Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders (Forensic Science)
In the United States, the DSM-IV-TR provides the most widely used classification system for mental disorders. This comprehensive manual lists approximately four hundred psychological disorders, including mental retardation, simple phobia, and paranoid schizophrenia. The manual was developed in coordination with the tenth edition of the World Health Organization’s International Classification of Diseases (ICD-10), which covers both medical and psychological disorders.
(The entire section is 61 words.)
Structure (Forensic Science)
The DSM-IV-TR is structured to require the diagnostician to evaluate a person’s condition along five axes, or separate branches, of information. First, the diagnostician must determine whether the person displays one or more clinical disorders from an extensive list. These include disorders usually first diagnosed in infancy, childhood, and adolescence, such as enuresis (bedwetting); delirium, dementia, amnesia, and other cognitive disorders; mental disorders due to a general medical condition; substance-related disorders; schizophrenia and other psychotic disorders; mood disorders; anxiety disorders; somatoform disorders; factitious (intentionally feigned) disorders; dissociative disorders (such as what was formerly called multiple personality disorder); eating disorders (such as bulimia); sexual disorders and gender identity disorder; sleep disorders; impulse-control disorders; and adjustment disorders. Some of the most frequently diagnosed disorders are anxiety disorders and mood disorders (depression).
Second, the diagnostician must decide whether the person is displaying long-standing problems including retardation and personality disorders, which can be overlooked because of the first set of clinical disorders. Mental retardation involves significantly below-average intellectual functioning plus impairments in present adaptive functioning and usually occurs before age eighteen. Personality disorders are rigid,...
(The entire section is 372 words.)
Strengths and Weaknesses (Forensic Science)
Two issues with any kind of diagnostic system are reliability (that is, different people agree on the diagnosis) and validity (that is, the diagnosis is accurate). The people who developed the DSM-IV-TR conducted extensive reviews of research to pinpoint which categories in past versions of the DSM had been too vague. They next developed some new diagnostic criteria and categories and conducted field trials in which many professionals and researchers used the new criteria in their work. It was found that, most of the time, the same clients or kinds of clients were receiving the same diagnoses, although some problems occurred. One problem was that practitioners had some trouble distinguishing one kind of anxiety disorder from another. Thus, although not totally reliable or valid, the most recently published version of the manual represents the best information available about diagnosis.
The DSM-IV-TR is designed to be primarily descriptive, so it avoids suggesting underlying causes for a person’s behavior. Instead, it paints a picture of the behavior itself. Also, it provides precise information so that researchers can explore causes of a problem, and two persons diagnosing the same person will arrive at the same diagnosis. This emphasis on behavior could be considered a strength or a weakness of the manual’s approach.
A potential problem with the DSM-IV-TR is that it...
(The entire section is 305 words.)
Further Reading (Forensic Science)
American Psychiatric Association. Desk Reference to the Diagnostic Criteria from DSM-IV-TR. Washington, D.C.: Author, 2000. Abridged version of the DSM-IV-TR is designed to be more portable and easier to use than the full 943-page edition. Includes the DSM-IV-TR classification chart, a differential diagnosis decision tree, and a list of the appendixes that appear in the unabridged edition.
Durand, V. Mark, and David H. Barlow. Essentials of Abnormal Psychology. 4th ed. Belmont, Calif.: Wadsworth, 2006. Presents thorough descriptions of the different diagnostic groups and includes examples of interviews with individuals who have specific disorders.
First, Michael B., and Allan Tasman. Clinical Guide to the Diagnosis and Treatment of Mental Disorders. Hoboken, N.J.: John Wiley & Sons, 2006. Provides clear, concise, and practical diagnostic and therapeutic advice to all practitioners involved in the treatment of mental disorders, covering all DSM-IV-TR diagnostic categories in a reader-friendly way.
