What Is The DSM And How Is It Used To Identify Disorders?
If you've ever seen a therapist or researched mental health, you might have heard of the DSM. DSM stands for the Diagnostic and Statistical Manual of Mental Disorders and is a book used by healthcare providers to diagnose and treat clients with mental illnesses using common language, just as medical physicians have common terminology for clarity in diagnosing diseases. Learning more about how the DSM works and why it is used can offer insight into how professionals may support you in a therapy or psychiatry session.
What is the DSM?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a tool mental health professionals use to diagnose and classify mental illnesses. The current definition of a mental illness by the American Psychiatric Association (APA) is "a mental health condition involving changes in emotion, thinking, or behavior (or a combination of these)." The most recent edition of the DSM covers nearly 300 mental conditions including depression, anxiety, post-traumatic stress disorder, acute stress disorder, borderline personality disorder, somatic symptom disorder, obsessive-compulsive disorder, prolonged grief disorder, neurodevelopmental disorders, and disorders caused by adverse effects of medication.
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The DSM’s development process included more than 200 researchers and clinicians, and although it has some controversy surrounding it, this tool has been used by psychologists, therapists, counselors, social workers, doctors, and psychiatrists since its publishing date in 1952 by the American Psychiatric Association. In DSM history, the APA has revised it five times; the current version is the DSM-5.
Since its inception, the goal of the DSM has been to accommodate the need for psychiatric canon and a standardized way of categorizing disorders that present symptoms in the population. With the field of psychology continually progressing, it is often revised to accommodate newly discovered mental illnesses, phasing out labels that no longer fit or changing terminology.
Though the DSM helps professionals classify mental illness, it does not offer treatment options for curious readers. Professionals use the tool only as a reference. In addition, insurance companies may require diagnostic codes for billing purposes. The DSM also provides a basis for research and treatment to further the study of psychology. This tool allows clinicians and researchers to develop new ways to combat symptoms and treat disorders.
How is the DSM organized?
The American Psychiatric Association separates the DSM into three sections:
- Diagnostic classification
- Diagnostic criteria sets
- Descriptions
Diagnostic classification
The first section of the DSM involves a complete list of all psychiatric disorders. In addition, it lists codes for health professionals to use for diagnostic and billing purposes. This section may differ from the regulations in the ICD, the International Classification of Diseases.
Diagnostic criteria sets
The second section of the DSM focuses on the methods of identifying mental illness. In this section, the clinician references how the client's presenting symptoms match the existing criteria outlined in the manual regarding behaviors, feelings, and the time the symptoms present for a diagnosis to occur. They may use the requirements to make a diagnosis of mental disorders. Some clients may have symptoms from more than one diagnosis.
Descriptions
The third section of the manual includes emerging measures and models, which go into a further description of each disorder and its subsets. It also includes information about how cultural influences or cultural differences could affect a diagnosis. The report might be used to learn more about a condition and develop a treatment plan, although the DSM does not suggest any treatments.
Who can use the DSM?
Trained professionals only use the DSM as a diagnostic tool in treating psychological disorders. While it is available to the public, professionals do not recommend its usage if you're not a professional. Someone may best make a psychiatric diagnosis with the experience and schooling to offer a correct diagnosis.
Why has the DSM been revised so often?
Due to the constant change of cultural norms and ever-evolving research, the DSM has gone through regular text revision to account for these changes and stay relevant. For example, the causes of a mental health condition may be better understood with research, and the DSM may change to reflect that cause.
Since its inception, psychology has continued to evolve. Researchers and psychologists understand that certain mental health conditions may need updating or eliminating due to the change in understanding. As the techniques for treatment have expanded over the years, so must the criteria and classification of disorders.
Examples of DSM updates may include more concise and accurate descriptions, appropriately outlining revised criteria, creating unbiased reports of the cause of the mental illness, updating risk and prognostic factors, and revising the descriptive language.
What is the DSM controversy?
