What is the DSM-5?

In this blog we present you a complete guide into the DSM-5.

We also briefly discuss what theDiagnostic and Statistical Manual (DSM) is, its history, changes, use and development, and how it is used in clinical practice. 

What is the DSM-5?

The DSM-5 is the abbreviated name for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition published by the American Psychiatric Association (APA) .

The DS-5 is a resource and a diagnostic tool that provides criteria and information for healthcare providers to diagnose mental health disorders.

The DSM-5 is organised into sections. These sections are as follows:

  • Section 1 provides information as to the use and instruction of how to use the manual.
  • Section 2 provides diagnostic criteria for specific mental disorders that have been categorised into chapters. 
  • Section 3 includes assessments and tools for mental disorders including a guide to cultural formulation, and alternative conceptualisations of personality disorders.

There has been some changes in the DSM-5 compared to the earlier editions starting from the change from Roman numerals to Arabic numbers in the name of the manual the earlier editions of the DSM such as DSM-IV and DSM-IV-TR.7 

The DSM-5 also eliminated the use of the multiaxial system and instead uses lists to categorise disorders along with a number of different related disorders. 

For example, DSM-5 categories in the form of chapters include anxiety disorders, bipolar and related disorders, depressive disorders, feeding and eating disorders, obsessive-compulsive and related disorders, and personality disorders. Each chapter is further broken down into specific disorders. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is widely referred to as the handbook for the categorization and diagnosis of psychiatric illnesses that is used primarily by clinicians and psychiatrists.

It covers all known categories of mental health disorders for both adults and children that have been presented in the form of chapters that are further broken down into specific conditions. .

The DSM contains information related to the disorder such as:

  • Description of the disorders
  • Diagnostic Criteria 
  • Symptoms
  • Gender differences
  • Onset and development of the condition
  • Factors that increases risk of the condition 
  • Treatment prognosis and common approaches to treatment for the disorder
  • It also includes comobid and differential diagnosis. 
  • Brief information regarding the prevalence of the condition as of 2013.

Updates of the latest version of the DSM-5 are also provided on the APA website in real time.

Overview of DSM History

The DSM was developed as a way to establish information regarding mental health disorders by the American Psychological Association.

It was after the second world war, that the US Army began to develop a system to better describe and record mental disorders that were observed in the general population as well as in the military population as a result of war. 

It was also during the same time that the World Health Organisation (WHO) included a separate section on mental disorders in its International Classification of Diseases and Related Health Problems (ICD)- tus recognising Mental disorders as clinical conditions for the first time. 

However, the APA believed that there was a need for a universally recognized mental disorder manual or a classification system for mental disorders. Thus efforts were made, pioneered by the APA to develop the DSM. 

The timeline of the different versions of the DSM are as follows:

VersionYear
DSM-I1952
DSM-II1980
DSM-III1987
DSM-IV1994
DSM-IV-TR2000
DSM-52013

What are the new Changes in the DSM-5?

The DSM-5 published in the year 2013, contains a number of significant changes. These changes include:

  • The change from Roman numerals to Arabic numbers in the name of the manual the earlier editions of the DSM such as DSM-IV and DSM-IV-TR.7 
  • The DSM-5 also eliminated the use of the multiaxial system and instead uses lists to categorise disorders along with a number of different related disorders. 

For example, DSM-5 categories in the form of chapters include anxiety disorders, bipolar and related disorders, depressive disorders, feeding and eating disorders, obsessive-compulsive and related disorders, and personality disorders. Each chapter is further broken down into specific disorders. 

  • Asperger’s Syndrome was eliminated and replaced as well as incorporated under the category of autism spectrum disorder.
  • Disruptive mood dysregulation disorder as an effort to reduce the overdiagnosis of childhood bipolar disorders.
  • Several new diagnoses were officially recognised as a mental disorder and added to the manual. These new disorders include: binge eating disorder, hoarding disorder, and premenstrual dysphoric disorder (PMDD).
  • The DSM-5 which is the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), added two specifiers to further classify diagnoses. 
  • Depression with mixed features- where manic symptoms are also present without meeting the full criteria of a manic episode.
  • Depression with anxious distress where there is a presence of anxiety that affects prognosis, treatment, and outcomes of treatment.

Who Uses the DSM-5?

The DSM-5 and all other editions of the DSM is a tool or resource that has been and is being used by many different mental health professionals and researchers.

The manual is most often used by psychiatrists, clinical psychologists, social workers, and licensed professional counsellors for the diagnosis of mental disorders. 

It has to be mentioned that only professionals who have received specialised training and possess sufficient experience are qualified to diagnose and treat mental illnesses.

In some cases, Medical doctors and nurses who often come across mental health patients also use the manual for their practice and knowledge. 

DSM-5 is also often used for research purposes or for the formulation of diagnostic assessment tools and scales by developments and researchers for the diagnosis of mental disorders. 

In most cases the items of assessment tools such as interview structure, questions, questionnaire, and scales often contain information related to the DSM criterias for diagnosis. 

The Types of Mental Disorders the DSM-5 Covers

The DSM-5 consists and has categorised hundreds of mental disorders and each disorder has a code that matches the International Classification of Diseases, 9th edition.

