The DSM-5 is the go-to source for understanding, classifying, and explaining a variety of mental health disorders. It has been described by some as sort of a “bible” for mental health professionals, as they heavily rely on it when diagnosing individuals with a mental illness. But what exactly is it?
In fact, it’s not a Bible: the content changes, based on accumulated scientific evidence and clinical experience. The DSM-5 is the fifth iteration of the Diagnostic and Statistical Manual of Mental Disorders. It is a book used by mental health professionals to classify and diagnose disorders related to psychiatric functioning in adults and children. The original DSM, published in 1952, was developed in response to psychiatrists’ desire for a uniform method of categorizing and describing the disorders they encountered in clinical practice. The Manual is regularly updated to reflect changes in disorders, diagnostic criteria, and symptomatology.
The DSM-5 identifies and describes disorders by categories that are broken down into areas related to mood, psychosis, development, and substance use, among others. Each disorder contained in the Manual is defined by its features and accompanied by diagnostic criteria required for an individual to be diagnosed with that disorder. Diagnostic criteria include variables such as symptoms, symptom length, and the number of symptoms required to render a diagnosis. Some disorders also include “specifiers” that denote variables such as symptom severity (i.e., mild, moderate, severe) and accompanying disturbances (i.e., mood, perception). The DSM-5 also outlines available research concerning the prevalence, prognosis, and life course of a particular disorder.
While the DSM-5 is an invaluable tool for mental health professionals, it is not without controversy. Prior to its publication, many critics expressed concerns with proposed revisions or removals. Once the latest edition of the Manual was published in May of 2013, mental health professionals around the world voiced criticisms of the changes that came to fruition. For example, the previous edition (i.e., DSM-IV-TR, 2000) utilized a “multiaxial” diagnostic system which included the following:
- Axis I: Clinical Disorders (e.g., Major Depressive Disorder)
- Axis II: Personality Disorder and Mental Retardation (e.g., Antisocial Personality Disorder)
- Axis III: General Medical Conditions (e.g., Hypertension)
- Axis IV: Psychosocial and Environmental Problems (e.g., legal trouble, homelessness)
- Axis V: GAF – General Assessment of Functioning (e.g., GAF, overall functioning; scale of 0-100)
The DSM-5 removed the above multiaxial diagnostic system in favor of a single-axis system that required clinicians to list all disorders from the first three axes on a single access, in order of clinical significance. The GAF score was eliminated, as the scoring was too unreliable.
There were also criticisms of disorder-related changes. The DSM-IV-TR included Asperger’s Disorder (AD), a disorder related to Autism. Similar to Autism, AD is characterized by impaired social interactions and repetitive behaviors. However, individuals with AD do not exhibit the early developmental delays observed in children on the Spectrum. Despite several differences in the features of the above disorders, the DSM-5 eliminated Asperger’s Disorder as an independent diagnosis and included it under the umbrella of Autism Spectrum Disorder. Other criticisms of the DSM-5 were related to diagnostic criteria for disorders including Schizophrenia (removing subtypes) and Major Depressive Disorder (removing bereavement exception).
Despite the above controversies, the DSM-5 is an invaluable tool for mental health professionals, including Forensic Psychologists. We frequently use the Manual in daily practice. When we interview and evaluate clients, we observe their behavior and often administer psychological tests. Data from behavioral observations, testing results, and available records are then used to determine whether an individual displays or reports behaviors consistent with a mental disorder. If so, we refer to the DSM-5 to determine which disorder best articulates the scope of the presenting and reported behavior. The Manual can also help Forensic Psychologists to determine when a behavior is inconsistent with an individual’s reported or exhibited symptoms, suggesting further investigation and/or testing is needed. When this happens, we sometimes rely on different assessment measures to help us determine whether an individual’s presentation is atypical or likely a result of malingering.
As has been the case with previous publications of the Manual, several changes to the DSM-5 have been proposed to the American Psychiatric Association. One of the proposed changes is currently available for review and will be subject to a 45-day public comment period, from April 6, 2020 to May 20, 2020 (https://www.psychiatry.org/psychiatrists/practice/dsm/proposed-changes). It will be interesting to see what changes will ultimately be made in the DSM’s next version.
American Psychiatric Association Website – www.psychiatry.org
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
American Psychiatric Association. (2011). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision).
Live Science (2013). Psychiatric Manual Stirs Controversy. Obtained from https://www.livescience.com/34496-psychiatric-manual-stirs-controversy.html