Diagnostic and statistical Manual of Mental Disorder (DSM), published by American Psychiatric Association, is the most comprehensive and authoritative book devoted to the standard classification of psychiatric illness used by mental health professional in the United States and other countries. It is used by clinician, insurance companies, pharmaceutical companies, policy makers and researches of many different orientations such as biological, psychodynamic, cognitive, behavioral and interpersonal. It is also designed for use across settings, inpatient, outpatient, partial hospital, clinic, private practice, and primary care, and with community population. It is also popular among psychiatrists, psychologists, social workers, nurses, occupational and rehabilitation therapists, counselors, and other health and mental health professionals.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was first published in 1952, by the American Psychiatric Association. It had 106 categories of different mental disorders. It was developed from an earlier classification system adopted in 1918 to meet the need of the federal Bureau of the Census for uniform statistics form psychiatric hospitals. The DSM-II was published in 1968. Both DSM-I and DSM-II was strongly influenced by the psychodynamic approach. There was no sharp distinction between normal and abnormal, and all disorders were considered reactions to environmental events. When the first draft of DSM-III was prepared, many new categories of disorder were introduced. As soon as the National Institute of Mental Health (NIMH) conducted the reliability of the new diagnosis, a controversy emerged regarding deletion of the concept of neurosis. In spite of all these, the DSM-III was published in 1980 listing 265 diagnostic categories. With publish of DSM-III, the psychodynamic view was abandoned and the medical models become the primary approach, introducing a clear distinction between normal and abnormal. In 1987 the DSM-III-R was published as a revision of DSM-III which contained 292 diagnoses. DSM-IV, published in 1994 was the last major revision of the DSM. It was the culmination of a six-year effort that involved over 1000 individuals and numerous professional organizations. Numerous changes were made to the classification, to the diagnostic criteria sets, and to the descriptive text based on a careful consideration of the available research about the various mental disorders. A text version of the DSM-IV called DSM-IV-TR was published in July 2000 to maintain the currency of the DSM –IV text. In addition to the correction of errors identified in DSM-IV, some of the diagnostic codes were changed to reflect updates to the ICD-90-CM coding system adopted by the US Government. The DSM-IV is scheduled for publication in 2011.
DSM-IV-TR uses a multiaxial approach to diagnosing because rarely do other factors in a person's life not impact their mental health. DSM-IV-TR is classified into five Multiaxial Classification Systems. DSM-IV-TR recommends that clinicians assess an individual's mental state according to five axes that provide a broad range of information about the individual's functioning, not just a diagnosis. The system contains the following axes.
1. Axis I: Clinical Disorders, most V-Codes, and conditions that need Clinical attention. Psychologist use Clinical Disorders to report various disorders or conditions, as well as note other conditions that may be a focus of clinical attention. Clinical disorder are identified into 14 categories, including Anxiety Disorders, Childhood Disorders, Cognitive Disorders, Dissociative Disorders, Eating Disorders, Factitious Disorders, Impulse Control Disorders, Mood Disorders, Psychotic Disorders, Sexual and Gender Identity Disorders, Sleep Disorders, Somatoform Disorders, and Substance- Related Disorders. Some examples of Clinical Disorders are Agoraphobia, Panic Attack, Obsessive-Compulsive disorders, Amnestic, Bulimia Nervosa, Pyromania, Pedophilia, Dyspareunia, Nightmare Disorder and Conversion Disorder.
2. Axis II: Personality Disorder and Mental Retardation. Personality is the qualities and traits of being of being a specific and unique individual. It is the enduring part of our thoughts, feelings, and behaviors, it is how we think, love, feel, make decisions and take actions. Individual with Personality Disorders have more difficulty in every aspect of their lives. In mental Retardation problems in brain development have usually occurred and virtually will affect all aspect of the individual's cognitive functioning. Psychologists records Personality Disorder and Mental Retardation that gives consideration to additional intervention and treatment choices. Some examples of this axis are Borderline Personality Disorder, Mental Retardation, and Schizoid Personality Disorder.
3. Axis III: General Medical Condition. It is for reporting current medical conditions that are potentially relevant to the understanding or management of the individual's mental disorder. The purpose of distinguishing General Medical Condition is to encourage thoroughness in evaluation/assessment and to enhance communication among health care providers. Some examples of Axis III are Neoplasm, Disease of the skin and Subcutaneous Tissue, Congenital Anomalies, and Poisoning.
4. Axis IV: Psychological and Environmental Problems. This Axis is for reporting psychosocial and environmental stressors that may affect the diagnoses, treatment, and prognosis of mental disorders. This Axis falls into nine categories, including primary support group, problems related access to health care services, problems related to interaction with the legal system, problems related social environment, educational problems, occupational problems, housing problems, economic problems, and other psychological and environmental and problems that are affecting an individual's ability to function in their daily activities of life
5. Axis V: Global Assessment of Functioning Scale (GAF). This Axis is for reporting the clinician's judgment of the individual's overall level of functioning and carrying out activities of daily livings which is important in planning treatment and measuring its impact, and in predicting outcome. The GAF scale is particularly useful for managed care-driven diagnostic evaluations to determine eligibility for treatment and disability benefits and to delineate the level of care required for patients.
In spite of a number of persistent critical debates concerning the DSM, the current version of DSM which is DSM-IV-TR is helping all Health Care Professionals to diagnose and explore different types of Mental Disorders. We hope that another publication of DSM which will be the DSM-V will help tp treal Mental Disorders more efficiently. Enthusiasm
Sources Used
http://psyweb.com/Mdisord/DSM_IV/jsp/dsm_iv.jsp
http://allpsych.com/disorders/dsm.html
http://www.dsmivtr.org/index.cfm
http://www.bipolarworld.net/Bipolar%20Disorder/History/hist4.htm
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