DSM 5 (An 11 point overview)

In this brief guide DSM will be introduced, changes made in the different editions and how the DSM 5 is different from the previous versions and ICD.

There are two main classifications of disorders that are used worldwide by mental health professionals. The one developed by world health organization (WHO) is the International Classification of Diseases (ICD) and the other one is the Diagnostic and Statistical Manual of Mental Disorders (DSM), which covers all the mental disorders, is developed by the American Psychiatric Association (APA).

Different Version of DSM

For clinical diagnosis, all the mental disorders are classified into DSM including children and adult disorders. The Diagnostic Statistical Manual of Mental Disorders lists the causes of the disorders as well such as gender, prognosis, and age at onset. It has various advantages in the research area as well and is considered more accurate. It has been frequently revised and the recent and fifth publication of the Diagnostic Statistical Manual of Mental Disorders (DSM 5) was in 2013. The historical background of DSM goes back to 1952 when the US military acknowledged the need to classify mental disorders. Initially, it was not considered as a useful guide but in 1980, Robert Spitzer revised it for the third time (DSM-III) which was then considered important to use DSM in research.

Changes in different versions of DSM

DSM-I

Categories:

It contained 128 categories.

Publication date:

It was published in 1952 and was published as smallish (132 pages) book.

Number of pages:

The number of pages was 132.

Number of diagnosis:

The number of diagnoses were 128

Order:

DSM-I had a well-ordered system in which the early node in the hierarchy was having a difference between organic brain syndromes from “functional” disorders.

Focus:

DSM-I had focus on inpatient psychiatry.

It mainly focused on organic and psychotic disorders.

DSM-II

Categories:

DSM-II had 193 diagnostic categories.

Publication date:

It was published in 1968

Number of pages:

DSM-II consisting of 119 pages had a hierarchical organization.

Anxiety disorders, depressive disorders, personality disorders, and disorders of childhood/adolescence were larger subclasses than they had in DSM-I.

Number of diagnosis:

The number of diagnoses were 193.

DSM-III

Categories:

The DSM-III contained diagnostic criteria to specify the sense of the categories. For each category, there was an explanation of the classic demographic profile of patients experiencing this disorder. Categories of mental disorders in the DSM-III  was 228 (163 categories defined using diagnostic criteria).

System: Another innovation to the DSM-III was a multiaxial system.

Size:

Size was much larger than either the DSM-I or DSM-II

Publication date:

It was published in 1980.

Number of pages: Number of pages were 494.

Number of diagnosis:

The number of diagnoses were 228

DSM-III-R

DSM-III starting working on a revised version of the DSM-III called the DSM-III-R, which was planned to correct the diagnostic criteria.

Categories:

The DSM-III-R contained new diagnostic groups that had not appeared in the DSM-III.

Classification:

Structurally was in terms of its multiaxial system and in terms of its specifics, the classification system changed significantly. “Inhalant Abuse,” “Inhalant dependence,” and “Inhalant addiction” were added to the DSM-III-R. “Schizoid disorder of childhood or adolescence” dropped.

Publication date:

It was published in 1987.

Number of pages:

Number of pages were 567.

Number of diagnosis:

The number of diagnosis were 253.

DSM-IV

Categories:

The DSM-IV contained 383 categories. From which 201 diagnostic categories were defined using diagnostic criteria.

Publication date:

It was published in 1994.

Number of pages: Number of pages were 886.

Number of diagnosis:

The number of diagnoses were 383.

DSM-IV-TR

Publication date:

It was published in 2000.

Number of pages:

Number of pages were 943.

Number of diagnosis:

The number of diagnoses were 383.

DSM-5

Categories: In total there were 541 diagnostic categories, increase of closely 160 categories compared with DSM-IV.

Publication date:

It was published in 2013.

Number of pages:

Number of pages were 947.

Number of diagnosis:

The number of diagnoses were 541. (Roger K. Blashfield, 2014)

Diagnostic Statistical Manual of Mental Disorders 5 (DSM 5)

After the development and advancement in the mental health field, the different editions of DSM have been published by the American Psychiatric Association. Over a 12-year process, the establishment of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) was a massive undertaking that involved hundreds of people working towards a common goal. A lot of measures were taken in order to improve the clinical usefulness of the DSM 5 as a roadmap to mental disorder diagnosis. A great deal of consideration and deliberation was included in reviewing the diagnostic criteria, taking into account the structure of every component of the manual and creating new elements that were considered to be most useful to mental health professionals.

