individual s personality to a combination of psychological, social, and biological factors.

DSM-I also incorporated the nomenclature for disorders developed by the United States Army and modified by the Veterans Administration to treat the postwar mental health problems of service personnel and veterans. The VA classification system grouped mental problems into three large categories: psychophysiological, personality, and acute disorders. DSM-II, which was published in 1968, represented the first attempt to coordinate the American Diagnostic and Statistical Manual of Mental Disorders with the World Health Organization s (WHO) International Classification of Diseases, or ICD. DSM-II appeared before the ninth edition of the ICD, or ICD-9, which was published in 1975. DSM-II continued DSM-I s psychoanalytical approach to the etiology of the nonorganic mental disorders and personality disorders. DSM-III, DSM-III-R and DSM-IV DSM-III, which was published in 1980 after six years of preparatory work, represented a major break with the first two editions of DSM. DSM-III introduced the present descriptive symptom-based or phenomenological approach to mental disorders, added lists of explicit diagnostic criteria, removed references to the etiology of disorders, did away with the term neurosis, and established the present multi-axial system of symptom evaluation. This sweeping change originated in an effort begun in the early 1970s by a group of psychiatrists at the medical school of Washington University in St. Louis to improve the state of research in American psychiatry. The St. Louis group began by drawing up a list of research diagnostic criteria for schizophrenia, a disorder that can manifest itself in a variety of ways. The group was concerned primarily with the identification of markers for schizophrenia that would allow the disease to be studied at other research sites without errors introduced by using different types of patients in different centers. What happened with DSM-III, DSM-III-R, and DSM-IV, however, was that a tool for scholarly investigation of a few mental disorders was transformed into a diagnostic method applied to all mental disorders without further distinction. The leaders of this transformation were biological psychiatrists who wanted to empty the diagnostic manual of terms and theories associated with hypothetical or explanatory concepts. The transition from an explanatory approach to mental disorders to a descriptive or phenomenological one in the period between DSM-II and DSM-III is sometimes called the neoKraepelinian revolution in the secondary literature. Another term that has been applied to the orientation represented in DSM-III and its successors is empirical, which denotes reliance on experience or experiment alone, without recourse to theories or hypotheses. The word occurs repeatedly in the description of The DSMIV Revision Process in the Introduction to DSM-IV-TR. DSM-IV built upon the research generated by the empirical orientation of DSM-III. By the early 1990s, most psychiatric diagnoses had an accumulated body of published studies or data sets. Publications up through

1992 were reviewed for DSM-IV, which was published in 1994. Conflicting reports or lack of evidence were handled by data reanalyses and field trials. The National Institute of Mental Health sponsored 12 DSM-IV field trials together with the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The field trials compared the diagnostic criteria sets of DSM-III, DSM-III-R, ICD-10 (which had been published in 1992), and the proposed criteria sets for DSM-IV. The field trials recruited subjects from a variety of ethnic and cultural backgrounds, in keeping with a new concern for cross-cultural applicability of diagnostic standards. In addition to its inclusion of culture-specific syndromes and disorders, DSM-IV represented much closer cooperation and coordination with the experts from WHO who had worked on ICD-10. A modification of ICD-10 for clinical practitioners, the ICD-10-CM, is scheduled to be introduced in the United States in 2004. Textual revisions in DSM-IV-TR DSM-IV-TR does not represent either a fundamental change in the basic classification structure of DSM-IV or the addition of new diagnostic entities. The textual revisions that were made to the 1994 edition of DSM-IV fall under the following categories: correction of factual errors in the text of DSM-IV review of currency of information in DSM-IV changes reflecting research published after 1992, which was the last year included in the literature review prior to the publication of DSM-IV improvements to enhance the educational value of DSM-IV updating of ICD diagnostic codes, some of which were changed in 1996 Critiques of DSM-IV and DSM-IV-TR A number of criticisms of DSM-IV have arisen since its publication in 1994. They include the following observations and complaints: The medical model underlying the empirical orientation of DSM-IV reduces human beings to one-dimen-