The mental disorders that are part of the DSM-r diagnoses include:

  • Neurodevelopmental Disorders
  • Schizophrenia Spectrum and Other Psychotic Disorders
  • Bipolar and Related Disorders
  • Depressive Disorders
  • Anxiety Disorders
  • Obsessive-Compulsive and Related Disorders
  • Trauma- and Stressor-Related Disorders
  • Dissociative Disorders
  • Somatic Symptoms and Related Disorders
  • Feeding and Eating Disorders
  • Elimination Disorders
  • Sleep-Wake Disorders
  • Sexual Dysfunctions
  • Gender Dysphoria
  • Disruptive, Impulse Control, and Conduct Disorders
  • Substance-Related and Addictive Disorders
  • Neurocognitive Disorders
  • Personality Disorders
  • Paraphilic Disorders
  • Other Disorders

The mental disorders are presented in the form of chapters and each chapter or heading is then broken down into sub-chapters of mental health disorders and conditions that fall underneath it.

For example, there are seven conditions that fall under the heading “Neurodevelopmental Disorders”:

  • Intellectual disabilities
  • Communication disorders
  • Autism spectrum disorders
  • Attention deficit hyperactivity disorder
  • Specific learning disorder
  • Motor disorders
  • Other neurodevelopmental disorders

The chapters provide specific information related to each of the mental disorders that fall under the same category of the main chapter. 

The subchapters are further divided or further listed out into more specific mental conditions where the conditions that are more likely to affect children are described first.

For example, the “Intellectual disabilities” category lists the following conditions:

  • Intellectual disability (intellectual developmental disorder)
  • Global developmental delay
  • Unspecified intellectual disability

How Is the DSM-5 Used to Help Diagnose a Mental Disorder?

The DSM -5 provides a list of criterias that must be met for an individual or a patient to be diagnosed with a mental disorder. 

These criterias consist of common behavioural, cognitive, and social symptoms that play a role in the overall dysfunction caused by the mental disorder. 

The Criterias must be observed within the individual by a professional or the individual must be assessed with an assessment tool that has been developed based on the DSM-5 criteria for the individual to be diagnosed. 

For example,

For a diagnosis of “major depressive disorder” , the following criteria must be met:

Five or more of the following symptoms during the same two-week period, with at least one of the symptoms being depressed mood or loss of interest or pleasure:

  • Depressed mood most of the day
  • Significantly decreased interest or pleasure in activities
  • Major change in weight
  • Insomnia or hypersomnia
  • Restlessness or significant decrease in normal activity levels
  • Feeling exhausted or having a loss of energy
  • Feelings of worthlessness or extreme guilt
  • Difficulty thinking, concentrating, or making decisions
  • Frequent thoughts of death

The DMS-r also provides information related to the disorder such as:

  • Factors that can increase a person’s risk of having a mental disorder
  • The impact of Culture and gender in mental health disorders.
  • Comorbidity rates
  • Differential diagnosis which helps professionals differentiate between probability of one disease versus that of other diseases with similar symptoms

These aspects of the DSM-5 help professionals make a diagnosis as well as develop treatments for the intervention and care of the individual patients. 

Criticisms of the DSM-5

The latest version of the DSM-5 was published in the year 2013 and a supplement to the DSM-5 was later published in 2018. 

Updates of the latest version of the DSM-5 are also provided on the APA website in real time. However the DSM-5 was met with some controversy.

One of the major push backs that the DSM5 received ws around the validity of the manual. In response to this criticism, the National Institute of Mental Health (NIMH) established the Research Domain Criteria (RDoC) project.

The goal of this project is to incorporate biological sciences such as genetics research,  brain imaging, cognitive science, and information that will present as the foundation of diagnosis going forward. 

The DSM-5 and the RDoC is considered to be complementary to each other for the classification and treatment of mental disorders and provides some of the best information that is currently available as of recent years. 

Conclusion

In this blog we presented you a complete guide into the DSM-5.

We also briefly discussed what theDiagnostic and Statistical Manual (DSM) is, its history, changes, use and development, and how it is used in clinical practice. 

FAQ related to the DSM5

Can you read DSM-5 online?

Yes. The DSM-V Online (Diagnostic and Statistical Manual of Mental Disorders, 5th edition; American Psychiatric Association) is available on the internet for free and updates of the DSM-5 can be accessed from the APA website. 

Is the DSM available to the public?

Yes the DSM can be accessed by the public. However, It has to be mentioned that only professionals who have received specialised training and possess sufficient experience are qualified to diagnose and treat mental illnesses.

What is the current DSM edition?

As of when this blog was written the latest version is the DSM-5 but it has been speculated that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) DSM-5-TR will be published in March 2022.

References

Bailey.A.An Overview of the DSM-5. Verywellhealth. Retrieved on 15th March 2022. https://www.verywellhealth.com/an-overview-of-the-dsm-5-5197607 

Cherry.K. Diagnostic and Statistical Manual (DSM) Overview. Verywellmind. Retrieved on 15th March 2022. https://www.verywellmind.com/the-diagnostic-and-statistical-manual-dsm-2795758

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