Diagnostic Statistical Manual of Mental Disorders (DSM 5) has the primary purpose to help and aid trained mental health professionals in diagnosing mental disorders in their patients. That will help them in making case formulation for each individual and subsequently informed treatment plan. The diagnostic criteria of disorders contain symptoms that are not the comprehensive definitions of underlying disorder because each disorder consists of behavioural, cognitive, physiological and emotional aspects that are too complex to be described briefly as summaries.

Sections of DSM 5

There will be three sections of the new DSM 5.

Section I give instructions on how the manual should be used. This include:

●       Orientation

●       Historical background

●       DSM 5 Development

●       How to use it

●       Dimensional assessment

●       Changes in criterions

Section II comprises of the categorical diagnosis with a new organizational structure that replaces the multi-axial framework of DSM-IV and incorporates a developmental progression and organization, life-span perspective instead

Section III includes suggestions about what conditions to be studied in further research, cultural and other contextual information and alternatives for many categories of diagnosis

●       Emerging measures and models

The section of Emerging measures and models includes techniques and tools that enhance the understanding of the cultural context of mental disorder, recognizing emerging conditions for further study and the clinical decision-making process.

●       Assessment measures

●       Cultural formulation

For effective assessment and management, it is important to understand the cultural context of the experience of illness. Culture is the combination of concepts, knowledge, practices, and rules learned and transmitted to generations to come. Language, spirituality and religion, ceremonial rituals, family structures, legal and moral systems, and customs are included in culture. Cultures are dynamic and are ever-changing. Individuals, sometimes, are exposed to a different culture that makes their identity. Due to these features, it is important not to overgeneralize cultural information in terms of fixed cultural traits.

●       Alternative Model for Personality Disorders

Inclusion of this in section III is an effort to introduce a new approach that addresses different shortcomings in the current approach to personality disorders. In this model, personality disorder is characterized by pathological traits of personality and impairments in personality functioning. These include antisocial personality disorder, narcissistic personality disorder, borderline personality disorder, schizotypal personality disorder, avoidant personality disorder, obsessive-compulsive personality disorder. Histrionic and schizoid personality disorders are excluded from this section.

Life-span Perspective: This perspective is very important for the treatment of mental disorders in childhood. The perspective acknowledges the role of development and age in the onset of mental disorder, its development, diagnosis, and treatment.

Forensic Use

DSM 5 is mainly designed for clinicians and helping them in making case formulations, treatment planning, and conducting clinical assessments. Its use is not only limited to that though, in assessing forensic consequences of mental illness for the attorneys and courts, DSM 5 is used as a reference. Hence, the definition of all the disorders that are included in DSM 5 was developed in order to meet the needs of public health professionals, research investigators, and mental health professionals and not just for the technical needs of legal professionals and courts. It is necessary to understand that the Diagnostic and statistical manual of mental disorders fifth editions does not include any treatment plans but just the classification of symptoms.

New Disorders in the Diagnostic Statistical Manual of Mental Disorders fifth edition

●       Social (Pragmatic) Communication Disorder

●       Disruptive Mood Dysregulation Disorder

●       Premenstrual Dysphoric Disorder

●       Hoarding Disorder

●       Excoriation (Skin‐Picking) Disorder

●       Disinhibited Social Engagement Disorder (split from Reactive Attachment Disorder)

●       Binge Eating Disorder

●       Central Sleep Apnea

●       Sleep-Related Hypoventilation

●       Rapid Eye Movement Sleep Behavior Disorder

●       Restless Legs Syndrome •Caffeine Withdrawal

●       Cannabis Withdrawal

●       Major Neurocognitive Disorder with Lewy Body Disease (Dementia Due to Other Medical Conditions)

●       Mild Neurocognitive Disorder

Eliminated Disorders in the DSM 5

●       Sexual Aversion Disorder

●       Polysubstance-Related Disorder

Differences in the previous versions of DSM and DSM 5

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders has been released in May 2013 at the meeting of APA. The changes and revision of DSM 5 were based on the principle that it should be feasible for clinical use as well as the research evidence should follow it back. The revised version of the Diagnostic Statistical Manual of Mental Disorders (DSM) has three sections followed by the appendix. Following are the few of the differences made in DSM 5 from the previous versions of DSM

●       Detailed and specific criteria has been made in DSM 5 to reduce the reliance on diagnosing not otherwise specified has been replaced by category of unclassified or other

●       An effort has been made in the newer version of DSM to reduce the number of categories of disorders and to do that, many disorders are combined under one diagnosis

●       All the axis has been eliminated in DSM 5. The reason to do so is that Axis was not supported by research. Now the personality disorders have a separate chapter. They no longer come under Axis II

●       There is no completely different and separate section for children, rather, all the disorders are defined further by lifespan as well. For instance, under the trauma section, PTSD has the criteria for children of 6years and younger

●       There is a whole chapter for Substance Use and in that dependence and substance abuse have been combined along with the severity modifiers

●       Other than these, DSM 5 recommends using the WHO scale of disability assessment which is made available in the section of Assessment Measures

●       In general, some of the criteria have been deleted from the DSM 5 which was present in the previous versions. For instance, in PTSD, when experiencing trauma it was necessary to feel fear, hopelessness or horror in DSM IV but it has been deleted in DSM 5 as the majority of the PTSD cases didn’t fulfil the respective criteria.

