The DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used by clinicians and psychiatrists to diagnose psychiatric conditions.

It originated in 1952 and has been updated frequently since. The current version is the DSM-5 which was released in 2013. The diagnostic manual contains more than 250 known disorders. There are some aspects which can cross over in terms of symptoms, and multiple diagnoses are often present.

The case study provided in step 2.7 Case Study will give you an overview of the DSM 5 and allow you to see how a diagnosis is made for a specific mental health issue.

Why we need a diagnostic manual

Classifications of mental health issues are needed in psychiatry, just as they are in medicine, to assist communication and provide a common language for clinicians about the nature and of problems, prognosis and treatment (Gross 2015). Even in this age of brain scans and genetic analysis, we lack the capability to diagnose a psychiatric condition with objective tests. Therefore, psychiatrists and clinicians depend on the symptoms reported by patients and their own observations to make a diagnosis. Clinicians can compare the patient’s symptoms with the standardised lists of symptoms and criteria compiled within diagnostic manuals such as the DSM-5 (Fitzgerald 2012).

Characteristics of the DSM-5

The DSM-5 was published in 2013 and has a symptom-based criteria that has been devised by expert committees and tested in studies to see how well they define distinct groups of patients. The evidence base for the criteria for any specific disorder will change over time. The DSM-5 is the most comprehensive revision so far.

The DSM-5 provides an important standardisation of diagnostic categories for psychiatric research and treatment. The use of standardised interview schedules and explicit diagnostic criteria has increased the reliability of diagnosis in more recent additions of the DSM. In the past there were substantial variations in the way certain diagnoses were applied. This made clinical diagnosis inconsistent and substantial advances in psychiatric research impossible.

In an effort to improve the quality of diagnosis and care of people from all backgrounds (Gross 2015) the DSM-5 has included greater cultural sensitivity but this still requires some revision.

Why the DSM-5 is controversial

Classification systems of mental health disorders strive to be objective and reliable but in reality often fall short of this (Davey 2017). The DSM does not classify according to the causes of the mental health issue, but rather to the symptoms that a patient may present. This can be misleading, and encourage mental health disorders that look the same on the surface to be misdiagnosed, which can impact on the treatment that is subsequently given to the patient.

Additionally, the DSM gives labels to people based on a set of symptoms without the explanation of the cause. The label of a mental health issue can be extremely stigmatising and harmful. People are often treated differently in society once they have a label of a mental disorder and the impact of this can extend to many areas of their lives. Furthermore, it has been found that people do tend to adopt a diagnostic label whereas individuals who reject the label have a better rate of recovery (Davey 2017).

The DSM is controversial because although there are defined categories of disorders within it, many of these commonly co-occur. This is termed comorbidity and individuals who are diagnosed with two or more distinct disorders is the norm rather than the exception. This in turn makes a case for hybrid disorders that contain elements of a number of different disorders rather than distinct disorders as the DSM suggests.

In spite of all the conceptual difficulties associated with the DSM and the many criticisms, it is still the most extensively used classification and diagnostic system for mental health disorders.

Your task

• ‘In spite of all its shortcomings, the DSM-5 s still a very useful tool for treating people living with mental health issues’. How far do you agree with this point of view?

Post your thoughts in the comments area.

References

_{Davey, G.,C. (2017) Psychopathology. 2nd edn. Chichester: Wiley}

_{Fitzgerald, P. (2012) ‘Explainer: What is the DSM and How are Mental Disorders Diagnosed?’ The Conversation [Online]. available from http://theconversation.com/explainer-what-is-the-dsm-and-how-are-mental-disorders-diagnosed-9568 [16th November 2018]}

_{Gross, R. (2015) Psychology: The Science of Mind and Behaviour. 7th edn. London: Hodder Education}

Further reading

_{American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders DSM-5.® (2013) 5th edn. Arlignton Va: APA}