What is the DSM-V? - Here On The Spectrum
August 10, 2022

The Diagnostic and Statistical Manual of Mental Disorders is a manual used by clinicians to diagnose mental health disorders. The latest version, the DSM-V, has been considered controversial because it’s more inclusive than previous versions. What are some examples of changes in diagnoses?

The “DSM-V” is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. It’s a book that has been updated to include new disorders, as well as changes in how these disorders are diagnosed. Read more in detail here: dsm meaning.

The American Psychiatric Association (APA) is the publisher of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (APA). It is the official repository for all ailments that have been classified as mental health illnesses.

The gadget contains two essential components. It includes details that are essential for diagnosing mental diseases, such as:

  • descriptions
  • symptoms
  • diagnostic standards

The second crucial element is statistics, denoted by the letter S in DSM-V. The DSM includes statistics for each mental health issue, such as:

  • usual onset age
  • the most impacted population
  • results of the therapy
  • most prevalent forms of therapy

The Development of the DSM

The DSM was first released in 1952. The DSM has undergone several updates since its beginnings as the APA and the general public’s knowledge of mental disease develops and changes. DSM-5 is the version that came after DSM-IV and was first released in 2013. (published in 1994). Using DSM-5-TR, which was released in 2022, is the most recent version to date. The distinction between the DSM-5 and Using DSM-5-TR will also be discussed in this article.

System of Criteria

The DSM follows a number of precise criteria in order to classify the mental diseases that are described. In an ideal world, mental health experts may agree on the DSM’s criteria and address and treat a variety of mental health issues with a mostly consistent rate of success. The criteria allow for the somewhat more systematic collection of public health records on the prevalence of mental Conditions.

Using the Multiaxial Diagnosis and the DSM-IV-TR

The idea of a multiaxial or multidimensional approach to diagnosis was introduced in the 2000 publication of the DSM-IV-TR. A “multiaxial” assessment system is the term used to describe the particular diagnostic method the DSM employs to pinpoint mental diseases. It was developed to assist doctors in assessing many aspects of a mental health problem, such as:

  • psychiatric influences
  • external variables
  • biological components

The multiaxial paradigm views many symptoms as possible parts of a bigger, all-encompassing picture that depicts a generalized mental disease.

The five separate pillars that make up the multiaxial system, collectively known as the “five axis,” are each used to represent a different aspect of mental diseases. These are the axes of the DSM:

  • Axis I
  • Axis II
  • Axis III
  • Axis IV
  • Axis V

Axis I, the first axis, measures all the various acute symptoms that call for rapid medical attention. The most well-known illnesses, including panic attacks and manic episodes, fall within Axis I.

Mental retardation and personality abnormalities are referred to as axis II. Intellectual impairment has taken the role of mental retardation, and it often lasts a lifetime. Neurological or physiological issues that result from psychological disorders are referred to as Axis III.

Axis V is a numerical evaluation (1-100) of a patient’s overall functional capacity, while Axis IV addresses societal causes of psychological stress, such as romantic breakup, loss of job, or unemployment.

DSM 5: What is it? A Development and Significant Changes

After some important adjustments, the DSM-5 was released. The Roman number system is the one that stands out the most. Roman numerals were used in earlier versions (DSM-IV or DSM V for example). Arabic numbers are used in lieu of Roman numerals in the new system. DSM-V was upgraded to DSM-5.

Why the change starting with the DSMV?  The change was made to create discontinuity from previous versions.  The new system illustrates a major change in diagnostic standards.  Another advantage was the ability to create infinite revisions to the DSM as often as needed.  Future versions could be ordered DSM-5.1, DSM-5.2, etc.

Categories

The earlier multiaxial arrangement was abandoned with the DSM-5. As a result of this revision, other associated diseases and categories of mental health problems were formed. These categories include, for example:

  • disorders of depression
  • worry disorders
  • PTSD and other stress-related disorders
  • problems of eating and drinking
  • personality dysfunction
  • gastrointestinal disorders
  • Paraphilic Conditions
  • Other psychotic illnesses and the schizophrenia spectrum
  • disorders connected to obsessive-compulsive behavior
  • abnormalities of the neurodevelopment
  • disorders connected to bipolar

Conditions

Under each of these headings are specific Conditions.  For example, there are nine specific Conditions that fall under the header of “worry disorders.”  These include:

  • Disorder of separation anxiety
  • specific mutism
  • particular phobia
  • disordered social anxiety (social phobia)
  • panic attack
  • agoraphobia
  • disordered anxiety generally
  • drug- or alcohol-induced anxiety disorder
  • related to another medical problem, anxiety disorder

Other significant adjustments include:

  • There is no longer a diagnosis for Asperger Syndrome. It is classified as an autistic spectrum disorder.
  • Schizophrenia subtypes were eliminated
  • Added diagnoses include hoarding disorder and binge eating disorder.

