The Diagnostic and Statistical Manuals are considered the ''bible'' of mental illnesses used for diagnosing psychiatric disorders. The books have been influential because they determine the status of a mental disorder and define what is and what is not a mental disorder. The manuals have also a great impact on society because as mental disorders are determined, public awareness, as well as industries' relating to mental health care, has grown. The manuals are responsible for the explosion of research and sales of pharmaceuticals relating to mental health.

DSM versions have a checkered history. The first versions were simple listing of common mental illnesses. In 1968, the second edition of the Diagnostic and Statistical Manual (DSM-II) added Hyperkinetic Reaction of Childhood disorder to its list of disorders. It used only one sentence to tell that the disorder is characterized by restlessness, distractibility, overactivity, and short attention span, especially in young children. The manual took its clue from the researcher Chess who believed this disorder was benign and usually diminished by adolescence; he considered this hyperkinetic action simply normal and really an insignificant problem.

In 1980, the publication of DSM-III showed a major change from DSM-II. This manual changed the concept from Hyperkinetic Reaction of Childhood to ADD with or without hyperactivity. The new diagnostic criteria emphasized inattention and impulsivity as defining features of the disorder and produced a more specific symptoms list.

In 1994 the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR), was published. According to the DSM-IV-TR, patterns of behavior indicate three types of ADHD: predominantly hyperactive-impulsive, predominantly inattentive, and combined, which may display both symptoms.

DSM-IV-TR turned a thin guidebook into an 886-page ''bible'' that expanded the meaning of mental illness. Some traits that were once associated with simple personality traits, such as shyness, became symptoms of social anxiety disorder. Drugs were developed for those mental disorders. Kent Garber in a January 7, 2008, article in U.S. News and World Report quoted a 2006 study that found that more than half of the researchers who worked on the manual had at least one financial tie to the drug industry.

Beginning in 2008, the American Psychiatric Association (APA) will develop a new edition of DSM. The target date for completion is 2013. APA pledges to avoid any appearance of conflict of interest by carefully screening the taskforce. The members will be asked for detailed financial information about stocks, honoraria, and consulting fees from drug interests. Although receiving fees does not necessarily indicate influence on decisions made for the manual, the APA desires to maintain transparency in erasing any appearance of conflict of interest.

The impact of the diagnosis of ADHD and related disorders will likely be changed in some ways. However, until the next version of the manual, DSM-IV-TR will hold for diagnosis.

Bibliography:

1) American Psychiatric Association. 2004. Diagnostic and Statistical Manual of the American Psychiatric Association. 4th Ed. Arlington, VA.: American Psychiatric Association.

2) Barkley, Russell. 2006. Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. 3rd ed. New York: Guilford Press.

3) Garber, Kent. 2008. Who's behind the bible of mental illness? U.S. News &World Report (December 31, 2007/January 7, 2008):25-26.

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