<P> In 1987, the DSM - III - R was published as a revision of the DSM - III, under the direction of Spitzer . Categories were renamed and reorganized, and significant changes in criteria were made . Six categories were deleted while others were added . Controversial diagnoses, such as pre-menstrual dysphoric disorder and masochistic personality disorder, were considered and discarded . "Ego - dystonic homosexuality" was also removed and was largely subsumed under "sexual disorder not otherwise specified", which can include "persistent and marked distress about one's sexual orientation ." Altogether, the DSM - III - R contained 292 diagnoses and was 567 pages long . Further efforts were made for the diagnoses to be purely descriptive, although the introductory text stated that for at least some disorders, "particularly the Personality Disorders, the criteria require much more inference on the part of the observer" (p. xxiii). </P> <P> In 1994, DSM - IV was published, listing 410 disorders in 886 pages . The task force was chaired by Allen Frances . A steering committee of 27 people was introduced, including four psychologists . The steering committee created 13 work groups of five to 16 members . Each work group had about 20 advisers . The work groups conducted a three - step process: first, each group conducted an extensive literature review of their diagnoses; then, they requested data from researchers, conducting analyses to determine which criteria required change, with instructions to be conservative; finally, they conducted multicenter field trials relating diagnoses to clinical practice . A major change from previous versions was the inclusion of a clinical significance criterion to almost half of all the categories, which required that symptoms cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning". Some personality disorder diagnoses were deleted or moved to the appendix . </P> <P> A "text revision" of the DSM - IV, known as the DSM - IV - TR, was published in 2000 . The diagnostic categories and the vast majority of the specific criteria for diagnosis were unchanged . The text sections giving extra information on each diagnosis were updated, as were some of the diagnostic codes to maintain consistency with the ICD . The DSM - IV - TR was organized into a five - part axial system . The first axis incorporated clinical disorders . The second axis covered personality disorders and intellectual disabilities . The remaining axes covered medical, psychosocial, environmental, and childhood factors functionally necessary to provide diagnostic criteria for health care assessments . </P> <P> The DSM - IV - TR characterizes a mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual (which) is associated with present distress...or disability...or with a significant increased risk of suffering ." It also notes that "no definition adequately specifies precise boundaries for the concept of' mental disorder'...different situations call for different definitions". It states that "there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder" (APA, 1994 and 2000). </P>

When did the dsm iv tr come out