The Classification Systems in Psychiatry in a Phase of Crisis? Focus on DSM-5

Abstract

Since the chaotic atmosphere of psychiatric diagnosis of the sixties, psychiatric classification systems followed several theoretical models. The first two systems – DSM-I and DSM-II – were influenced by psychoanalysis, predominant in USA hospitals. With the implementation of DSM-III, published in 1980, there was a shift towards a neo-Krapelinian paradigm with an emphasis in the medical model, defining psychiatric disorders as medical diseases. The ongoing criticism regarding the poor validity of diagnostic categories and the failure to identify neurobiological markers led to the idea that classification showed symptoms of crisis in the Kuhnian sense. The assumption that the moment had arrived for a scientific revolution in psychiatric classification led to a revision of DSM–IV and the development of a new system – the DSM-5. The final result showed a failure in this unrealistic and overambitious objective and the new system is an “hybrid” one with empirical similarities with the previous one.