Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and internationally. The International Statistical Classification of Diseases and Related Health Problems (ICD) is a commonly-used alternative.

Some psychologists have stated that they use DSM primarily for completing forms for the government or insurance companies, some of which require a patient to be classified by a diagnosis.

Cautionary Statement

A DSM cautionary statement is required to create balance and perspective for the various diagnoses and criteria used in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. The DSM provides diagnostic categories and criteria for their diagnoses. The proper use of these requires clinical training, knowledge and skills to apply them. Their use by people without this background is likely to lead to an inappropriate application of diagnoses.

The various criteria and diagnostic discussions based on the DSM are provided for information. Any reader who believes that they or someone close to them could be diagnosed with one of the conditions mentioned is advised to consult with a specialist in the field (a psychiatrist or psychologist) for further clarification. The criteria that are described in the DSM are meant to be used by clinicians and investigators. They should not be used in a legal setting without considering other aspects which are not specifically mentioned.

The criteria and classification system of the DSM are based on the majority opinion of people who represent American mental health specialists. Therefore, the content of the DSM does not reflect all opinions on the subject of psychopathology, nor are there any objective standards to which it can adhere. The criteria, and the way they are applied by individual clinicians are at least to some extent influenced by cultural variables. What is and what is not considered a mental disorder changes over time. For example, several decades ago homosexuality was commonly considered a mental disorder, and it was listed in the DSM as such. Today, homosexuality is seen by most psychologists and psychiatrists as a normal sexual orientation. It is also known that diagnosis of some mental disorders is influenced by gender role expectations. That is, while diagnostic criteria do not mention gender, clinicians diagnose women's and men's behaviour in different ways.1

The categories do not represent a complete list of all psychiatric disorders or research topics. For instance, the DSM does not categorize mental disorders that are specific to other (i.e. non-American) cultures, such as koro, susto, or taijin kyofusho. The DSM categories do not include many uncommon or rare syndromes although at times they are mentioned in the text.

Brief history

Users should be reminded that the manual is, to an extent, a historical document. The science used to create categories, taxonomies, and diagnoses is based on statistical models. These systems are thus subject to the limitations of the methods used to create them. Deconstructive critics assert that DSM invents illnesses and behaviors. Detractors of DSM argue that patients frequently fail to fit into any particular category or fall into several, that time limits and numbers of clinical characteristics required for a categorisation are arbitrary and that attention directed towards finding a suitable DSM category for a patient would be better spent discussing possible life-history events that precipitated a mental disturbance or monitoring treatment. Since effective treatment is the aim of the psychiatric profession they would argue that it makes more sense to regard ailments on the basis of how they should be treated rather than on deciding what clinically irrelevant differences place them in one category and not another. This would allow for the modular treatment of different sets of symptoms, for instance prescribing antidepressants for a deficit of serotonin and tranquillisers to deal with acute anxiety.

The first edition (DSM-I) was published in 1952, and had about 60 different disorders. DSM-II was published in 1968. Both of these editions were strongly influenced by the psychodynamic approach, which provides no sharp distinction between normal and abnormal. All disorders are considered reactions to environmental events, with mental disorders existing on a continuum of behavior. In this sense, everyone is more or less abnormal. The people with more severe abnormalities have more severe difficulties with functioning.

The classificatory structure of early editions of the DSM was rooted in a distinction between two poles of mental disorder, psychosis and neurosis. A psychosis is a severe mental disorder characterized by a disconnect from reality. Psychoses typically involve hallucinations, delusions, and illogical thinking. A neurosis, however, is a milder mental disorder characterized by distortions of reality, but not a complete break with reality. Neuroses typically involve anxiety and depression. Among the most noted examples of controversial diagnoses is the classifying in the DSM-II of homosexuality as a mental disorder, a classification that was removed by vote of the APA in 1973 (see also homosexuality and psychology).

In 1980, with DSM-III, the psychodynamic view was abandoned and the biomedical model became the primary approach, introducing a clear distinction between normal and abnormal. The DSM became atheoretical since it had no preferred etiology for mental disorders.

In 1987 the DSM-III-R appeared as a revision of DSM-III. Many criteria were changed.

In 1994, it evolved into DSM-IV. This work is currently in its fourth edition. The most recent version is the 'Text Revision' of the DSM-IV, also known as the DSM-IV-TR, published in 2000. The vast majority of the criteria for the diagoses were not changed from DSM-IV. The text in between the criteria was updated.

DSM-V, is not scheduled for publication until 2011 or possibly later. The APA Division of Research does not expect to begin forming DSM development workgroups until 2007 or later.

A Multiaxial Approach

The Diagnostic and Statistical Manual of Mental Disorders, presently in its fourth revised (IV-TR, 2000) edition, systemizes psychiatric diagnosis in five axes:

• Axis I: major mental disorders, developmental disorders and learning disabilities
• Axis II: underlying pervasive or personality conditions, as well as mental retardation
• Axis III: any nonpsychiatric medical condition ("somatic")
• Axis IV: social functioning and impact of symptoms
• Axis V: Global Assessment of Functioning (on a scale from 100 to 0)

Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, and schizophrenia. Common Axis II disorders include borderline personality disorder, schizotypal personality disorder, avoidant personality disorder, and antisocial personality disorder.

The contents of the DSM are determined by experts whose mandate is to create a set of diagnoses that are replicable and meaningful. While the classification system was originally intended to enhance research into both diagnosis and treatment, the nomenclature is now widely used by both clinicians and insurance companies.

Reference

1 Ford, M. R. & Widiger, T. A. (1989) Sex bias in the diagnosis of histrionic and antisocial personality disorder. Journal of Consulting and Clinical Psychology, 57, 301-305. This article is licensed under the

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Diagnostic and Statistical Manual of Mental Disorders".