Klott, Jack, and Arthur E. Jongsma, Jr. The Co-occurring Disorders Treatment Planner. Hoboken, N.J.: John Wiley & Sons, 2006. Contains the elements practitioners need to develop formal treatment plans quickly and easily, with a focus on treating adults and adolescents with alcohol, drug, or nicotine addictions and co-occurring disorders such as...
(The entire section is 253 words.)
Diagnostic and Statistical Manual of Mental Disorders (Encyclopedia of Mental Disorders)
Nature and purposes
The Diagnostic and Statistical Manual of Mental Disordersis a reference work consulted by psychiatrists, psychologists, physicians in clinical practice, social workers, medical and nursing students, pastoral counselors, and other professionals in health care and social service fields. The book's title is often shortened to DSM, or an abbreviation that also indicates edition, such as DSM-IV-TR,which indicates fourth edition, text revision of the manual, published in 2000. The DSM-IV-TRprovides a classification of mental disorders, criteria sets to guide the process of differential diagnosis, and numerical codes for each disorder to facilitate medical record keeping. The stated purpose of the DSMis threefold: to provide "a helpful guide to clinical practice"; "to facilitate research and improve communication among clinicians and researchers"; and to serve as "an educational tool for teaching psychopathology."
The multi-axial system
The third edition of DSM, or DSM-III, which was published in 1980, introduced a system of five axes or dimensions for assessing all aspects of a patient's mental and emotional health. The multi-axial system is designed to provide a...
(The entire section is 3167 words.)
Diagnostic and Statistical Manual (DSM) (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
The Diagnostic and Statistical Manual of Mental Disorders is the most widely accepted diagnostic system in the United States. First published by the American Psychaiatric Association (APA) in 1952, the DSM is used by medical professionals, insurance companies, and the court system to diagnose and define mental illnesses and disorders, including substance abuse and dependence. In fact, the diagnosis code assigned to a case often determines insurance reimbursement for treatment. The book is also an important indicator of societal mores: until 1973 homosexuality was defined as a mental disorder.
The first tabulation of mental illness in the United States appeared in the 1840 census, when the category "idiots" and the category "insane" were first counted. By the 1880 census, seven types of mental illness were recognized, including epilepsy. In 1917 the American Medico-Psychological Association (now the APA), in conjunction with the National Commission on Mental Hygiene, further enlarged its categories of mental illness. This broader list, while certainly of greater clinical use, was still chiefly designed to count the numbers and types of patients in mental hospitals. Several years after this tabulation, the newly renamed APA released a compendium of nationally recognized psychiatric termsost of which applied to psychotic disorders and severe neurological impairmentshat would become part of the American Medical Association's standard classified nomenclature of disease.
After the end of World War II, the Veterans Administration (VA) added many more diagnoses to the APA inventory, incorporating the various psychological manifestations exhibited by servicemen. This expanded compilation proved to be influential, for shortly after its publication the World Health Organization (WHO) published the sixth edition of its International Classification of Diseases (ICD), which for the first time included information on mental disorders, much of it based on by the VA classifications.
The first edition of the DSM (DSM-I), published in 1952, was little more than a pamphlet. Its importance, however, lay in its description and definition of the approximately 100 diagnostic categories then recognized by clinicians. DSM-I, like its successor, DSM-II, was heavily influenced by the seventh and eighth editions of ICD. In fact, until the publication of of DSM-III, the American system for classifying psychiatric disorders was virtually identical to the ICD.
During the 1970s, however, researchers affiliated with the Washington University School of Medicine (Feighner et al., 1972) developed the "re-search diagnostic" approach to psychiatric diagnosis, which emphasized clearly formulated and observable signs and symptoms that could be used for both research and clinical practice. DSM-III, published in 1980, incorporated this approach, adding clear diagnostic standards and objective descriptions of symptoms and behaviors.
