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Research and Review

July 1, 2013

Postpartum Depression and Perinatal Mood Disorders in the DSM:
History and PSI Advocacy

by Lisa Segre, PhD and Wendy Davis, PhD

Making news headlines, in May 2013 the American Psychiatric Association (APA) released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This revision was chaired by David J. Kupfer, M.D (Chair) and Darrel A. Regier, M.D., M.P.H. (Vice-Chair), and a task force comprised of 13 work-groups: each comprised of a chair and work group members who were key experts in psychiatric treatment, research and epidemiology. (See following url for more information on the committee: http://www.dsm5.org/Pages/Default.aspx)

The DSM, which has been called “the bible of diagnostic criteria” for mental health professionals and researchers, is used to determine whether a cluster of symptoms is recognized as a disorder, according to the APA. This recognition can have substantial practical consequences, for example whether or not treatment is reimbursed by insurance or in determining outcomes in court cases. As an organization devoted to the emotional well-being and mental health of pregnant and postpartum women, Postpartum Support International is keenly interested in psychiatric diagnostic developments during pregnancy and the postpartum period. The purpose of this article is to describe recent changes in the DSM-5 that pertain to pregnant and postpartum women. However, for individuals who may not be familiar with prior versions of DSM, it may be challenging to understand the significance of recent changes. The following very brief history provides this background as a framework.

Did you ever wonder why this manual is called the Diagnostic andStatistical Manual? While the word “diagnostic” is easily understood, the reference to “statistical” is not intuitive.

Diagnostic Classification for Census
Although diagnoses have been around for a very long time, the first diagnostic classification system was developed for the purpose of documenting the number cases of “idiocy/insanity” in the 1840 census. By the time of the 1880 census, an expanded classification scheme recognized seven psychiatric illnesses: mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy. In 1917 the Census Bureau, still with a focus on counting and statistics, developed an expanded classification scheme to gather standardized data from mental institutions with the assistance of two collaborating organizations: the American Medico- Psychological Association and the National Commission on Mental Hygiene. This classification, titled Statistical Manual for the Use of Institutions for the Insane, included 22 diagnoses. Shortly after this collaboration, in 1921, theAmerican Medico-Psychological Association changed its name to theCommittee on Statistics of the American Psychiatric Association.

Diagnostic Classification for Assessment and Treatment 
The large scale involvement of U.S. psychiatrists in World War II (1939-1945) shifted the focus of these psychiatric diagnostic classifications from use in census to a more applied use: the selection, assessment, and treatment of soldiers. In 1943 Brigadier General William C. Menninger, founder of the Menninger Clinic, developed a broader classification scheme which addressed these more practical issues and also which addressed symptoms frequently presented by World War II active duty servicemen and veterans. This classification scheme –called the Medical 203— was eventually adopted by all armed forces and also used by many military psychiatrists in civilian hospitals and clinics upon their return to civilian practice. Around the same time of the development of the Medical 203, the World Health Organization (WHO) published a 6th edition of the International Classification of Diseases (ICD), which for the first time included a classification scheme for mental disorders. With several different classifications schemes now in use, in 1950, the APA Committee on Nomenclature and Statistics was charged with the task of creating a standardized classification scheme for the use in the U.S. ….Read the rest of the article here to learn about the status of pregnancy and postpartum mood disorders in the DSM, and PSI’s input on the revisions.