[The history of psychiatric diagnostic concepts]

Abstract

Background: Those engaged with mental health problems are confronted with the existence of DSM categories and ‘diagnoses’. This situation is the result of a development spanning two centuries.

Aim: To properly understand the current situation, knowledge of the historical developments that led to the idea of capturing behavioral deviations in ‘diagnoses’ is essential.

Method: We describe the development of diagnostic concepts from the early 19th century to the present, in the form of a narrative review.

Results: During the 19th century, a conceptual framework was formulated to describe behavior and syndromes. Based on longitudinal observations, the 20th century came to regard the distinction between mood and psychotic disorders as fundamental. The clinical elaboration of behavioral psychology led to behavior therapy and to the definition of the group of anxiety disorders. The 1960s–1970s saw the necessity to standardize diagnostic concepts, which led to the publication of the DSM-III.

Conclusion: The existing formal classification systems have brought a certain order to the description of behavioral disorders and mental problems. However, the choices made in the process are not value-free. The current diagnostic categories have limited prognostic value and fail to include the role of personal meaning in the emergence of symptoms.