DSM IV PSYCHOLOGICAL DISORDERS
DSM IV is the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. It is also known as DSM-IV-TR. It is a manual published by the American Psychiatric Association (APA) that includes all currently recognized mental health disorders. It is used in the United States and in varying countries around the world. It is used by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, phameceutical companies, and policy makers. There have been five revisions since it was first published in 1952. It gradually included more mental disorders although some have been removed and are no longer considered to be mental disorders, most notably homosexuality. The manual was first used for collecting census and psychiatric hospital statistics, and from a manual developed by the US ARMY and was dramatically changed in 1980. The last major edition was the fourth edition (DSM-IV) and was published in 1994. DSM uses a coding system. The coding system is designed to correspond with codes from the International Classification of Diseases, commonly referred to as the ICD. However, the ICD and DSM are not the same. Early versions of the DSM did not correlate with ICD codes and updates. The DSM has attracted controversy and criticism as well as praise. Some critics argue that the DSM represents an unscientific system that tells the opinions of a few powerful psychiatrists. One man, Willliam Glasser, an America Psychiatrist born in Clevland Ohio, refers to the DSM as “phony diagnostic categories”, arguing that “it was developed to help psychiatrists make money. The history behind the DSM-IV starts in 1994. It was published with 297 disorders in 886 pages. The task force was lead by Allen Frances. The makers were comprised of a 27 person commitee including four psychologists. The committe created 13 groups of 5-16 members. Each work group has approximately 20 advisors. The work groups would conduct a three-step proccess. First, each group conducted an extensice literature review of their diagnosis. The they would request data for researchers, conducting analysis to determine which criteria required change, with instructions to be conservative. Fianlly, they conducted multicenter field trials relating diagnoses to clinical pracitce. The biggest change from the previous versions was the inclusion of a clinical significance criterion to almost half of all the categories, which required symptoms cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning.” Let us dive into some of the uses of the DSM. Many mental health professionals use the manual to determine and help communicate a patient's diagnosis after an evaluation; hospitals, clinics, and insurance companies in the US also generally require what the call a “five axis” DSM diagnosis of all the patients treated. The DSM can be used clinically in this way, and al to categorize patients using diagnostic criteria for research purposes. Studies done on specific disorders often recruit patients whose symptoms match the criteria listed in the DSM for that disorder. The DSM-IV is a categorical classification system. The categories are protoypes, and a patient with a close approximation to the prototype is said to have that disorder. The DSM-IV states, “there is no assumption. Each category of mental disorder is a completely discrete entity with absolute boundries.” Qualifiers are sometimes used, for example, mild, moderate or severe forms of a disorder. For nearly half the disorders, symptoms must be sufficient to cause clinically significant distress or impairment in social occupational, or other important areas of functioning. Each category of disorder has a numeric code taken from the ICD coding system used for health service administrative purposes. The DSM-IV organizes each psychiatric diagnosis into five dimensions (axis) relating to different...
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