DSM-III also introduced a multiaxial system for diagnostic evaluation to ensure that all relevant clinical information was considered. Axis I describes syndromes, such as major DEPRESSION, SCHIZOPHRENIA, and substance use disorders. Axis II covers childhood and personality disorders that often persist into adult life. Axis III refers to physical disorders or conditions that are potentially relevant to the understanding or management of the patient. Axis IV rates the severity of psychosocial stressors that have occurred in the year preceding the current evaluation and that may have contributed to the patient's symptoms. Axis V is a global assessment of psychological, social and occupational functioning, which should be taken into account in treatment planning.
For the first time DSM-III listed substance use disorders as a separate diagnosis category, distinguishing them from personality disorders, which they had previously been considered. In addition, the term dependence replaced the more generic alcoholism or addiction, and was distinguished from abuse by the presence of the symptoms of TOLERANCE or WITHDRAWAL. Alcohol and drug abuse were assigned to separate subcategories, permitting a greater differentiation and range of severity for each.
Another important change to the substance use disorders section in DSM-III (Rounsaville, Spitzer, & Williams, 1986) was the adoption of a new dependence syndrome concept (Edwards, Arif, & Hodgson, 1981), in which dependence was defined as an interrelated cluster of psychological symptoms: a strong desire or CRAVING for the substance; physiological signs, especially tolerance and withdrawal; and behavioral indicators, particularly using the substance to relieve withdrawal discomfort. Significantly, the medical and social consequences of both acute intoxication and chronic substance use, such as ACCIDENTS and liver damage are not among the primary diagnostic criteria of dependence. They do, however, play a prominent role in defining the substance abuse category.
After the publication of a revised third edition in 1987 (DSM-III-R), a fourth edition (DSM-IV) was published in 1994. This version contained further changes in the diagnosis of substance-related disorders that were designed to assure compatibility between DSM and ICD. Both publications now define substance dependence as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three or more of the following symptoms occurring in the same twelve-month period:
Tolerancehe need for markedly increased amounts of the substance to achieve intoxication or the desired effect
Withdrawalehavioral changes that occur when blood or tissue levels of the substance decline after a period of prolonged or heavy use; often accompanied by use of the substance to relieve withdrawal symptoms.
Increased useaking the substance in larger amounts or over a longer period.
Unsuccessful attempts to cut down or control substance use.
Much time spent in activities related to procuring or using the substance.
Ignoring or reducing important social, occupational, or recreational activities because of substance use.
Continued use despite physical or psychological problems caused by the substance.
Patients can become dependent on any of the following: ALCOHOL, TOBACCO, SEDATIVES-HYPNOTICS-ANXIOLYTICS, CANNABIS (MARIJUANA), STIMULANTS, OPIOIDS, COCAINE, HALLUCINOGENS, PCP (PHENCYCLIDINE), or a combination of drugs, which is known as POLYSUBSTANCE ABUSE. The most important factor in determining dependence, according to the DSM-IV, is not simply abusing alcohol or drugs, but the patient's refusal to stop using the substance(s) despite recognizing the serious problems this causes.
(SEE ALSO: Addiction: Concepts and Definitions; ; Disease Concept of Alcoholism and Drug Abuse)
AMERICAN PSYCHIATRIC ASSOCIATION. (1994). Diagnostic and statistical manual of mental disorders-4th edition. Washington, DC: Author.
AMERICAN PSYCHIATRIC ASSOCIATION. (1987). Diagnostic and statistical manual of mental disorders-3rd edition-revised. Washington, DC: Author.
AMERICAN PSYCHIATRIC ASSOCIATION. (1980). Diagnostic and statistical manual of mental disorders-3rd edition. Washington DC: Author.
EDWARDS, G., ARIF, A., & HODGSON, R. (1981). Nomenclature and classification of drug- and alcohol-related problems: A WHO memorandum. Bulletin of the World Health Organization, 59, 225-242.
FEIGHNER, J., ET AL. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57-63.
ROUNSAVILLE, B. J., SPITZER, R. L., & WILLIAMS, J.B. (1986). Proposed changes in DSM-III substance use disorders: description and rationale. American Journal of Psychiatry, 143, 463-468.
THOMAS F. BABOR
REVISED BY AMY LOERCH STRUMOLO