The number of mental disorders increased from more than 200 in the DSM-III to more than 300 in the DSM-IV. 

Number

The threshold for approval of a diagnosis in DSM-IV was more conservative, requiring more empirical backing. 

Threshold

DSM-IV emphasized more on culture-specific aspects of diagnosis, including new discussions of "cultural variation", all based on the assumption that the DSM-IV must be applicable cross culturally. 

Culture-specific aspect

The most significant changes in DSM-IV were in the revision process itself. The process was more systematic, obtaining and reviewing empirical input through literature review, data reanalyses, and field trials, so that decisions are based on evidence, not individual opinion. 

Process

Number

Threshold

Culture-specific aspect

Process

University of Illinois at Urbana-Champaign

In 1994, the DSM-IV was published by the American Psychological Association (APA) with guidance from a new taskforce headed by Allen Frances. The revisions for this edition were largely focused around providing more research credibility to the existing diagnoses, while also adding stricter “clinically significant” requirements for most symptoms to be considered for a diagnosis. This was in accordance with an updated definition of mental disorder, focusing on the same requirement of “clinically significant” aspects of distress or disability. 

DSM-IV

Sanders, J. L. (2011). A distinct language and a historic pendulum: the evolution of the Diagnostic and Statistical Manual of Mental Disorders. Archives of psychiatric nursing, 25(6), 394-403. https://doi.org/10.1016/j.apnu.2010.10.002

A distinct language and a historic pendulum: the evolution of the Diagnostic and Statistical Manual of Mental Disorders

Clegg, J. W. (2012). Teaching about mental health and illness through the history of the DSM. History of psychology, 15(4), 364. https://doi.org/10.1037/a0027249

Teaching about mental health and illness through the history of the DSM

Revised the DSM-III-R so that "development could be coordinated with the ongoing development of the 10th revision of the ICD".

The rise of DSM-IV

The structure and theoretical orientation was largely unchanged; a descriptive orientation and multiaxial system remained. 

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