Curious Thinker Psychology

A Psychiatric Guide

The Diagnostic and Statistic Manual of Mental Disorders (DSM) is a guidebook published by the American Psychiatric Association (known as “the other APA,” to distinguish it from the American Psychological Association) to provide standardized criteria for diagnosing mental disorders. This helps mental health professionals by providing a common language to communicate with, and is especially useful when referring a patient to another professional.

It is important to note that while the DSM provides descriptive text on mental disorders for professionals, it is not the final word on diagnostic definitions. The American Psychiatric Association describes the manual as only a convenient shorthand meant for easy communication of mental conditions.

With that said, let’s take a look at the history behind the manual and a little bit about how it’s categorized.

Why the DSM?

Throughout history, there has always been a need for a standard, medical classification of mental disorders. Referring to people as either sane or insane simply wasn’t sufficient. Several attempts were made at such classification and after years of revision, we finally have that classification.

The first attempt at gathering statistical data regarding mental health was during the 1840 census, when the frequency of “Idiocy/Insanity” was recorded. By the next census in 1880, seven categories of mental health had been established some of which were dementia, epilepsy, and mania. By 1917, a group now known as the American Psychiatric Association had developed a statistical manual detailing 22 diagnoses for mental health hospitals.

By the end of World War II, the first DSM had been established. Over the next forty years, it underwent major revisions in diagnostic criteria. The latest version is the DSM-IV, originally published in 1994. A more recent version, DSM-IV-TR, was published in 2000; however, the primary goal of the text revision was to update descriptive texts and correct various errors.

The Five Axes

The plural of axis, that is! The DSM has five axes of diagnostic categorization:

• Axis 1) Clinical disorders or all diagnoses that aren’t personality or developmental disorders. For example: Depression, Obsessive-Compulsive Disorder, Social Phobia. These tend to require immediate care, although some cases may be mild.
• Axis 2) Personality and developmental disorders, such as autism or borderline personality disorder. This axis is quite similar to the first one, except the symptoms are longer lasting and is more concerned with how an individual interacts with the world. These may or may not require immediate attention depending on the severity of symptoms.
• Axis 3) Physical condition/disorders. Sometimes it is possible that mental health issues are being caused by general medical problems such as brain injury, diabetes or HIV/AIDS.
• Axis 4) Environmental dynamics. Events and lifestyles such as starting/losing a job, poverty, and dysfunctional families can have significant impact on a person’s ability to function normally, or exacerbate existing Axis 1 conditions. Events such as these are listed and rated under this axis.
• Axis 5) Global Assessment of Functioning Scale. This axis is a rating system used by clinicians to examine their current and highest level of functioning within the last year. The rating goes from low scores (10: “Persistent danger of severely hurting self or others“) to middle scores (50: “Serious symptoms or impairment in social, occupational, or school functioning“) and high scores (100: “Superior functioning in a wide range of activities“). ¹

What’s in store for the future?

The latest edition, DSM-V, is just around the corner, expected to be published in 2013 — nearly twenty years since its predecessor! Many things have changed in that period, and our understanding of psychology is no exception. We’ll visit the DSM-V in a later article.

Now that you have a better understanding of the history and structure of the DSM, what are your opinions? Leave your thoughts and comments below!