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The DSM is the most well‐known and widely used classification and diagnostic system for psychological disorders in the US. The DSM was born out of the American Psychiatric Association’s (APA) desire to create a coherent system of communication in the field of psychiatry, and the first edition was published in 1952. The DSM‐I contained 128 diagnoses organized into different classes of disorders (Blashfield et al., 2014). The distinct disorders were derived from the clinical experiences of APA members and not through research, as available studies at that time were extremely limited. Each category and diagnosis contained a brief description of that class and the disorders’ symptoms, traits, and behaviors (Blashfield et al., 2014). Of significant note, the DSM‐I contained few references to children or adolescents, or how psychopathology would present itself in these periods of development.

The DSM would go on to be substantively revised five times (DSM‐II, III, III‐R, IV, and 5), with the number of diagnoses listed increasingly steadily since 1952 (see Figure 1.1). Whereas the DSM‐I contained 128 diagnoses, the DSM‐5 contains 541 diagnoses organized into 22 diagnostic categories. Between the publication of DSM‐I in 1952 and the publication of DSM‐II in 1963, studies examining the reliability of psychiatric diagnoses and the clinical utility of categories of diagnoses increased (Blashfield et al., 2014). This provided the APA with some empirical evidence for drafting DSM‐II and began the shift that would lead the DSM from being a descriptive, clinically based classification system to an empirically supported one.

The publication of DSM‐III was significant because it aimed to bring psychiatry in line with the rest of medicine by ensuring that more information was provided in the text about the symptomology, demographics, etiology, and course of each disorder, basing this information on available empirical evidence. Importantly, it provided specific symptom thresholds for determining whether the disorder was present (e.g., at least three of seven symptoms must be present), and exclusion criteria for determining when an individual should not be diagnosed with a disorder. DSM‐III was also atheoretical, which means that it did not adhere to any one theory about psychopathology (e.g., psychoanalytic, behavioral).

These changes initiated a period of rapid, systematic empirical research. For the first time, researchers at different institutions were able to reliably assess and report on disorders because of the newly operationalized symptoms, and the provision of exclusion criteria allowed studies to examine specific disorders one at a time. Structured interviews were also created, and these further increased the reliability of assessment. However, almost immediately after publication of DSM‐III, several studies suggested that the diagnostic criteria published had a number of flaws (Blashfield et al., 2014). Therefore, in 1987, DSM‐III‐R was published with new diagnoses and diagnostic categories, updated diagnostic criteria for many of the disorders, and a section containing unofficial disorders for further research and consideration. Reliance on empirical evidence for revising the DSM continued to increase such that prior to the publication of DSM‐IV, workgroups were assigned to each diagnostic category to conduct thorough literature reviews and analyses of existing databases so that empirical evidence could be used to revise the diagnostic criteria and organization of the DSM.

FIGURE 1.1 Schizoid Personality as Defined by DSM‐I Through DSM‐5 and the AMPD of DSM‐5

Leading up to the publication of DSM‐5, many researchers pushed for the inclusion of more dimensional representations of psychopathology. A dimensional approach suggests that symptoms and traits exist on continuums. Rather than putting people into yes–no categories based on whether or not they have a certain number of symptoms, researchers who advocate for a dimensional approach place people on a dimension of symptom severity ranging from not present or not severe to very severe, for example. This is in contrast to a categorical representation of psychopathology (the majority of the DSM) where symptoms are assessed and a clinician makes a dichotomous (yes/no) decision about the presence of a diagnosis. Some studies have found that these distinct, diagnostic categories are supported by empirical data, but most studies have found that they are not.

Subsequently, a number of dimensional components were integrated into the DSM‐5 (Regier, Kuhl, & Kupfer, 2013). For example, an alternative dimensional model for personality disorders was introduced to Section III of the DSM for “Emerging Measures and Models” for future research. Additionally, the diagnoses of autistic disorder, Asperger’s disorder, and pervasive developmental disorder were combined into one autism spectrum disorder. This reflects an understanding that these disorders do not differ in “kind” of symptoms or problems, but in “degree” (of severity). Finally, and importantly to the topic of developmental psychopathology, the DSM‐5 had several revisions that improved the assessment of psychopathology in children and adolescents. Specifically, the DSM‐5 added a heading entitled “Development and Course” to each disorder section to describe the typical development of an individual with that disorder across the lifespan and how the individual might present during each developmental stage. The text of many disorders now also expands upon individual variables or characteristics important to the etiology of that disorder, including culture and gender.