Once a ‘Disorder’, Always a Disorder, by Sahar Dorani, M.A.

The most recently used edition of the DSM, the Diagnostic and Statistical Manual of Mental  Disorders- fourth edition- text revision, has gone through quite an evolution since the publication of its first edition in 1952. As a student learning how to utilize this diagnostic tool (while attempting to avoid ‘over-diagnosing’), I find myself captivated when discovering previous diagnoses that were actually viewed as legitimate "disorders", but then later were revised and no longer considered a disorder. The definition of ‘Disorder’ in the mental health field is explained as: 1. A lack of order or regular arrangement; confusion.; 2. An ailment that affects the function of mind or body. Given this definition and its use by us diagnosticians, it feels unnatural that the term ‘ailment’ seems to have a time-limited implication.  It makes sense logistically that some ailments may become alleviated over time, but it seems that I have been repeatedly dumbfounded that a group of professionals in the American Psychiatric Association decide what characteristics of “the human condition and development” are to be considered ailments or irregular to the ‘normal’ development of an individual. At the same time, I must respect that this is the best devised systematic way yet to assign mental health diagnoses to be treated.



The one fact that was truly appalling upon discovering it, was that up until the release of the DSM-II (originally published in 1968), “homosexuality” was included as diagnosis. How was this possible? That the most well-respected and efficiently trained mental health professionals were able to link “homosexuality” to a mental health disorder?

It is only now, decades later, that suggesting that one’s sexual orientation implies an existence of a mental ‘ailment’ may sound bizarre and outrageous. With regards to how the DSM has evolved, the first and second editions were published in a cultural historical context that were rooted in homophobia in the eyes of Western civilization. As I learned that the DSM-II was revised in 1974, I assumed that the diagnosis of “homosexuality” would be eradicated altogether. My wishful thinking was disproven as I learned that the “diagnosis of homosexuality” was retained in the second printed version of the DSM-II; it seemed that the only difference was that it was only a disorder now if it created ‘persistent psychological distress which prevents the individual from pursuing desired heterosexual relationships’. As the Diagnostic and Statistical Manual of Mental Disorders aims to keep up with the zeitgeist, it was relieving to read that there were no diagnoses linking homosexuality to a psychological disorder in the DSM-III’s release in 1980.  

As society worked towards the less discriminatory way of viewing human behavior, previous publications of the Diagnostic and Statistical Manual of Mental Disorders are proof that our society’s changing views on human behavior can certainly infiltrate the process of perceiving and treating individuals from within the mental health field. As the DSM has just barely released its fifth edition, which has yet to be fully endorsed and utilized by pre-DSM-V trained professionals, it will be interesting to see what disorders may have been modified (or eliminated) since the DSM-IV’s publication twelve years ago in June 2000.

(Photo by a.drian)