illness at some point in their life. The Citizens Commission on Human Rights of Vancouver agrees, saying the manual may inappropriately label or diagnose people, even children, to increase pharmaceutical profits.

In terms of validity, critics and professors of psychiatry have stated that the diagnoses listed in the DSM rely on opinion and use no outside criteria; furthermore they say the manual doesn’t accurately take into account the whole person when giving a diagnosis. Though created as a tool to supplement diagnosis and not treatment, the DSM continues to receive criticism from patients, psychiatrists and academia.