DIAGNOSTIC AND

STATISTICAL
MANUAL OF
MENTAL
DISORDERS
FIFTH EDITION
International Classification of
Diseases
A Brief History

The creation of this 5th manual was a massive undertaking

which involved hundreds of people working towards a
common goal. It focuses more on the evaluation of the
diagnostic criteria, considering every aspect of the manual
The Diagnostic and Statistical Manual of Mental Disorders
and creating new features which are believed to be very
is now in its fifth edition. The first one was established in
useful for clinicians. All of these were directed towards a
1844 as a statistical classification of institutionalized
goal to enhance the usefulness of DSM5 as a guide in the
mental patients. It was primarily designed to improve
diagnosis of mental disorders. Reliable diagnoses will
communication about the types of patients cared for in the
guide treatment recommendations, identifying prevalence
hospitals. After WWII DSM evolved through four major
rates for mental health service planning, identifying patient
editions into a diagnostic classification systems for
groups for clinical and basic research. DSM5 is designed
psychiatrists, other physicians and other mental health
to better fill the need of clinicians, patients and families
professionals, and it described the essential features of the
and researchers for a clear and concise description of each
full range of mental disorders.
mental disorder organized by explicit diagnostic criteria,
supplemented when appropriate by dimensional measures
that cross diagnosis boundaries, the risk factors, associated
features and various expressions of the disorder.
How is Mental Disorder defined in DSM5?

An expectable or culturally
approved response to a
A mental disorder is a
common stressor or loss such
syndrome characterized by
as the death of a loved one, is
clinically significant
not a mental disorder.
disturbance in an
Mental disorders are usually Socially deviant behavior
individual’s cognition,
associated with significant examples are political,
emotion regulation, or
distress or disability in social, religious or sexual and
behavior that reflects
occupational, or other conflicts that are primarily
dysfunction in the
important activities. between the individual and
psychological, biological or
society are not considered
developmental processes
mental disorders unless the
underlying mental
deviance or conflict results
functioning.
from a dysfunction in the
individual.
Diagnostic Criteria
 The Diagnostic Criteria will be composed of:
 Symptoms
 Behaviors
 Cognitive functions
 Personality Traits
 Physical Signs
 Syndrome Combinations
 Duration
The use of the Manual
The introduction and history plus the
developmental process of the DSM5
will be the practical guide particularly
for those in clinical practice. This will
assist trained clinicians in the
diagnosis of their patient’s mental
disorder as part of a case formulation.
We need the following information:
• Causal Factors : Biological, Psychological,
Socio-Cultural (social-environmental)
• Typical Signs and Symptoms
• Psychopathology : viewpoints example culture
bound syndrome specifically tubong atin or
Filipino psychopathology
• Construct of culture
What is a clinical case formulation?
•It involves a careful clinical history and concise summary of the social, psychological and biological factors
that may have contributed to developing a given mental disorder.
•It is not simply a check off the symptoms in the diagnostic criteria but to apply for every patient the relative
severity and valence of individual criteria and their contribution to a diagnosis require clinical judgment. The
symptoms in our diagnostic criteria are part of the relatively limited repertoire of human emotional responses to
internal and external stresses that are generally maintained in a homeostatic balance without a disruption in
normal functioning.
•For clinical judgment it sh and are indicated by the instruction”ould to recognize the combination of
Predisposing, Precipitating, Perpetuating and Protective factors resulting to a psychopathological condition in
which the physical signs and symptoms exceed normal ranges.
• We need as well strong foundations on Neuro-Anatomy( example transmitters and endocrinology),
Biopsychology , (Theories of Development and Personality Theories) Psychological Assessment and Diagnosis.
• 
Elements of a Diagnosis
 Principal Diagnosis When more than one diagnosis is given for an
individual in an outpatient setting, the reason for the visit is the
condition that is chiefly responsible for the ambulatory care
medical services received during the visit. It is often difficult (and
somewhat arbitrary) to determine which is the principal diagnosis
example alcohol use disorder.
 Provisional Diagnosis the specifier “provisional” can be used
Diagnostic Criteria and Descriptors are the guidelines for making diagnoses and their use should be informed by
when there is a strong presumption that the full criteria will
clinical
Medication- judgment.
Induced
Subtypesdisorder
conditions maysubtypes
Following
Movement
and specifiers (inand
be listed as aor
phenomenological subgroupings
the assessment
Disorders
the fourth,
specifiers
reason
and other ofConditions
fifth or
as sixth
appropriate.
for clinical
within
diagnosticthat
digit.) Subtypes
criteria
Severitytoand
visit in addition
a diagnosis
mayclinicians
define
be a Focus
course
or in
and are, indicated
should
placespecifiers
by thethe
consider
for Clinical
mutually exclusive
should
of the mental
instruction
and
the application
attention.
bejointly
applied
disorders.
“specify
These of
exhaustive
to denote the
A separate
whether” in the
ultimately be met for a disorder, but not enough information is
individual’s current presentation but only when full criteria are met. 
chapter is devoted to medication-induced disorders and other adverse effects of medication that may be assessed and
criteria set. They are indicated by the instruction “Specify” or “Specify if”
treated by clinicians in mental health practice. available to make a firm diagnosis.
 Example: when a client has a major depressive disorder but
there is no adequate history, then it can not be given full criteria
but provisional.
 Coding and Reporting Procedures Each disorder is accompanied
by an identifying diagnostic and statistical code which is typically
used by institutions and agencies for data collection. There are
specific recording protocols for these diagnostic codes.
 • The DSM5 diagnostic criteria and text are
primarily designed to assist clinicians in

Cautionary conducting clinical assessment, case

formulation, and treatment planning, it is also
used as a reference for the courts and

Statement attorneys in assessing the forensic

consequences of mental disorders. Therefore,
it is important to note that the definition of

for the
mental disorder was developed to meet the
needs of clinicians, public health professionals,
and research investigators, rather than all of

Forensic Use
the technical needs of the courts and legal
professionals. It is also important to note that
DSM5 does not provide the treatment

of DSM5
guidelines for any give n disorder.
The International Classification of Diseases

The International Classification of Diseases is made up of thousands of codes that are used around the world to classify diseases and
conditions and generate statistics that are used to monitor health trends, plan how services are delivered and make financing decisions about
health systems. It also includes letters and numbers to indicate a code, because it is a very important code because it is about a person’s
health. A pregnancy (eclampsia), a birth,( low birth rate resulting to birth deaths), a disease, (tuberculosis) an injury, an outbreak ( ebola or
covid-19) or even death.

It is a code with a long and winding journey from one person in a hospital or a clinic, it joins up with other codes from other places, regions
and countries, it becomes a small but important part of a bigger picture to monitor the health of populations large and small. It can be used to
plan how health services will be delivered, to help diagnose diseases and detect changing patterns of diseases. The ICD is a common
language used all over the world by doctors, nurses, policy makers and researchers and many others to classify disease and conditions so that
they will have the best possible picture of everyone’s health around the world more than one hundred countries use the ICD to have reports
to know the reasons why people die, to monitor the health of the populations and to help make financing conditions about the health
systems. The world needs better health data and ICD is delivering it.
Harmonization with ICD

The existence of the two major classifications of mental disorders hinders the collection and use of
national health statistics, the design of clinical trials aimed at developing new treatments and the
consideration of global applicability of the results by international regulatory agencies.

More broadly, the existence of two major classifications complicates attempts to replicate scientific
results across national boundaries.

Even when the intention was to identify identical patient populations, before DSM5 DSM IV and ICD 10
diagnoses did not always agree.