Because the APA has revised the DSM many times over the years, some professionals exercise caution when using it because the limited outlines of mental illnesses may prevent the proper diagnosis of patients. Sometimes symptoms for conditions will overlap. For example, bipolar disorder and borderline personality disorder can have similar symptoms. In addition, symptoms may mask themselves as other conditions, or clients may not be upfront about all their symptoms. Diagnosis may not always be the most accurate tool for treatment. Many psychologists also work from a "treat the symptoms, not the condition" point of view. This can be problematic in the case of an axis II personality disorder, for instance, some symptoms of which can be difficult to differentiate from non-clinical personality traits or signs of other mental health conditions.
Outdated information and information based on social and cultural biases can also be harmful. Homosexuality and gender provide an example of how, if it weren't for evolving research, clients would still receive "treatment" for these identities, which are not mental illnesses. In the early years of the DSM, homosexuality was listed as a disorder without empirical evidence to determine it as such until it was removed in 1973. Another recent example is gender dysphoria, which was referred to as “gender identity disorder” from 1980 when it was added until 2013 when it was updated.
Some critics believe the DSM promotes the use of psychotropic medications as treatment for many mental illnesses for the financial gain of pharmaceutical companies. Many critics presume that the descriptions and requirements for diagnosis are deliberately broad for pharmaceutical companies to take advantage of potential patients. A few of the authors of the DSM in the past have been involved financially with these institutions, so this issue has been considered a conflict of interest in history.
Despite these controversies, the DSM remains a trusted tool for researchers and clinicians looking for updated ways to diagnose and treat illnesses. The breadth and scope of research and contributions from mental health professionals worldwide make it a resource that can offer practical guidance. However, many therapists also use the ICD manual for diagnosis, which may be the primary guide in other countries.
How do therapists make a diagnosis?
Diagnosing a mental illness can be a multi-step process. The professional psychologist or psychiatrist you meet with may evaluate your physical health, current medical condition, and any history of diseases from you or your family. For further study, they may present you with a questionnaire and ask you questions about your symptoms, background, and any thoughts you may have about your symptoms. They can then use the information gathered from this process and the DSM-5 to determine a diagnosis and treatment plan.
Counseling options
If you believe you are experiencing symptoms of a mental illness, you may find it valuable to reach out to a licensed therapist. Symptoms can present themselves differently from person to person and can change with time. In addition, you don't need a diagnosis to see a provider. Many therapists can work with you based on your symptoms and goals for treatment.
You can meet with a therapist online if you face barriers to seeing a provider in person, such as distance, cost, or other concerns. Although many online therapists cannot make diagnoses, they can guide you in building a treatment plan and understanding yourself more profoundly. Platforms like BetterHelp connect clients with licensed, accredited therapists experienced in mental health challenges. You can choose the right therapist for you, and they'll work with you to develop a treatment plan on your schedule via online messaging, video chat, or phone call sessions.
If you're unsure about the effectiveness of internet-based counseling, studies show that it can be as effective as in-person options. One study that reviewed 17 studies on online therapy found that it was effective in reducing symptoms of common mental health conditions like anxiety and depression. One of the 17 studies showed that online treatment could be more effective than in-person options for treating depression.
Takeaway
dissociative disorders, and hundreds more. It also clarifies common terminology, such as autism spectrum and gender dysphoria, to create clarity across the many branches of psychology. However, the DSM is not the only diagnostic tool available, and many therapists treat symptoms individually. If you're interested in learning more about receiving a diagnosis or learning about mental health symptoms, consider reaching out to a provider in your area or online to get started.
Frequently asked questions (FAQs)
Below are some of the most commonly asked questions about the DSM.
What is the DSM-5 definition of mental disorders?
A mental disorder is a mental illness. The American Psychiatric Association (APA) website defines mental illness as "health conditions involving changes in emotion, thinking, or behavior (or a combination of these)."
What is the difference between the DSM-4 and DSM-5?
The revisions made to the DSM-5 were made to improve the classification of mental health conditions. The DSM-5 includes terminology and diagnoses not present in the DSM-4, allowing more people to get an accurate diagnosis. For example, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) are no longer listed under anxiety disorders, and gender dysphoria is now considered a diagnosis.
