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Currently in its fifth edition (DSM-5), the
Diagnostic and Statistical Manual (DSM) is sometimes referred to as psychiatry’s bible. Within its covers are specific diagnostic criteria for mental disorders, as well as a series of codes that allow therapists to easily summarize often complex conditions for clinical
research and insurance purposes.
Nội dung chính Show
- History of the DSM
- DSM-I and DSM-II
- DSM-IV and DSM-5
- Clinical Uses of the DSM
- Advantages of the DSM
- Standardization
- Research Guidance
- Therapeutic Guidance
- Disadvantages of the DSM
- Oversimplification
- Misdiagnoses and Over-Diagnoses
- Labeling and Stigmatization
- What You Can Do to Ensure Proper Diagnosis
- A Word From Verywell
- What is the purpose of the DSM V quizlet?
- What is the DSM What was the purpose of its development?
This method offers a number of advantages, such as standardization of diagnoses across different treatment providers. But increasingly, mental health professionals are considering the drawbacks of the DSM, including the possibility of over-diagnosis. In order to understand the debate, it is first necessary to understand what the DSM is and is not.
History of the DSM
Although its roots are traceable to the late 19th century, the standardization of mental illness classifications really took hold in the years immediately following World War II. The U.S. Department of Veterans Affairs (then known as the Veterans Administration, or VA) needed a way to diagnose and treat returning service members who had a wide range of mental health difficulties.
In 1949, the World Health
Organization released its sixth edition of the International Classification of Diseases (ICD), which for the first time included mental illnesses. Although this work represented some of the earliest standards for mental health diagnosis, it was far from complete.
DSM-I and DSM-II
In 1952, the American Psychiatric Association (APA) published the DSM-I, an adaptation of a classification system developed by the armed forces during WW2. It was designed for use by doctors and other treatment providers.
The DSM-I was the first of its kind, but experts agreed that it still needed work. The DSM-II, released in 1968, attempted to incorporate the
psychiatric knowledge of the day. It was heavily influenced by psychoanalytic concepts that were prominent that time.
DSM-III
Published in 1980, DSM-III represented a radical change in the DSM structure. Its goal was to improve the validity and standardization of psychiatric diagnoses. It was the first version to introduce such elements as the multi-axis system and explicit diagnostic criteria. It also removed
much of the earlier versions’ bias toward psychodynamic, or Freudian, thought in favor of a more descriptive and categorical approach.
Although the DSM-III was a pioneering work, real-world usage soon revealed its flaws and limitations. Confusing diagnostic criteria and inconsistencies led the APA to develop a revision. Some of these changes were based on changing societal norms. For example, in the DSM-III, homosexuality was diagnosed as ego-dystonic
homosexuality. In the revision, this specific classification was removed.
By the late 1980s, however, homosexuality was no longer seen as a disorder, although anxiety and distress about sexual orientation were. The DSM-III-R, released in 1987, fixed many of the internal difficulties of the earlier work.
DSM-IV and DSM-5
Published in 1994, the DSM-IV reflected numerous changes in
the understanding of mental health disorders. Some diagnoses were added, others subtracted or reclassified. In addition, the diagnostic system was further refined in an effort to make it more user-friendly.
The DSM-5, published in May 2013, represented another radical shift in thinking in the mental health community. Diagnoses have been changed, removed or added, and the organizational structure underwent a major reworking.
Previous editions went decades between revisions. The DSM-5 is expected to be revised more regularly with mini additions (such as the DSM-5.1, DSM-5.2, etc.) in an effort to be more responsive to research.
Clinical Uses of the DSM
Every mental health professional uses the DSM in his or her own way. Some practitioners rigidly stick to the manual, developing
treatment plans for each client based solely on the book’s diagnoses. Others use the DSM as a guideline—a tool to help them conceptualize cases while focusing on each client’s unique set of circumstances.
But in the modern world, virtually every mental health professional must refer to the
DSM’s codes in order to bill treatment to insurance companies.
