Holy Book of the Psychiatric World

Opinion2.jpgThe Diagnostic and Statistical Manual of Mental Disorders, DSM, includes descriptions and classifications of most mental disorders. Published by the American Psychiatric Association, the DSM is widely used by mental health specialists to aid them in the diagnosis of a mental disorder. DSM-IV is the fourth edition of this manual which is the product of consistent and careful revisions of the previous versions.

Some say, that due to the involvement of the psychiatrists in the writing of this manual, it reflects a medical model approach to the diagnosis and treatment of mental disorders. Categorical systems such as this are based on the analysis of behavioral symptoms that currently exist or, on the history of the symptoms. By using these as a criterion, patients can be placed into their respective diagnosis. In some ways, this system acts beneficial, but it can also be a drawback to the patient.

The DSM was born to bring about uniformity among mental health professionals when diagnosing a disorder. The need for constancy gave rise to the criteria and classification system of the DSM. An advantage to the classification system used in the DSM-IV is that of reliability. That is, this method of classification facilitates communication by providing consistent and common language for psychologists and other health professionals alike, when diagnosing patients. By using clear, set guidelines, health professionals around the world can ensure, using the same factors, to determine if someone meets a particular diagnosis. As this system focuses on objective symptoms, it steers clear of personal opinions and cultural differences between clinicians and therefore reliability is maintained.

The DSM uses a multiaxial method to diagnosing mental disorders. This is great as it recognizes that a person’s mental health is influenced by lots of other factors. The five axes of DSM-IV classification are:

  • Axis I — clinical syndromes
  • Axis II — personality disorders and mental retardation
  • Axis III — general medical conditions
  • Axis IV — psychosocial and environmental problems
  • Axis V — global assessment of functioning

The multidimensional disposition of DSM-IV encompasses a range of biopsychosocial indicators for which it is used and liked by many. In today’s world, most mental health specialists believe that it is essential to integrate and understand the biopsychosocial parameters when assessing and diagnosing mental disorders. Even though the DSM-IV does not place equal emphasis on the different factors, it nevertheless presents the various factors from which the clients and consultant can operate from.

Another advantage with this system is especially beneficial to the patient. It provides technical information such as the description of symptoms and it also gives information about the prevalence, course, cultural, age, gender and family patterns. These might eliminate uncertainty felt by an individual as they understand that they are not alone. Although the DSM does not discuss the causes of the disorders, it offers information perhaps as to which of their symptoms lead to the diagnosis of a particular disorder. A person might feel better having diagnosed with a specific disorder, rather than to live with a mixture of meaningless symptoms. Pooling of these symptoms and conferring an appellation to it may result in a reduction in stress and fear of the unknown. And even though the DSM does not directly address treatment options, the APA has been publishing treatment guidelines using the DSM criteria. Consequently, understanding the diagnosis permits one to obtain and use other information about treatment and prognosis.

However, as with most things with life, there is another side to this coin. As wonderful as it may be to categorize a person with a disorder, it is also possible that at that very moment, that person loses his individuality and becomes a representation of that disorder and a mere statistical figure. When one gets labeled with a certain disorder, the stigma and the presumption by others that the patient conforms to a stereotypical behavioral pattern of that disorder can work against the one suffering from it. Also, because this system is categorical, it does not give way for dimensions of a disorder. So one either has or not has a disorder. As there is no continuum, some people who are on the less severe end of the disorder may still be given the label of having that disorder and may feel abnormal and more disparate from the society than they truly are.

Another disadvantage is to do with this model being a medical model. Hence treatment is inclined towards medical interventions. Every type of “abnormal” behavior is seen as a symptom and the core purpose comes solely down to eradicating or alleviating these symptoms. The focus is mainly on medications rather than psychosocial, rehabilitation or healing therapies. A huge concern with this is that medications, and other medical interventions may be over emphasized and this in turn diminishes the need for therapy.

On the whole, the DSM provides plenty of information to guide the classification and diagnosis of mental disorders. It offers us with a mutual ground when discussing diagnoses and also facilitates communication & treatment.

Nevertheless, the DSM needs to develop into a more amicable resource that aims to reduce the stigmatization of mental disorders. Pinning of a label from DSM to a person leads to grave consequences. Hopefully, there will be a day where being diagnosed with autism or schizophrenia will hold similar implications as being diagnosed with cancer or pneumonia. Hope that day arrives soon.