The Rise and Fall of the Diagnosis of Psychoneurosis of Childhood.

American child and adolescent psychiatry was dominated in most of its first century by a psychoanalytic framework. Child psychiatrists, as well as their treatment team partners in social work and psychology, assumed that children developed mood and behavior problems based on unconscious conflicts, which were driven by difficulties in early childhood experiences within their families. Treatment depended on a painstaking untangling of the strands of the conflict in each individual child. Diagnosis per se was not initially a goal for child mental health providers. Instead, a broad concept of psychoneurosis was central to emphasize the depth and complexity of childhood psychiatric problems. Psychoneurosis did not translate into the 1980 nosology of the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition [DSM-III]), however, and mostly disappeared from child psychiatry by the 1990s. The loss of the developmental, individual, and contextual perspective embedded in psychoneurosis (and other childhood disorders) has been a loss because the widespread use of the DSM symptom criteria has unintended consequences when applied to children.