The Role of the Diagnostic Statistic Manual IV (DSM-IV) in Diagnosing Mental Disorders

The Diagnostic Statistic Manual was first complied in 1952 and is periodically reviewed and revised by the American Psychiatric Association (U.S. Surgeon General, n.d.; WebMD, 2007). (The current manual is the fourth revision). Ultimately, many professionals across various fields use the DSM-IV to determine if their patients may be suffering from mental illness. These professionals include those that we automatically think of as people who diagnose mental disorders, such as therapists, psychiatrists, and psychologists. However, other professionals, who we may not immediately associate with diagnosing mental illness (e.g., social workers and physicians), also frequently utilize the DSM-IV (PsychNet-UK, n.d.).

Categories of Disorders

Basically, the DSM-IV offers healthcare professionals an organized and logical way of assessing a patient's symptoms and determining the best possible diagnosis. First, it accomplishes this by giving detailed criteria for each mental disorder that the patient must meet before he or she can be diagnosed with that disorder (PsychNet-UK, n.d.; U.S. Surgeon General, n.d.). It also makes the diagnostic process much easier by dividing all the recognized mental disorders into sixteen main categories:

(1) "Disorders usually first diagnosed in infancy, childhood, or adolescence,"

(2) "Delerium, dementia, and amnestic and other cognitive disorders,"

(3) "Mental disorders due to a general medical condition,"

(4) "Substance-related disorders,"

(5) "Schizophrenia and other psychotic disorders,"

(6) "Mood disorders,"

(7) "Anxiety disorders,"

(8) "Somatoform disorders,"

(9) "Factitious disorders,"

(10) "Dissociative disorders,"

(11) "Sexual and gender identity disorders,"

(12) "Eating disorders,"

(13) "Sleep disorders,"

(14) "Impulse-control disorders,"

(15) "Adjustment disorders,"

(16) And "personality disorders" (U.S. Surgeon General, n.d.; Table 2-5. Major Diagnostic Classes of Mental Disorders [DSM-IV]).

The DSM-IV Axes

In addition to these tools, the DSM-IV also contains five different Axes to make the diagnostic process even less complicated. Axis I is comprised of almost all of the recognized mental illnesses, excluding mental retardation and personality disorders. Then, the second axis is reserved for the mental disorders not listed under the first axis: personality disorders, as well as mental retardation. The next axis, Axis III, is designed any general medical problems or conditions that could complicate a patient's treatment or even be the cause or one of the causes of the symptoms the patient is complaining about. Furthermore, the fourth axis is used to record any external factors that may be contributing to the individual's illness or that could complicate the recovery process (e.g., death of someone close, long-term unemployment, or recent divorce). And finally, Axis V is made up of the Global Assessment of Functioning, which is an assessment tool that helps the professional to make an educated guess as to how well an individual is functioning and helps other professionals to be able understand the original professional's take on the mental state of that individual at that particular time (Byers, 2007; PsychNet-UK, n.d.).

The DSM-IV in Action: Assessment Interview

Now that I have reviewed the DSM-IV, its various parts, and how it is used to assist various health professionals in diagnosing possible mental illness among their patients, I will turn to the subject of the assessment interview. The first goal of the assessment interview should be to determine if the individual does or does not require additional psychiatric evaluation. If the patient is concerned about specific aspects of his or her behavior and thoughts or that individual was referred to the mental health professional because of something that caused that professional concern, those behaviors and/or thoughts should be the first thing discussed between the psychiatrist and patient during the initial interview. At times, behavior that might cause alarm in one situation can be totally understandable or even acceptable in a vastly different situation. Also, many of the symptoms of a number of disorders are actually a normal part of life if they do not last for extensive periods of time and are not to an extreme degree (Byers, 2007; WebMD, 2007).

For example, it is quite normal to feel sad, overwhelmed, insecure, and even depressed after the sudden loss of a loved one. It is a type of event that is very traumatic for so many people. However, there is a normal healing process that allows the healthy individual to gradually learn how to cope with the loss and then to eventually discover how to go back to normal living again as the pain and sadness eases. In the case of a mentally ill person, though, the loss may overwhelm him or her so much that life literally stops and he or she cannot seem to move beyond it to start functioning normally again.

Therefore, the initial interview should evaluate if the person's responses may be abnormal. It should be explored if the behavior or thinking is causing the patient concern or even suffering. Also, the patient's complaints should be carefully weighed to see if the behavior or thinking is causing serious harm to the individual's normal functioning in everyday life. Furthermore, the professional should evaluate if the patient's symptoms could possibly harm the individual or even others. And lastly, all behavior and thinking should be evaluated within the context of the patient's culture and background to determine whether or not this conduct violates social norms. In this manner, it will be must easier to determine if the patient's symptoms are perfectly normal or actually a real need for concern (Byers, 2007).

Then, if the mental health professional truly believes that the patient is displaying abnormal behavior, he or she should attempt to glean from the patient (and possible even those who are close to the patient, if necessary) every piece of information that may be pertinent to the successful diagnosis and treatment of the individual. This should include such things as the patient's medical history, family medical problems, background, current employment, situations that may be causing him or her exceptional amounts of stress, what he or she wishes to accomplish with treatment, and further information about his or her symptoms and concerns. And simultaneously, as the psychiatrist is gathering this information, he or she should made notes of any possible diagnoses that may account for the patient's complaints, so he or she will be able to look into this possible diagnoses after the interview (Byers, 2007; WebMD, 2007).

DSM-IV & Criminal Justice

In conclusion, I would like to note that although the DSM-IV is an excellent assessment tool in clinical settings, it has several shortcomings when used in the criminal justice fields. In many cases, the DSM-IV and the legal system do not see eye to eye concerning mental disorders. Unfortunately, just because the DSM-IV may recognize an individual as mentally ill, it does not mean that same person will be seen in that manner under the laws and statutes. The legal system allows room for mental illness; however, it often requires much more specific data than that in the DSM-IV before it may recognize that individual as having a mental disorder. Furthermore, under the law, it must be proven that the individual could not control his or her behavior at the time of the incident, instead of just saying that he or she has a mental illness that hinders judgment. Therefore, to avoid as many problems as possible, the DSM-IV should be utilized extremely carefully in forensic settings (Irons & Schneider, 1996).

References:

Byers, K. (2007, October 13). Chat posting. Retrieved October 14, 2007, from CTU Online, Virtual Campus, PSYC336-0704A-02: Abnormal Psychology, Phase 1 Chat Archive: https://mycampus.ctuonline.edu

Irons, R., & Schneider, J. P. (1996). Differential diagnosis of addictive sexual disorders using the DSM-IV. Sexual Addiction & Compulsivity, 3, 7-21. Retrieved November 13, 2007, from http://www.jenniferschneider.com/articles/diagnos .html

PsychNet-UK. (n.d.). DSM IV explained. Retrieved November 13, 2007, from http://www.psychnet-uk.com/dsm_iv/_misc/dsm_diagnosis.htm

U.S. Surgeon General. (n.d.). Section 2: Overview of mental illness. In Mental health: A report of the Surgeon General (chap. The fundamentals of mental health and mental illness). Retrieved November 13, 2007, from http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec2.html

WebMD. (2007). Mental health: Making the diagnosis - How are mental illnesses diagnosed? In Anxiety & panic disorders guide. Retrieved November 13, 2007, from http://www.webmd.com/anxiety-panic/guide/mental-health-making-diagnosis