DSM is short for The American Psychiatric Association's, Diagnostic & Statistical Manual of Mental Disorders
and is general referred to simply as "the DSM."
Most licensed or trained mental health professionals are familiar with it.
If you see a mental health professional, there is a chance that you may be diagnosed with a mental illness. You
should ask the professional you see whether they plan to diagnose you and what they plan to do with the
information. There are a number of reasons why you should make this your business.
Mental health professionals themselves have a wide range of complaints and concerns about the use of the
DSM. In fact, these complaints and concerns are so numerous that it may be difficult to list them all here. Many
of the complaints and concerns, however, are unfounded, and this will be discussed on this page as well.
Founded or unfounded, these are some of the complaints and concerns about mental health
diagnosis and the use of the DSM:
The upside to the use of the DSM for diagnosis:
and is general referred to simply as "the DSM."
Most licensed or trained mental health professionals are familiar with it.
If you see a mental health professional, there is a chance that you may be diagnosed with a mental illness. You
should ask the professional you see whether they plan to diagnose you and what they plan to do with the
information. There are a number of reasons why you should make this your business.
Mental health professionals themselves have a wide range of complaints and concerns about the use of the
DSM. In fact, these complaints and concerns are so numerous that it may be difficult to list them all here. Many
of the complaints and concerns, however, are unfounded, and this will be discussed on this page as well.
Founded or unfounded, these are some of the complaints and concerns about mental health
diagnosis and the use of the DSM:
 | Labeling: Many people find the use of psychiatric labels dehumanizing and stigmatizing. | |
| Stigma: In certain circles, presumptions are made about people with diagnosed "mental disorders." | |
| Presumptions: Many professionals become over-reliant on the DSM and presume that people with | |
| unusual lifestyles, certain difficulties, or certain ways of coping, are mentally "disordered," which all too frequently translates into ideas of mental "illness." Rarely does anyone ask, "Who wrote this book anyway, and what is the quality of science to back it up?" | ||
| The Medicalization of Life Problems: Not everyone who has a problem or seeks help is "ill." Seeing | |
| difficulties in living as an "illness" suggests that difficulties in living should be treated with medication rather than other modalities such as talk therapy. Medications and the pharmaceutical industry will be discussed on another page. | ||
| Over-generalizations: Even if someone's condition can be found in the DSM and named, not | |
| everyone's conditions can be found in there. Again, the individual stands to get lost due to the statistical aspect of the DSM. Statistics may help us understand general trends, but they do not help us much with unique and complex individuals. It is easy for the diagnostician to forget this and to use the DSM like a cook-book. | ||
| Cook-book Mental Health Services: It is not uncommon for those who provide mental health services | |
| to diagnose every single person who walks through their door with some sort of mental disorder out of the DSM. Among other possible reasons for this is the fact that most insurance companies will not pay for therapy unless it is "medically necessary," and again, we see the medicalization of life problems. Therapists and other mental health professionals want their paychecks as do hospitals and mental health centers. Rarely do mental health professionals fail to diagnose something. Rarely does the client hear," I don't think I have a diagnosis for you." | ||
| Better Services: Services could be better provided if the practitioner simply listened closely to the | |
| complaints and concerns of the people who come to them for help, rather than risk bias based on DSM diagnoses. | ||
| Communication Among Professionals: Again, we look at presumptions. Mental health practitioners | |
| are busy people. When there is communication among them, often the time saver is to report a diagnosis. Unfortunately, one depressed person is not like another, and much gets lost in translation. |
The upside to the use of the DSM for diagnosis:
 | Categorization: Although it is not always useful, categorization can be very helpful when we are trying to | |
| understand the differences between one thing and another. To the extent that psychiatry uses scientific method to understand these distinctions, it is no different than the other sciences, such as physics, biology & chemistry. | ||
| Limits of Categorization: The DSM is clear that not all aberrant behavior is to be classified as a mental | |
| disorder. In order to be diagnosed with a mental disorder, not only does an individual need to meet certain criteria, but the individual needs to show a clear disruption in their usual level of functioning, and/or experience significant subjective distress about their feelings, thoughts or behaviors. If an individual shows no disruption in their usual level of functioning and is not experiencing distress, in most cases, no diagnosis is given. Too, the most recent DSM's have included dimensional factors which take into consideration the duration of the disturbance, age of on-set, persistence and severity of the symptoms and so on. | ||
| Cultural Factors: The DSM is aware of cultural factors and does not diagnose people with mental | |
| disorders simply because their ways are different from the dominant culture. Where there are differences between cultures or among sub-cultures, we enter the realm of sociology and may discuss the relative merits of cultures in a sociological context. Nevertheless, people from other cultures can be diagnosed, with the same precautions, if their symptoms are clearly out of line with the culture to which they identify. The DSM includes a number of examples of aberrant behavior in various other cultures which may or may not constitute mental disorders in those cultures. | ||
| On-Going Study: The DSM is well aware that its various categories are not all-inclusive. Each new | |
| edition of the DSM outlines a set of categories that warrant further study. Sometimes, these are disorders that are on their way to inclusion in the DSM and some of these disorders have been excluded from the most recent editions but are still considered to have merit in using the DSM's categorical system. | ||
| Striving to Get the Full Picture: The DSM recommends the use of a "multi-axial" format in diagnosis | |
| toward understanding as fully and accurately, the full picture of the individual. Generally, there are five axes which include, in order; |
- 1) Clinical Disorders or Other Disorders That May Be a Focus of Clinical Attention
2) Personality Disorders or Mental Retardation (generally, more persistent conditions)
3) General Medical Conditions (physical problems or conditions to be factored in)
4) Psychosocial and Environmental Problems (often, life stressors)
5) Global Assessment of Functioning (an overall rating of functioning)
- Toward this, the DSM encourages diagnosticians to use a different diagnostic system if it facilitates
competent and ethical practice, is the diagnostician's preference, or better serves the client or patient.
