What Is the Diagnostic and Statistical Manual (DSM)?

The Diagnostic and Statistical Manual of Mental Disorders is used by clinicians and psychiatrists to diagnose psychiatric illnesses. In 2013, a new version known as the DSM-5 was released. The DSM is published by the American Psychiatric Association and covers all categories of mental health disorders for both adults and children. The DSM is utilized widely in the United States for psychiatric diagnosis, treatment recommendations and insurance coverage purposes.

The manual is non-theoretical and focused mostly on describing symptoms as well as statistics concerning which gender is most affected by the illness, the typical age of onset, the effects of treatment and common treatment approaches.

DSM Updates

The Diagnostic and Statistical Manual has been revised a number of times in its history.

1952: The DSM-I
1968: The DSM-II
1974: The DSM-II Reprint
1984: The DSM-III
1987: The DSM-III-R
1994: The DSM-IV
2000: The DSM-IV-TR
2013: The DSM-5

The newest version of the DSM was published in May of 2013. The revision was met with considerable discussion and some controversy.

A major issue with the DSM has been around validity. In response to this, the NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science and other levels of information to lay the foundation for a new classification system they feel will be more biologically based.

Later, NIMH director Thomas R. Insel issued a statement in conjunction with American Psychiatric Association president Jeffrey A. Lieberman noting that the DSM-5 "...represents the best information currently available for clinical diagnosis of mental disorders." The statement went on to suggest that the DSM-5 and NIMH’s own system, the Research Domain Criteria (or RDoC), represent "complimentary, not competing, frameworks" for the classification of mental disorders.

The DSM-5’s Predecessor: The DSM-IV-TR

The DSM-IV was originally published in 1994 and listed more than 250 mental disorders. An updated version, called the DSM-IV-TR, was published in 2000 and contained minor text revisions in the descriptions of each disorder. Mental health providers used the manual to better understand a client's potential needs as well as a tool for assessment and diagnosis.

The DSM-IV-TR described disorders using five different dimensions.

This multiaxial approach was intended to help clinicians and psychiatrists make comprehensive evaluations of a client's level of functioning because mental illnesses often impact many different life areas.

Axis I: Clinical Syndromes
This axis described clinical symptoms that cause significant impairment. Disorders were grouped into different categories such as mood disorders, anxiety disorders or eating disorders.
Axis II: Personality and Mental Retardation
This axis described long-term problems in functioning that were not considered discrete Axis I disorders. Personality disorders cause significant problems in how a patient relates to the world and include antisocial personality disorder and histrionic personality disorder. Mental retardation is characterized by intellectual impairment and deficits in other areas such as self-care and interpersonal skills.

Axis III: Medical Conditions
These included physical and medical conditions that influence or worsen Axis 1 and Axis II disorders. Some examples include HIV/AIDS and brain injuries.
Axis IV: Psychosocial and Environmental Problems
Any social or environmental problems that may impact Axis I or Axis II disorders were accounted for in this axis. These include such things as unemployment, relocation, divorce, or the death of a loved one.
Axis V: Global Assessment of Functioning
This axis allowed the clinician to rate the client's overall level of functioning. Based on this assessment, clinicians could better understand how the other four axes interacted and the effect on the individual's life.

Changes in the DSM-5

The DSM-5 contains a number of significant changes from the earlier DSM-IV. The most immediately obvious change is the shift from using Roman numerals to Arabic numbers.

Perhaps most notably, the DSM-5 eliminated the axis system, instead listing categories of disorders along with a number of different related disorders. Some examples of categories included in the DSM-5 include anxiety disorders, bipolar and related disorders, depressive disorders, feeding and eating disorders, obsessive-compulsive and related disorders, and personality disorders.

A few other changes in the DSM-5:

Asperger's disorder was removed and incorporated under the category of autism spectrum disorders.
Disruptive mood dysregulation disorder was added, in part to decrease over-diagnosis of childhood bipolar disorders.
Several diagnoses were officially added to the manual including binge eating disorder, hoarding disorder and premenstrual dysphoric disorder

While the DSM is an important tool, it is important to note that only those who have received specialized training and possess sufficient experience are qualified to diagnose and treat mental illnesses. The manual is important for diagnosis and treatment, but mental health professionals use the DSM to classify patients for billing purposes. Just as with other medical conditions, the government and many insurance carriers require a specific diagnosis in order to approve payment for treatment.

Learn more about some of the major changes in the DSM-5 in the following resources:

_References

_{American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.}

_{American Psychiatric Association. (2013). Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Publishing. Retrieved from http://www.dsm5.org/documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf.}

_{American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.}

_{Insel, T. (2013). Director's Blog: Transforming Diagnosis. National Institute of Mental Health. Retrieved from}_{http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml}

_{Insel, T.R., & Lieberman, J.A. (2013). DSM-5 and RDoC: Shared Interests. National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-shared-interests.shtml.}