●       The Obsessive-Compulsive Disorder has its separate chapter now. Furthermore, PTSD has been separated from the Anxiety Disorders and is now under trauma-related Disorders

Differences from ICD

The ICD includes all of the health problems and diseases. For health management and treatment purposes, ICD is consulted by the health professionals. It has a section for mental disorders as well including the definitions of disorders, their criteria, and general rules.

It is different from DSM in the following ways:

●       The first and foremost difference between DSM and ICD is that the DSM includes mental disorders only, their criteria and aetiology in detail. Whereas, ICD includes all of the other health problems as well as mental disorders

●       ICD basically is developed by different medical professionals belonging to different countries around the world by WHO for the purpose of public health. DSM was developed by the US association of psychiatry for the use of psychiatrists and therapists

●       The disorders in the DSM has been covered using sixteen chapters while in ICD, there are ten chapters covering the diseases

●       ICD has given the importance and special focus on the middle and low-income countries, whereas, high-income countries are mainly focused on psychiatric care in DSM

●       With each succession, there is addition of more disorders with more details in the DSM and the major focus for ICD’s revision is to reduce the number of disorders to be mentioned

●       Diagnostic and statistical manual for mental disorders has proper operational criteria on which the therapists rely on whereas in ICD there is a description of the disorder and some guidance but it does not have criteria for disorders

Pros of DSM 5

●       Standardization of Diagnosis – it helps to ensure that patients receive appropriate and beneficial treatment irrespective of their location, social class or ability to pay. DSM 5 provides a practical assessment of the problems and helps to develop specific therapy goals and a standard of measure to assess treatment efficacy

●       Research Guidance – different groups of researchers are following the same diagnostic checklist to study the same disorder

●       Therapeutic guidance – many physicians don’t have the time to fully delve into the history and root causes of certain condition, so the DSM 5 criteria is a guide map to handle the symptoms present

Cons of DSM 5

●       Oversimplification of human behaviour

●       Misdiagnosis and over-diagnosis

●       Labelling and stigmatizing

Conclusion

Diagnostic Statistical Manual of Mental Disorders is the hard work of the American Psychological Association which contains all the categories of mental disorders, their classifications, and criteria for clinical use. The historical background of DSM goes back to 1952. The Diagnostic Statistical Manual of Mental Disorders lists the causes of the disorders as well such as gender, prognosis, and age at onset. It has various advantages in the research area as well and is considered more accurate.

Frequently Asked Questions for DSM

What does DSM mean?

DSM means the Diagnostic and Statistical Manual (DSM), DSM is a handbook for mental health practitioners for the diagnosis in the United States and other areas of the world.

What is the DSM in psychology?

DSM in psychology means Diagnostic and Statistical Manual of Mental Disorders used by mental health practitioners to diagnose the mental illness. DSM was published by the American Psychiatric Association.

How many DSM are there?

There are the number of editions in DSM. The DSM I was published in 1952, and the current version of DSM 5 was published in 2013.

What disorders are in the DSM 5?

In DSM 5 there are a number of disorders added as below:

Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder, Conduct Disorder, Disruptive Mood Dysregulation Disorder, Eating Disorders, Gender Dysphoria,

Intellectual Disability, Internet Gaming Disorder, Major Depressive Disorder and the Bereavement Exclusion, Mild Neurocognitive Disorder Obsessive-Compulsive and Related Disorders, Paraphilic Disorders, Personality Disorder, Posttraumatic Stress Disorder, Schizophrenia, Sleep-Wake Disorders, Specific Learning Disorder, Social Communication Disorder, Somatic Symptom Disorder, Substance-Related and Addictive Disorders.

Please use the comment section below if you have any questions.

References

Psychiatry Online

Mental Help

Very Well Mind

Recommended Readings

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM 5

The Pocket Guide to the DSM 5(TM) Diagnostic Exam

DSM 5® Made Easy: The Clinician’s Guide to Diagnosis

DSM 5TM Handbook of Differential Diagnosis

DSM 5 Clinical Cases

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