DSM-5—Diagnostic and Statistical Manual of Mental Disorders

The fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM-5) is a guidebook utilized by physicians and other healthcare professionals in the United States as well as in many other nations of the world. DSM-5 is a standardized volume that details and classifies mental disorders for the improvement of diagnosis, treatment, and research in the psychiatry field.

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Importance of DSM

  1. The DSM manual consists of descriptions, symptoms, and other principles that help clinicians to diagnose and classify psychological disorders.
  2. Apart from the classification of content, DSM-5 also reflects the present accord of scholars, practitioners, and researchers on the current understanding of psychological disorders.
  3. The use of common language in DSM enables:
  • physicians to communicate about their patients;
  • research on diagnostic criteria to continue for the development of more effective medication protocols as well as other interventions
  • possible prospective revisions based on new insights based on a common database of diagnosis and treatment

History

The American medico-psychological association, later named as the American Psychiatric Association (APA) in 1918, published the earliest handbook on mental disorder classification. It consisted of 22 categories. The U.S. Army issued a reference manual for medical disorders termed as “Medical 203,” in order to formulate a standard to categorize medical illness. This was amended by the U.S. Navy.

Likewise, in 1949, the World Health Organization included a division called “Mental Disorders” in its ICD-6 (International Classification of Disease, sixth revision), which was used for payment purposes. Subsequently, the Committee on Nomenclature and Statistics appointed by the APA came out with the first DSM in 1952 to provide standard information on mental disorders. The DSM was periodically revised and published as the second, third, and fourth editions. The most recent edition is the DSM-5, which was published in 2013.

DSM-5 and ICD Interface

Currently, the DSM-5 contains updated standards for the diagnosis of mental disorders, while the ICD carries the codes that are employed in DSM-5. All the new and revised diagnostic categories of DSM-5 have been mapped to ICD-9 codes. For this reason, some disorders in DSM-5 must share codes for recording and billing purposes. As there may be several disorders connected with the same DSM-5/ICD-9 code, the descriptions of the DSM-5 diagnosis should always be recorded by name in the medical record in addition to listing the code.

Differences between DSM-IV (fourth revision) and

DSM-5

  1. DSM-IV had a regulatory structure that was found to be unsuccessful in indicating the symptoms of related disorders and the diagnostic groups. For example, symptoms of psychotic disorders may be related with bipolar disorders, depression, anxiety, psychosomatic disorders but the same symptoms might also be caused by neuronal changes or substance use, among other causes. However, DSM-5 reconstitutes these relationships within and across diagnostic categories to provide better indications about specific disorders.
  2. Throughout DSM-5, mental disorders are framed on the basis of the age, gender, and developmental characteristics of the patients. DSM-IV lacks the potential to address the lifetime perspectives of symptom variation. Cultural perspectives are also precisely described in DSM-5 in order to shift the focus toward cultural changes in the mode of symptom demonstration.
  3. The multiaxial system in DSM-IV is not needed to create a diagnosis of mental illness and has not come into widespread use. Thus, DSM-5 has transitioned to nonaxial certification of diagnosis that helps to eliminate the artificial distinction between medical and mental disorders.
  4. Another change is the more detailed discussion of advancements in fields like neuroscience and of clinical and public health needs in DSM-5 compared to DSM-IV.

Sections of DSM-5

DSM-5 has three major sections:

  • Section-1: Introduction and instructions for the use of DSM-5
  • Section-2: Diagnostic categories that contain three major elements, namely, diagnostic classification, diagnostic criteria sets, and descriptive textual matter
  • Section-3: Information regarding self-estimation tools and a special category containing mental disorders that require greater research

Elements of Section-2

  1. Diagnostic classification: This element consists of the official list of diagnoses of mental illness acknowledged in DSM-5. Each diagnosis carries a diagnostic code that is routinely employed by the individual providers, organizations, and agencies for payment purposes and collection of data. The diagnostic codes have been derived from the coding system used in ICD-9-CM (clinical modification).
  2. Diagnostic criteria sets: A set of diagnostic criteria is provided for each illness described in DSM-5. The criteria sets are meant to be employed by clinicians to increase the reproducibility of diagnosis. The diagnostic criteria sets provide information regarding:
  • the symptoms of mental illness and the minimum time period for which each should be present
  • the symptoms and conditions that must be rejected to meet the criteria for a specific diagnosis
  1. Descriptive textual matter: This element comprises every disorder included in DSM-5. The descriptive text gives details regarding these disorders under topics such as:
  • Diagnostic features
  • Related clinical signs and symptoms that support the diagnosis
  • Prevalence
  • Diagnostic measures
  • Specifiers and subtypes
  • Risk and predictive aspects
  • Differential diagnoses

Reviewed by Liji Thomas, MD.

References:

  1. https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm
  2. https://www.psychiatry.org/psychiatrists/practice/dsm
  3. https://www.appi.org/products/dsm-manual-of-mental-disorders
  4. https://www.psychiatry.org/psychiatrists/practice/dsm/feedback-and-questions/frequently-asked-questions
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683251/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635090/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777342/

Further Reading

Last Updated: Dec 12, 2017

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