Diagnostic and Statistical Manual of Mental Disorders
Nature and purposes
The Diagnostic and Statistical Manual of Mental Disorders is a reference work consulted by psychiatrists, psychologists, physicians in clinical practice, social workers , medical and nursing students, pastoral counselors, and other professionals in health care and social service fields. The book's title is often shortened to DSM , or an abbreviation that also indicates edition, such as DSM-IV-TR, which indicates fourth edition, text revision of the manual, published in 2000. The DSM-IV-TR provides a classification of mental disorders, criteria sets to guide the process of ...view middle of the document...
The biopsychosocial approach was originally proposed by a psychiatrist named George Engel in 1977 as a way around the disputes between psychoanalytically and biologically oriented psychiatrists that were splitting the field in the 1970s. The introduction to DSM-IV-TR is quite explicit about the manual's intention to be "applicable in a wide variety of contexts" and "used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, inter-personal, family/systems)."
The atheoretical stance of DSM-IV-TR is also significant in that it underlies the manual's approach to the legal implications of mental illness. DSM notes the existence of an "imperfect fit between questions of ultimate concern to the law and the information contained in a clinical diagnosis." What is meant here is that the DSM-IV-TR diagnostic categories do not meet forensic standards for defining a "mental defect," "mental disability," or similar terms. Because DSM-IV-TR states that "inclusion of a disorder in the classification ... does not require that there be knowledge about its etiology," it advises legal professionals against basing decisions about a person's criminal responsibility, competence, or degree of behavioral control on DSM diagnostic categories.
The five diagnostic axes specified by DSM-IV-TR are:
• Axis I: Clinical disorders, including anxiety disorders, mood disorders, schizophrenia and other psychotic disorders.
• Axis II: Personality disorders and mental retardation . This axis includes notations about problematic aspects of the patient's personality that fall short of the criteria for a personality disorder.
• Axis III: General medical conditions. These include diseases or disorders that may be related physiologically to the mental disorder; that are sufficiently severe to affect the patient's mood or functioning; or that influence the choice of medications for treating the mental disorder.
• Axis IV: Psychosocial and environmental problems. These include conditions or situations that influence the diagnosis, treatment, or prognosis of the patient's mental disorder. DSM-IV-TR lists the following categories of problems: family problems; social environment problems; educational problems; occupational problems; housing problems; economic problems; problems with access to health care; problems with the legal system; and other problems (war, disasters, etc.).
• Axis V: Global assessment of functioning. Rating the patient's general level of functioning is intended to help the doctor draw up a treatment plan and evaluate treatment progress. The primary scale for Axis V is the Global Assessment of Functioning (GAF) Scale, which measures level of functioning on a scale of 1–100. DSM-IV-TR includes three specialized global scales in its appendices: the Social and Occupational Functioning Assessment Scale (SOFAS); the Defensive Functioning Scale; and the Global Assessment of Relational...