DSM-IV Classification of Sleep Disorders

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Sleep disorders have been included in the Diagnostic and Statistical Manual of Mental Disorders since 1987. DSM-III-R (American Psychiatric Association 1987) classified patients first according to their primary complaint of “dyssomnia” (including insomnia, hypersomnia, and circadian rhythm disorder) or “parasomnia.” The DSM-III-R sleep disorder system was the first psychiatric sleep classification to demonstrated diagnostic interrater reliability by the use of a structured interview (Schramm et al. 1993). In DSM-IV (American Psychiatric Association 1994), patients are classified at the first level by presumed pathophysiology rather than by presenting symptom.

Thus, DSM-IV includes major sections of primary sleep disorders, sleep disorders related to another mental disorder, secondary sleep disorders due to an Axis III condition, and substance-induced sleep disorders (Table 89-1). The number of specific sleep diagnoses in DSM-IV is greater than that in DSM-III-R but far smaller than that in the International Classification of Sleep Disorders (ICSD), the classification used by most sleep specialists (Diagnostic Classification Steering Committee 1990). DSM-IV sleep disorders characterized by insomnia have moderately good interrater reliability in clinical practice, with mean kappa values in the range of 0.30-0.57 (Buysse et al. 1994). Specific diagnoses have also been shown to result in different treatment recommendations (Buysse et al. 1997b).

RELATED STORIES:
Sleep Disorders Physiology   Proposed Sleep Disorders   Medical and Psychiatric Sleep Disorders   Substance-Induced Sleep Disorder   Sleep Disorders - Conclusions   Sleep Disorders Due to a General Medical Condition   Hypersomnia Related to Another Mental Disorder   Sleep Terror Disorder and Sleepwalking Disorder   Parasomnia Not Otherwise Specified   Insomnia Related to Another Mental Disorder   Circadian Rhythm Sleep Disorder   Treatment of Specific Sleep Disorders

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