Too, regardless of the general diagnostic format, the diagnostition is encouraged by the DSM to include
any information which will facilitate the accurate understanding of the person and convey this information
as fully and accurately as possible to any other professionals who may be involved in the patient's
treatment.
| Knowledge of Its Own General Limitations: Although the DSM does not outline all of its own | |
| limitations, it is quite straight-forward about its limitations in general. These limitations are acknowledged early in the text and for a perceptive clinician, these reminders are evident throughout the book. | ||
| Cautions Issued to Clinicians: The DSM actively cautions clinicians to be aware of its limitations and to | |
| use the DSM responsibly. Clinicians are advised to make use of their own training, experience, and clinical judgement in making diagnoses and to not rely upon the DSM alone or to use it in a cook-book fashion. This is consistent with the ethical standards of most mental health professionals. Mental health professionals are encouraged to do their best to make sure their assessments and other professional work is not misunderstood or misinterpreted. For this and other reasons, non-professionals are discouraged from using the DSM. |
Insurance: If you have
not already done so, you
may wish to read the
page on this site which
provides information
about the use of
insurance. Most
insurance companies
and HMO's require a
DSM diagnosis in order
for you or your therapist
to receive reimbursement
for the services provided
and some diagnoses may
not be covered by your
policy. Many insurance
companies are now
requiring people to have
serious diagnoses in
order to qualify for use of
your benefits. Other
modes of diagnosis such
as those which may be
less stigmatizing are
generally not accepted.
This may be problematic
for you and you may
want to thoughtfully and
thoroughly discuss this
matter with your therapist
prior to treatment
not already done so, you
may wish to read the
page on this site which
provides information
about the use of
insurance. Most
insurance companies
and HMO's require a
DSM diagnosis in order
for you or your therapist
to receive reimbursement
for the services provided
and some diagnoses may
not be covered by your
policy. Many insurance
companies are now
requiring people to have
serious diagnoses in
order to qualify for use of
your benefits. Other
modes of diagnosis such
as those which may be
less stigmatizing are
generally not accepted.
This may be problematic
for you and you may
want to thoughtfully and
thoroughly discuss this
matter with your therapist
prior to treatment
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| Psychiatric Diagnosis & the Diagnostic and Statistical Manual of Mental Disorders (DSM): What You Should Know and Why |
| Christian Wolff, Psy.A., Licensed Psychologist Associate • Psychotherapist & Counselor 820 NW 21st Avenue, Suite B. Portland.Oregon. 97209. 503.381.2032. christian@christianwolff.com |
Editions of the DSM:
DSM-I: 1952.
DSM-II: 1968
DSM III: 1980
DSM III-R (Revised): 1987
DSM IV: 1994
DSM IV-TR (Text DSM V:
In Progress
DSM V is expected to be
published sometime in
2012 or 2013. It is
immersed in controversy.
The lead authors of the
previous versions are
critical of the current
authors and have publicly
accused them of poor
methodology and of taking
money from the
pharmaceutical industry.
They have suggested that
with the addition of many
new psychiatric diagnoses,
pills will be created and
sold by the millions for
every little problem and
that along the way,
perfectly healthy people
will be considered mentally
ill.
The current authors have
snapped back suggesting
that the former lead
authors simply do not want
to give up the profits they
are making from the sales
of dozens of items related
to the DSM IV and IV-TR.
DSM-I: 1952.
DSM-II: 1968
DSM III: 1980
DSM III-R (Revised): 1987
DSM IV: 1994
DSM IV-TR (Text DSM V:
In Progress
DSM V is expected to be
published sometime in
2012 or 2013. It is
immersed in controversy.
The lead authors of the
previous versions are
critical of the current
authors and have publicly
accused them of poor
methodology and of taking
money from the
pharmaceutical industry.
They have suggested that
with the addition of many
new psychiatric diagnoses,
pills will be created and
sold by the millions for
every little problem and
that along the way,
perfectly healthy people
will be considered mentally
ill.
The current authors have
snapped back suggesting
that the former lead
authors simply do not want
to give up the profits they
are making from the sales
of dozens of items related
to the DSM IV and IV-TR.
| DSM & Diagnosis: The Good, The Bad, and The Ugly: Things That You Should Know |