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.