Guía de Consulta de los Criterios Diagnósticos del DSM-5: Spanish Edition of the Desk Reference to the Diagnostic Criteria From DSM-5

Spanish is the second most commonly spoken language in the world, with over 400 million people using it as their first language, making it second only to Mandarin. In the United States alone, 60 million people speak Spanish currently, 40 million as a first language and 20 million as a second or “foreign” language (1). While the DSM system was designed primarily for the United States and Canada, starting with DSM-III, this set of criteria has had ample diffusion all over the world, and the manual has been translated into many languages. Spanish translations of DSM-III-R and DSM-IV have been completed mainly in Spain, and these have had limitations given the linguistic and idiomatic differences between the Spanish spoken in Spain and that of Latin American countries.

Translation is a complex process, as well described in a passage from the Spanish novel Don Quixote, by Miguel de Cervantes: “Translating from one language to another … is like looking at Flemish tapestries from the wrong side, for although the figures are visible, they are covered by threads that obscure them and cannot be seen with the smoothness and color of the right side.” A contemporary scholar referring to cross-cultural translation stated that the process “requires a keenness of insight surpassing that of most mortals” (2). Since DSM is often called “psychiatry’s bible,” it is befitting to mention the Bible, the most translated document in the world, starting with the translation of the Old Testament from the original Hebrew into the Greek Septuagint and then the New Testament from the original Greek to the Latin Vulgate, followed by the multiple translations into most world languages. In the preface of the 1611 edition of the King James version, the first English translation of the Bible, the translators included the following passage:

Bible translations undergo revision after revision by theologians and scholars, some of them validated with the nihil obstat of some superior authority. Interestingly, the English missals used by the 78 million U.S. Catholics were recently retranslated from Latin in efforts to recapture the essence of the original version, diluted more than 40 years ago by lax translations resulting from the notion of “dynamic equivalence.”

While literary translations may allow for a good deal of freedom, as evidenced by Gregory Rabassa’s English translations of works by Latin American authors (Rabassa, “one of the best translators who ever drew breath,” according to William Kennedy, is so gifted that even Gabriel Garcia Márquez, author of One Hundred Years of Solitude, said he preferred Rabassa’s English translation to his own original), technical translations, such as the translation of survey or measuring instruments, involve a more tedious and methodic routine and need to adhere to specific guidelines. Decades ago, our research group learned the complexities and nuances of this exercise when we did the first Spanish translation of the Diagnostic Interview Schedule, a structured interview for diagnosing DSM-III disorders in the Epidemiologic Catchment Area Study (3), and confronted the difficult task of translating documents developed for one culture/language into another. We also learned that it is quite difficult, if not impossible, to obtain a version that fits all the Spanish-speaking people in Latin America and Spain. Brislin et al. (4) articulated the state-of-the-art methodology and guidelines for cross-cultural translation of instruments since the 1970s. The process needs to take into account cultural, conceptual, and structural equivalence and should make use of back translation, bilingual subjects’ testing, and expert panels. Moreover, it is recommended that the source instrument to be translated employ simple sentences, use the active tense, and avoid metaphors and colloquialisms, as well as subjunctive and conditional verbs. The DSM-5 process paid particular attention to cultural issues. Thus, DSM-5 Task Force members, along with members of the various DSM-5 workgroups, sought input from international colleagues and experts in cross-cultural diagnosis, not only for changes in criteria and formulation of new diagnoses but also for writing the text of the diagnostic criteria and the descriptive information included in the manual. The DSM-5 “writers” had these guidelines in mind for the preparation of the manual, and this may facilitate the work of translators. However, certain English terms and idioms customarily used to define certain patterns of behavior have become part of the tradition, so that words such as “binges” and “craving,” as well as many others, continue to filter in and pose a challenge to translators. Here, it may be proper to remember Voltaire’s warning: “Woe to the makers of literal translations, who by rendering every word, weaken the meaning! It is indeed by so doing, that we can say the letter kills and the spirit gives life.”

The book reviewed herein is the first Spanish translation of one of the new DSM-5 manuals; in this instance, an abridged document called Desk Reference to the Diagnostic Criteria From DSM-5. Interestingly, the title was changed in the translation to Guía de Consulta (literally, Guide of Consultation), since literal translation of the “desk reference” term would sound odd in Spanish. The translation was done under the aegis of the APA because it was published by American Psychiatric Publishing. I assume that the “target” population for this translation includes all the Spanish-speaking psychiatrists and practicing clinicians in the United States, Latin America, and Spain. It is not clear, however, how the translation was actually done, since no details are given in the text, other than that the translation was done by Burg Translations, a company whose headquarters is in Chicago, and that it included, as expert consultant, Dr. Ricardo Restrepo, a Colombian-born psychiatrist practicing in the United States. The choice of a Colombian-origin expert is not surprising, since the Spanish spoken in Colombia appears to be more “neutral” relative to that spoken in Spain and other Latin American countries. When compared with the original version, this translation appears to be of very good quality. Ambiguous terms and idioms such as “binges” and “craving,” as well as many others, have been translated well in my opinion. There are a few things that could have been done differently, such as translation of the new diagnosis “hoarding disorder,” for which “trastorno de acumulación” was used. Because the notion of “hoarding” goes well beyond simple accumulation, a more drastic term, possibly “trastorno de acaparamiento,” could have been used instead. Also, changing the order of certain words and terms could have made the translation a bit closer to the original, but most of these would be rather trivial changes. For example, in page 364, the authors translate personality disorders as “trastornos de la personalidad limite, histrionica, narcisista, etc.” An alternative translation could be “trastorno limite, histrionico o limite de la personalidad,” but these are clearly minor, debatable points.

No dudo en recomendar esta traducción a todos los colegas hispano-parlantes y felicito a la APA por asumir la responsabilidad de publicar este importante trabajo. Esto refrenda la excelente iniciativa del editor del American Journal of Psychiatry de traducir los títulos y los abstractos en la versión electrónica de la revista.

(I recommend this translation without hesitation to all Spanish-speaking colleagues and congratulate American Psychiatric Publishing for assuming responsibility for this important work. It adds to the initiative of the American Journal of Psychiatry, of translating into Spanish the titles and abstracts in the electronic version of the Journal.)