How Doctors Make Diagnoses Using the DSM 

The DSM was developed by the American Psychiatric Association as a thorough reference for doctors and other mental health specialists.

  • psychiatrists
  • psychologists
  • nurses
  • occupational therapists and physical therapists
  • Legal and forensic experts
  • the social workers

The DSM offers a set of criteria for diagnosing mental health disorders to medical practitioners. We’ll take “Insomnia Disorder” as an example. An person must exhibit one or more of the following symptoms, according to the DSM:

  • trouble falling asleep
  • Having trouble staying asleep
  • Early morning arousal with difficulty going back to sleep

The DSM goes on to specify that the sleep difficulty must be present for at least three months and occurs at least three nights per week.  Additional diagnostic standards:

  • The impairment brought on by the sleep disruption is clinically substantial.
  • It happens despite having enough time to sleep.
  • It’s not more well stated, and it doesn’t just happen when another sleep condition is present.
  • It is not brought on by concurrent medical illnesses or mental health issues.
  • It’s not brought on by any drugs or substances

Outside of the Clinical Setting, DSM Implications

Both a proper medical diagnosis and an accurate mental health diagnosis are crucial. This is particularly true when choosing the best course of therapy (and having it covered!) A diagnosis is often required by insurance companies before they would pay for therapy. For the purpose of billing, it’s crucial that physicians and other mental health specialists establish the right diagnosis.

Using DSM-5-TR

The Diagnostic and Statistical Manual of Mental Disorders issued another revision in 2022 with Using DSM-5-TR.  This update is the result of contributions made by over 200 professional experts.  Using DSM-5-TR includes:

  • updated diagnostic standards
  • with all references and content updated
  • most recent ICD-10-CM codes

Using DSM-5-TR provides a common language for clinicians to make assessments across a variety of clinical settings including:

  • Private therapy
  • principal care
  • outpatient
  • inpatient
  • consultation-liaison

Some significant changes were made with Using DSM-5-TR including the use of more specific language.  These include:

  • The phrase “intellectual disability” was dropped and “intellectual developmental disorder” was added in its stead.
  • The phrases “individually assigned male at birth” and “individually assigned female at birth” have been used in lieu of “natal male” and “natal female,” respectively.
  • No longer used are adjectives like “Caucasian,” “minority,” and “non-white.”
  • “Racialized” was used in lieu of the word “race.”

A new disorder was added, prolonged grief disorder.  This new disorder is a longer lasting and more disruptive form of grief.  Using DSM-5-TR also adds symptom codes that allow practitioners to indicate if an individual has a history or presence of:

  • Suicidal tendencies
  • self-harm that is not suicide
  • potentially harmful actions that might result in harm

These provide a means for professionals to record symptoms but are not in and of themselves mental disorders.

In all, there are updated diagnostic standards for over 70 different disorders.

Criticisms And Controversy

Many people see the DSM as an authoritative and trustworthy source on the categorization of mental diseases. Some of its critics accuse it of lacking in its standards for more truly scientific measures.

The intrinsic subjectivity of some of the DSM’s statements, which might contradict any categorical claims of validity, has often been cited as a reason why some people have expressed some degree of skepticism about it.

Organizations like the National Institutes of Health have challenged the DSM for its debatable emphasis on surface symptoms in addition to subjectivity in the definition of pathological illnesses.

Is There an Interest Conflict?

The American Psychiatric Association implemented a financial conflict disclosure standard with the publishing of the DSM-5. The task force members of the DSM who declared financial ties to pharmaceutical firms were about 70%. Only 57% of the DSM-IV task group members had connections to the pharmaceutical industry. This growth suggests that prejudice isn’t always eliminated by openness.

A 2012 paper by Lisa Cosgrove and Sheldon Krimsky explains why this is alarming. An alarmingly high proportion of work group participants having connections to the pharmaceutical industry when examining mental health issues where pharmacological therapy is the first-line intervention.

Disorders of the mood: 67% of the panel

83 percent of the panel reported having a psychotic disorder

Disorders of sleep and wakefulness: 100% of the panel

They contend that there shouldn’t be any financial conflicts of interest among the DSM task committee members. If this isn’t practicable, at the very least exclude these people from positions where decisions about changes or the inclusion of new illnesses are made.

Related Website: 2015’s Top 10 Best Online Programs for Applied Behavior Analysis

Conclusion

The Diagnostic and Statistical Manual of Mental Disorders is a valuable tool for health care providers.

The DSM has persisted in being a pillar of the psychiatric community despite the controversies it has caused. Specific symptoms with dubious etiology may be treated and decreased with a lower margin of error using the DSM’s criteria. To far, DSM publications have generated an annual profit for the APA of over $100 million.

The “DSM-V” is a diagnostic manual that was published in 2013 and has 5 categories. These are the categories for autism, anxiety, bipolar disorder, depression, and schizophrenia. Reference: what are the 5 dsm categories.

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