Diagnostic and Statistical Manual (DSM) Overview

The Diagnostic and Statistical Manual of Mental Disorders is used by clinicians and psychiatrists
to diagnose psychiatric illnesses. In 2013, the latest version known as the DSM-5 was released.
The DSM is published by the American Psychiatric Association and covers all categories of
mental health disorders for both adults and children.

The DSM is utilized widely in the United States for psychiatric diagnosis, treatment
recommendations, and insurance coverage purposes.

The DSM is non-theoretical and focused mostly on describing symptoms as well as statistics
concerning which gender is most affected by the illness, the typical age of onset, the effects of
treatment and common treatment approaches.

DSM Updates

The Diagnostic and Statistical Manual has been revised a number of times in its history.
 1952: The DSM-I
 1968: The DSM-II
 1974: The DSM-II Reprint
 1984: The DSM-III
 1987: The DSM-III-R
 1994: The DSM-IV
 2000: The DSM-IV-TR
 2013: The DSM-5

The newest version of the DSM was published in May of 2013. The revision was met with
considerable discussion and some controversy.

A major issue with the DSM has been around validity. In response to this, the NIMH has
launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating
genetics, imaging, cognitive science and other levels of information to lay the foundation for a
new classification system they feel will be more biologically based.

Later, NIMH director Thomas R. Insel issued a statement in conjunction with American
Psychiatric Association president Jeffrey A. Lieberman noting that the DSM-5 "...represents the
best information currently available for clinical diagnosis of mental disorders." The statement
went on to suggest that the DSM-5 and NIMH’s own system, the Research Domain Criteria (or
RDoC), represent "complimentary, not competing, frameworks" for the classification of mental
disorders.

The DSM-5’s Predecessor: The DSM-IV-TR

The DSM-IV was originally published in 1994 and listed more than 250 mental disorders. An
updated version, called the DSM-IV-TR, was published in 2000 and contained minor text
revisions in the descriptions of each disorder. Mental health providers used the manual to better
understand a client's potential needs as well as a tool for assessment and diagnosis.
The DSM-IV-TR described disorders using five different dimensions.
This multiaxial approach was intended to help clinicians and psychiatrists make comprehensive
evaluations of a client's level of functioning because mental illnesses often impact many
different life areas.

 Axis I: Clinical Syndromes

o This axis described clinical symptoms that cause significant impairment.
Disorders were grouped into different categories such as mood disorders, anxiety
disorders, or eating disorders.
o
 Axis II: Personality and Mental Retardation
o This axis described long-term problems in functioning that were not considered
discrete Axis I disorders. Personality disorders cause significant problems in how
a patient relates to the world and include antisocial personality disorder and
histrionic personality disorder. Mental retardation is characterized by intellectual
impairment and deficits in other areas such as self-care and interpersonal skills.
o
 Axis III: Medical Conditions
o These included physical and medical conditions that influence or worsen Axis 1
and Axis II disorders. Some examples include HIV/AIDS and brain injuries.
o
 Axis IV: Psychosocial and Environmental Problems
o Any social or environmental problems that may impact Axis I or Axis II disorders
were accounted for in this axis. These include such things as unemployment,
relocation, divorce, or the death of a loved one.
o
 Axis V: Global Assessment of Functioning
o This axis allowed the clinician to rate the client's overall level of functioning.
Based on this assessment, clinicians could better understand how the other four
axes interacted and the effect on the individual's life.

Changes in the DSM-5

The DSM-5 contains a number of significant changes from the earlier DSM-IV. The most
immediately obvious change is the shift from using Roman numerals to Arabic numbers.
Perhaps most notably, the DSM-5 eliminated the axis system, instead listing categories of
disorders along with a number of different related disorders. Some examples of categories
included in the DSM-5 include anxiety disorders, bipolar and related disorders, depressive
disorders, feeding and eating disorders, obsessive-compulsive and related disorders, and
personality disorders.

A few other changes in the DSM-5:

 Asperger's disorder was removed and incorporated under the category of autism
spectrum disorders.
 Disruptive mood dysregulation disorder was added, in part to decrease over-diagnosis of
childhood bipolar disorders.
 Several diagnoses were officially added to the manual including binge eating disorder,
hoarding disorder, and premenstrual dysphoric disorder

While the DSM is an important tool, only those who have received specialized training and
possess sufficient experience are qualified to diagnose and treat mental illnesses.