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. 

University of Illinois at Urbana-Champaign

Number

Threshold

Culture-specific aspect

Process

Changes from DSM-III

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

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. 

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