The frequently asked questions page on the APA website explains the need for the changes made in the DSM-5 by saying, "Many of the changes in DSM–5 were made to characterize better symptoms and behaviors of groups of people who are currently seeking clinical help, but whose symptoms are not well defined by DSM–IV (meaning they are less likely to have to treatment). By more accurately defining disorders, we hope that diagnosis and clinical care will be improved, and new research will be facilitated to further our understanding of mental disorders."
What are the DSM-5 categories?
The categories included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) include the following:
Neurodevelopmental disorders
Schizophrenia spectrum and other psychotic disorders
Bipolar and related disorders
Depressive disorders
Anxiety disorders
Obsessive-compulsive and related disorders
Trauma and stressor-related disorders
Dissociative disorders
Somatic symptoms and associated disorders
Feeding and eating disorders
Elimination disorders
Sleep-wake disorders
Sexual dysfunctions
Disruptive, impulse-control, and conduct disorders
Substance-related and addictive disorders
Neurocognitive disorders
Personality disorders
Paraphilic disorders
Other mental disorders
What does the DSM-5 stand for?
"DSM-5" is the fifth version of the Diagnostic and Statistical Manual of Mental Disorders. It was released in 2013, whereas the DSM-4 was released in 1994.
Is the DSM-4 still used?
The DSM-4 isn't used in clinical settings and is no longer used for diagnosing mental disorders. When diagnosing mental illness, providers use the DSM-5. When using everyday language, however, some people still reference diagnoses and terms used in the DSM-4. For example, people may refer to ADD, which is no longer a diagnosis in the DSM-5. Instead, ADHD has been split into three categories.
What is a DSM category?
Categories in the DSM are used to group mental health conditions. For example, eating disorders are listed under the DSM category "feeding and eating disorders," and post-traumatic stress disorder (PTSD) is under the category called "trauma and stressor-related disorders."
Therapists, psychiatrists, general doctors, and those in the field of social work may reference the DSM. Clients, families, and clients seeking general or basic mental health information do not necessarily need to know all the details of the DSM categories. Still, the DSM-5 is often available in PDF format online.
What disorders are in the DSM-5?
There are hundreds of mental illnesses listed in the DSM-5. These conditions include but aren't limited to the following:
Depressive disorders
Anxiety disorders
Eating disorders
Dissociative disorders
Substance use disorders
Personality disorders
Is the DSM reliable?
The DSM can be reliable. While future revisions may occur as experts continue to gain knowledge about mental health, the DSM is used for diagnosing mental illness in the United States. It is compatible with billing codes used for insurance companies, which is one of the reasons why an accurate diagnosis can help people with mental health conditions.
The APA's website has a frequently asked questions page regarding the DSM-5 that explains the importance of the DSM and how it's used. According to the APA, "DSM-5's Task Force and 13 Work Groups include more than 160 mental health and medical professionals who are leaders in their respective fields." In addition to these work groups, the World Health Organization (WHO) developed the DSM-5.
What are the five axes in psychology?
In the DSM-4, the five axes involved:
Axis I: Mental health and substance use disorders
Axis II: Personality disorders and mental retardation
Axis III: Coding general medical conditions
Axis IV: Psychosocial and environmental problems
Axis V: Assessment of overall functioning via the GAF scale, which has since been dropped
Note that the DSM-4 is no longer used.
How many mental illnesses are listed in the DSM-5?
Almost 300 mental illnesses are listed in the DSM-5.
What does the DSM-5 say about ADHD?
The changes made to the DSM-5 reflect the increased knowledge that researchers have surrounding ADHD and other disorders. In the DSM-5, ADHD is classified under the category of neurodevelopmental disorders. In the DSM-5, ADHD is split into three categories, and ADD is no longer listed as a diagnosis. The three types of ADHD include the following:
Primarily inattentive ADHD (ADHD-PI)
Impulsive and hyperactive ADHD (ADHD-HI)
ADHD combined type
Why is diagnosis important in mental health?
What are two purposes of having a Diagnostic system like the DSM-5?
What is the most common DSM diagnosis?
How many disorders does the DSM-5 identify?
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