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What is the DSM-IV?

Now that you have an assessment, you should have a diagnosis.  For your information, the DSM-IV is the basis of that diagnosis, so we have attempted to help you understand its importance.

Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition.  Better known as the DSM-IV, the manual is published by the American Psychiatric Association and is the standard classification of mental health issues (disorders) for both children and adults.  It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches.

Mental health professionals use this manual when working with patients in order to better understand their illness and potential treatment and to help 3rd parties (e.g., insurance) understand the needs of the patient.  The book is typically considered the ‘bible’ for any professional who makes psychiatric diagnoses in Canada, the United States and many other countries.

The DSM uses a multiaxial or multidimensional approach to diagnosing because rarely do other factors in a person’s life not impact their mental health.  It assesses five dimensions as described below:

Axis I: Clinical Disorders

  • This is what we typically think of as the diagnosis (e.g., depression, schizophrenia, social phobia).  These are conditions that need clinical attention.

Axis II: Personality Disorders and Mental Retardation

  • Mental retardation and developmental disorders (e.g. autism) which are typically first evident in childhood.
  • Personality disorders are clinical syndromes which have more long lasting symptoms and encompass the individual’s way of interacting with the world (e.g. Paranoid, Antisocial, and Borderline Personality Disorders).

Axis III: General Medical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders.

  • Physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness are included here.

Axis IV: Psychosocial and Environmental Problems

  • Events in a person’s life, such as death of a loved one, starting a new job, college, unemployment, and even marriage can impact the disorders listed in Axis I and II.  These events are both listed and rated for this axis.

Axis V: Global Assessment of Functioning Scale

  • On the final axis, the clinician rates the person’s level of functioning both at the present time and the highest level within the previous year.  This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected.

The DSM-IV has been designed for use across settings– inpatient, outpatient, private practice and with community populations and by psychiatrists, psychologists, social workers, nurses, occupational and rehabilitation therapists, counsellors, and other health and mental health professionals.  The DSM consists of three major components: the diagnostic classification, the diagnostic criteria sets, and the descriptive text.

The diagnostic classification is the list of the mental disorders that are officially part of the DSM system. “Making a DSM diagnosis” consists of selecting those disorders from the classification that best reflect the signs and symptoms that are afflicting the individual being evaluated.  Associated with each diagnostic label is a diagnostic code, which is typically used by institutions and agencies for data collection and billing purposes.  These diagnostic codes are derived from the coding system used by all health care professionals.

For each disorder included in the DSM, a set of diagnostic criteria indicates what symptoms must be present (and for how long) in order to qualify for a diagnosis (called inclusion criteria).  It also includes those symptoms that must not be present (called exclusion criteria) in order for an individual to qualify for a particular diagnosis.  The use of these criteria has been shown to increase diagnostic reliability (i.e., likelihood that different users will assign the same diagnosis).

Finally, the third component of the DSM is the descriptive text that accompanies each disorder.  The text of DSM-IV  describes each disorder under the following headings: “Diagnostic Features”; “Subtypes and/or Specifiers”; “Recording Procedures”; “Associated Features and Disorders”; “Specific Culture, Age, and Gender Features”; “Prevalence”; “Course”; “Familial Pattern”; and “Differential Diagnosis.”

The last major revision was published in 1994, although a “text revision” was produced in 2000 (the DSM-IV-TR).  Changes were made to a handful of criteria sets in order to correct errors identified in DSM-IV.  The DSM-V is currently in consultation, planning and preparation, due for publication now in May 2013.

Links or Useful Resources for DSM-IV:
American Psychiatric Association - www.psych.org
Psychiatry Online - www.psychiatryonline.com
All Psych Online – www.allpsych.com