Graduate Thesis Or Dissertation
 

A Diachronic Linguistic Analysis of the Diagnostic and Statistical Manual of Mental Disorders (DSM)

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  • The Diagnostic and Statistical Manual of Mental Disorders (DSM) has reached a level of authority and ubiquity within the mental health field. It is the guidance force in insurance reimbursement or coverage for mental health treatment, determinations of disability related to mental health and in determinations of competence to stand trial in legal proceedings. Yet the DSM is a text in flux: there have been numerous previous versions and more versions are realistically anticipated. In addition to this, the DSM has had various different philosophies underpinning it and different groups of authors over time. These two factors alone would cause one to expect significant shifts in the overall composition of the DSM. Shifts in the DSM are problematic due to the DSM’s authority: what is added or taken away from the DSM has a significant impact on peoples’ lives. There have been numerous studies that have looked at discrete changes in the DSM from one version to another or have looked at the historical course of the development of the DSM. Despite this, no study has taken a linguistic approach to the development of the DSM and there have been no quantitative studies done on the DSM. But applying a corpus linguistics approach this study seeks to examine the DSM from a more rigorous and hither-to unexamined lens. In order to achieve this end, this study took a two-arm approach examining different sub-sections of the DSM, looking at different variables and applying slightly different approaches. Arm A of the study explored changes in linguistic and psychological variables in all versions of the DSM in the personality disorders subsections through a Linguistic Inquiry Word Count (LIWC) lens, while also examining changes in stance variables: boosters and hedges. Arm B of the study expanded the examination from not only the DSM versions, but also including some of the diagnostic manuals published by the American Psychiatric Association previous to the DSM that serve as the precursors to the DSM. In addition to this, Arm B also looked at a different subsection of the manuals, the substance use disorders subsections while also employing a different approach, looking at specific changes in word usage rates for a select number of terms utilizing a peaks and troughs methodology. Arm A utilized a log likelihood analysis combined with a Bonferroni correction and an additional pair-wise comparison for any significant results. Arm B utilized a scatter plot followed by a LOESS (locally estimated scatterplot smoothing) to fit a curve to the various data points, with peaks and troughs being identified as falling outside of the 99% confidence level. Additionally, a linear regression was used to examine the relationship between word count and publication order. Arm A of the research yielded minimal changes in linguistic and psychological process variables with no changes in the stance variables. Arm B yielded similar findings with few changes in word usage although overall word count went up significantly. These results were unexpected in the extreme. Taken together the results tend to suggest that at a linguistic level the DSM has not changed significantly from 1918 to 2013 with the exception of the overall word count. These results lead to additional avenues of research and disrupt the current conceptualization of the DSM as a dynamic document.
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