What is the DSM (Diagnostic & Statistical Manual of Mental Disorders)?

Why is it Important to You?


mother lecturing her daugtherWHAT IS THE DSM? The Diagnostic & Statistical Manual of Mental Disorders DSM (I) was first published in 1952 as an effort to provide descriptive diagnostic categories to serve as a useful guide for clinicians in diagnosing mental disorders. The manual was updated throughout the years with the DSM II 1968, DSM III 1980, DSM IV 1994, DSM IV-TR (Text Revision) 2000, and DSM V 2014.

The more recent DSM’s contain approximately 17 classification sections or headings. Each heading provides a list of categories and/or disorders with official diagnostic codes. The official codes are used to distinguish each specific mental disorder or condition. The official diagnostic codes are also mandatory to be reported by health care professionals on patient’s health insurance forms for reimbursement, under “reason for visit”, or “principal diagnosis”. In addition, the official coding system is used for collecting diagnostic data to produce statistic information for governmental agencies, private insurance companies, and for the World Health Organization. The DSM code for Selective Mutism is 313.23. It has been coordinated with the Mental and Behavioral
Disorders section of the International Classification of Diseases (ICD) for reporting systems for the U.S. Department of Health. The official code for Selective Mutism in the ICD is F94.0. It is important to note that the DSM intent is to act as the first step for a comprehensive evaluation, followed by additional sources of information. It provides guidelines for sound clinical judgment, and includes ethnic and cultural considerations to avoid misdiagnosing.

WHY IS THIS MANUAL IMPORTANT TO YOU? Selective Mutism (previously Elective Mutism), until the inception of our organization in 1991, was virtually ignored and regarded as a rare and low public interest disorder. There were no comprehensive research studies prior to the development of the Selective Mutism Foundation, Inc., only a few compromised and single case studies based upon theories. The available literature presented conflicting theories, with most describing Elective Mutism’s essential feature as a “refusal” to speak along with characteristics of willful, controlling, and manipulative behaviors, caused by maternal over protection, abuse, trauma, or family dysfunction. Even the name Elective Mutism, was indicative of a deliberate refusal to speak to EVERYONE and in ALL environments. There was no distinction between sudden mutism possibly caused by a traumatic event and shyness or social anxiety. There was also no distinction between a speech or language communication disorder and social phobia. All of these characteristics, and more, were summarized together within the diagnostic and associated features of Elective Mutism in the DSM III and III-R. The Selective Mutism Foundation’s input in 1991 was the major source in eliminating theories and replacing them with sound facts, including renaming the disorder Selective Mutism, for the DSM
IV, 1994.

This manual is important to you because the DSM is the most widely used mental disorders manual in the U. S. and is utilized by a diverse group of mental health professionals. The characteristics of Selective Mutism published prior to 1994 had a devastating impact on most families seeking professional help for their children. Especially alarming was the demoralized manner in which most Selective Mutism students were treated due to perception of school personnel, influenced by DSM misconceptions that were derived from available literature. Some parents were reported for, or suspected of child abuse. Others were told that they had caused the mutism by having too many children, not enough children, working fulltime, not bonding with the child, or not breast-feeding the child during infancy. Yet, others were told that their child was keeping family secrets of dysfunction, or the child was spoiled, angry, seeking attention, stubborn, and on and on. This domino effect of misdiagnosis that began with documented theories trickled down to many school psychologists and other school personnel who unknowingly misdiagnosed Selectively Mutism students. This resulted in inappropriate educational classifications and placements into Speech/Language therapy, segregated programs for the Emotionally Disturbed, Resource Room, and Specific Learning Disability classes, Occupational Therapy or Physical Therapy, etc. Some students were reprimanded, ridiculed, or denied extracurricular activities due to their “refusal to speak”; while others were easily ignored as they were not disruptful in class.

With the foundation’s efforts, through research encouragement and participation, we continue to be the only major source and acknowledged nationally to positively affect Selective Mutism criteria for the DSM. The current DSM reflects the more positive characteristics of Selective Mutism resulting in more parents seeking professional treatment for their children. The DSM is important for correct diagnosis of Selective Mutism as opposed to confusion for misdiagnosis of other disorders, such as Autism, etc. It is important for correct billing purposes to ensure insurance coverage for treatment. Also, for a more positive description of Selective Mutism as characteristics implying social anxiety.