Diagnostic criteria for mental disorders are essentially descriptions of symptoms that fall into one of four categories. The clinical usefulness of the DSM 4 is much more than a tool for making diagnoses of depression like major diosrder.
It is used by mental health professionals and physicians as a guide for communicating about mental health conditions. When two clinicians discuss a diagnosis such as "major depressive disorder, single episode, severe with psychotic features," they both have the same conceptualization of various aspects of the illness.
The DSM 4 also allows mental health professionals to reach consensus on which symptoms or groups of symptoms should define which disorders. Such decisions are based on empirical evidence research results , usually by a multidisciplinary staff of professionals. Further, the DSM 4 is used as an educational tool and a reference for conducting all types of research e.
The DSM IV is not used to categorize people , but to categorize conditions or disorders that people have. This may be a subtle distinction, but it is a very important one. We do not say that a person is cancer, or is heart disease, or is an illness. A person has an illness.
Likewise, we should not say that a person is a depressive, but that a person has clinical depression. Along the same lines, the value of diagnostic labels is often debated among mental health professionals and the general public. On the negative side, some people believe that making a diagnosis is simply the act of labeling a person. Once a person is labeled he or she may have difficulty overcoming the label, may lose hope of recovery, or may come to believe that he or she is the label.
On the positive side, some people are relieved when they finally learn that the symptoms they are experiencing have a name. This often offers a sense of hope and personal control over the illness as more can be learned about its treatment, causes, and outcome. Individuals representing different sociocultural and ethnic groups were selected to generalize the findings. Information was uncovered on the trustworthiness of each criterion for each psychiatric disorder.
According to DSM-IV , a mental disorder is a syndrome or behavioral pattern of clinical significance, that appears associated with discomfort or disability. Besides, this syndrome shouldn't merely be a culturally accepted response to a particular event for example, the death of a loved one. A mistake that society continues to make is the belief that the classification of psychiatric disorders also classifies people and not just the disorders that these people happen to have.
The manual is organized first with the instructions for use, the classification of the disorders a list of codes and categories , the description of the multi-axial system that DSM-IV operates with and the diagnostic criteria for each disorder along with a description and information on each one.
This system refers to the five axes that belong to different areas of information that can help the clinician to determine treatment and predict the results of this. The use of the axes facilitates complete evaluation of pathologies that the patient shows signs of. The five categories in this classification include:.
An example of this is expectable and culturally sanctioned trance states in religious rituals, and we suggest adding this example in parentheses.
The example in DSM-IV of death of a loved one exemplifies the difficulty in reaching a judgment about what is expectable. DSM-IV refers to behavioral, psychological or biological dysfunction. The term dysfunction can be understood in a statistical way, meaning deviance from a statistical norm Boorse, , or in an evolutionary framework, meaning deviance from functioning as selected for Wakefield, Both of these so-called naturalist approaches are controversial in various ways Bolton, One problem with the evolutionary theoretic approach to defining disorder, for example, is that it would involve speculative theoretical assumptions about what syndromes did or did not represent a failure of evolutionary selected psychological or behavioral mechanisms, which would adversely affect reliability of diagnosis.
Certainly, as other authors have also pointed out Horwitz, V et al. A key aspect of context is the developmental stage of the individual; the boundaries between function and dysfunction change over time, and might also be viewed differently by different caregivers e. This would not, however, resolve the difficulties involved in specifying appropriate use of the term. The concept that a disturbance is behavioral, psychological, or biological may be taken to imply that there are different levels or types of disturbance.
There is a growing awareness of the extent to which all behavior and psychology are dependent upon brain processes, and the extent to which brain changes have complex behavioral and psychological effects.
DSM-IV requires that deviant behavior and conflicts between the individual and society should not be regarded as disorder, unless they can be shown to be a symptom of dysfunction in the individual. This criterion is arguably not strictly necessary, in that criterion D already indicates that there is dysfunction.
Nevertheless, because of the difficulties in specifying fully appropriate use of this term, and because psychiatric diagnoses have been used for political purposes in the past and potential future misuse cannot be ruled out, we suggest, as a precaution, retaining the first part of this criterion.
First, any disorder in DSM should have diagnostic validity criterion F , on the basis of one or more key validators e. Although we conceptually require psychobiological dysfunction criterion D , in the absence of strong empirical evidence for this, other evidence of diagnostic validity is needed.
Evidence for diagnostic validity of different conditions is variable, reflecting in part the amount of research that has been done on each condition.
DSM-IV had an Appendix for disorders requiring further research, this provides a place for disorders with weaker validating evidence and may encourage such validation; we would therefore argue for retaining such an appendix in DSM-V, and possibly expanding it with poorly-validated DSM-IV categories. That is, we suggest that receipt of a DSM-V diagnosis needs to convey something important about that individual that is relevant in a treatment setting.
Diagnosis should facilitate the process of patient evaluation and treatment rather than hinder it. In this regard, it is notable that considerations of clinical utility may vary from setting to setting; DSM-V requires a balancing of such considerations, so that optimal utility is achieved across more specialized settings and primary care settings.
A large philosophical literature supports this point Fulford et al. However, we would also add that no definition of which we are aware adequately specifies precise boundaries for the concept of non-psychiatric medical disorder either.
Ongoing discussions address how best to organize the DSM classification. The issue of the value-laden nature of defining disorders has received a good deal of attention in the philosophical literature Fulford, ; Sadler, ; Bolton, We suggest acknowledging in criterion J that values inform nosological decisions and specifying that potential benefits should outweigh potential harms when considering whether to add a psychiatric disorder to, or delete a psychiatric disorder from, the nomenclature.
On the other hand, the position of the DSM process, that our classification system can improve over time as the scientific knowledge base progresses, also seems correct. The situation in psychiatry is reminiscent of some other areas of medicine, where there are also shifting boundaries between normality and abnormality, with evidence-based changes made over time. It is also redolent of many areas of biology, where there may be fuzzy boundaries between constructs e.
The approach taken here perhaps takes a middle course through some of these debates. For example, we would argue that although gaps in current science mean that a descriptivist position is important focusing on the symptoms and course of a disorder, rather than merely on its underlying mechanisms , current understandings of psychobiology may usefully inform certain nosological decisions.
Disorders cannot be perfectly defined in necessary and sufficient terms, and there are likely to be particularly robust disagreements about more atypical categories.
National Center for Biotechnology Information , U. Psychol Med. Author manuscript; available in PMC Nov 1. Dan J. Stein , Katharine A. Phillips , Derek Bolton , K. M Fulford , John Z. Sadler , and Kenneth S. Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Psychol Med.
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