Advantages of the DSM
Despite its flaws, the DSM is uniquely helpful for several reasons.
Standardization
Beyond billing and coding, standardization provides a number of important benefits to the clinician and the client. Standardization of diagnoses helps ensure that
clients receive appropriate, helpful treatment regardless of location, social class, or ability to pay. It provides a concrete assessment of issues and helps therapists develop specific goals of therapy, as well as assess the effectiveness of treatment.
Research Guidance
In addition, the DSM helps guide research in the mental health field. The diagnostic checklists help ensure that
different groups of researchers are studying the same disorder—although this may be more theoretical than practical, as so many disorders have such widely varying symptoms.
Therapeutic Guidance
For the mental health professional, the DSM eliminates a lot of guesswork. Proper diagnosis and treatment of mental illness remains an art, but the DSM diagnostic criteria serve as a sort of map.
In the age of brief therapy, a clinician may see a specific client only a handful of times, which may not be long enough to delve fully into the client’s background and issues. Using the diagnostic criteria contained in the DSM, the therapist can develop a quick frame of reference, which is then refined during individual sessions.
Advantages
Standardizes billing and coding
Standardizes diagnoses and treatment
Guides research
Guides treatment
Disadvantages
Oversimplifies human behavior
Increases risk of misdiagnosis or over-diagnosis
Provides labels, which can be stigmatizing
Disadvantages of the DSM
No tool is perfect, and the DSM
is no exception. Being aware of its drawbacks is important for both patients and therapists.
Oversimplification
The latest round of criticism echoes a long running debate on the nature of mental health. Many critics of the DSM see it as an oversimplification of the vast continuum of human behavior. Some worry that by reducing complex problems to labels and numbers, the scientific
community risks losing track of the unique human element.
Misdiagnoses and Over-Diagnoses
Possible risks include misdiagnosis or even over-diagnosis, in which vast groups of people are labeled as having a disorder simply because their behavior does not always line up with the current ideal. Childhood attention deficit/hyperactivity disorder
(ADHD) is a common example. Shifts in terminology and diagnostic criteria in DSM-IV coincided with a massive upturn in the number of children on
Ritalin or other medications.
Labeling and Stigmatization
Other risks involve the possibility of stigmatization. Although mental health disorders are not viewed in the negative light that they once were, specific disorders can be perceived
as labels. Some therapists take great care to avoid attaching labels to their clients. But for a variety of reasons, a specific diagnosis may be required.
What You Can Do to Ensure Proper Diagnosis
Despite the concerns of some segments of the mental health community, the DSM remains the standard for diagnosis of mental health conditions. Like any other professional manual, however, the DSM is designed to be used
as one of many tools for proper diagnosis and treatment.
There is no substitute for professional judgment on the part of a mental health provider. It is important to interview potential clinicians as you would any other service provider. Ask questions about their background and therapeutic approach, and choose the one whose style best melds with your personality and goals for
treatment.
In recent years, some mental health associations have published supplemental handbooks that attempt to address some of the DSM’s drawbacks with more specific diagnostic criteria relevant to the association’s school of thought. For example, five associations teamed up to create the Psychodynamic Diagnostic Manual, or PDM, in 2006.
That particular handbook is geared toward mental health clinicians who
incorporate a psychodynamic or psychoanalytic perspective in their work with patients. The goal of this approach is to describe dimensions of a patient’s overall personality and emotional functioning and ways this might influence the therapeutic process.
A Word From Verywell
If you have any concerns about your diagnosis, ask your clinician for more information.
Finding the right therapist or mental health professional can be challenging, but the rewards are well worth the trouble.
What is the purpose of the DSM V quizlet?
*General Purpose: “The purpose of the DSM-IV is to provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study and treat people with various mental disorders.”
What is the DSM What was the purpose of its development?
Published by the American Psychiatric Association (APA), the DSM covers all categories of mental health disorders for both adults and children. It contains descriptions, symptoms, and other criteria necessary for diagnosing mental health disorders.
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