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DSM 5

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James Humphreys

on 6 September 2016

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Transcript of DSM 5


Created by the APA (American Psychiatric Association).
DSM 5
(Diagnostic and statistical manual of mental Disorders)
The diagnostic classification is the list of the mental disorders that are officially part of the DSM system. Similar disorders are grouped together e.g. Anxiety Disorders.“Making a DSM diagnosis” consists of selecting those disorders from the classification that best reflect the signs and symptoms that are exhibited by the individual being evaluated. Every diagnosis has a code e.g. Schizophrenia is 295.90
How does it work?
However this is "optional", as is recording psychosocial factors (e.g. work/relationship status). Will anyone bother?

DSM I (1952)
106 Disorders
DSM iI (1968)
182 Disorders
DSM iiI (1980)
265 Disorders
DSM iv (1994)
297 Disorders
DSM 5 (2013)
300 Disorders
1. Diagnostic classification
For each disorder a set of diagnostic criteria indicate what symptoms must be present (and for how long) as well as symptoms, disorders, and conditions that may rule out a particular diagnosis. Severity may be specified for some disorders.
2. diagnostic criteria sets
The text of DSM-5 gives additional information which systematically describes each disorder under the following headings: "Diagnostic Features"; "Associated Features Supporting Diagnosis"; "Subtypes and/or Specifiers"; "Prevalence"; "Development and Course"; "Risk and Prognostic Factors"; "Diagnostic Measures"; "Functional Consequences"; "Culture-Related Diagnostic Issues"; "Gender-Related Diagnostic Issues"; "Differential Diagnosis"; and "Recording Procedures". This information is to improve the diagnosis and to identify any issues which may lead to misdiagnosis.
3. descriptive text
There are 3 steps to make a diagnosis
Some disorders are given severity ratings (e.g. Bipolar disorder - mild, moderate or severe)
Some disorders can be given dimension ratings (e.g. different symptoms in Schizophrenia) which is good as it is a more holistic way of diagnosing a disorder. (It allows for individual differences)
it's
the bible
of diagnosis
Advantage #1
A list of specific symptoms are described and listed for any particular disorder, like Schizophrenia. For example, Schizophrenia has a list of symptoms that are distinct from Obsessive Compulsive Disorder (OCD).
Hallucinations are one them. This should increase validity
Advantage #2
By agreeing on what symptoms a particular disorder has, and what symptoms
rule it out
, clinicians can make reliable diagnoses.
For example, Bipolar Disorder and Major Depression share similar symptoms but excluding symptoms should avoid misdiagnosis.
Advantage #3
If the diagnosis is reliable (and also valid), then the treatment plan should be more effective and less likely to cause unintended side effects or harm.
The last thing you want to do is give the wrong medications to somebody because you misdiagnosed them!
Issue #2
Field tests were carried out by the DSM 5 task force to test the inter-rater reliability of 23 disorders, 9 were low in reliability, including the 2 most commonly diagnosed disorders, General Anxiety Disorder and Major Depressive Disorder.
Issue #3
Some psychiatrists believe that the diagnostic criteria have been lowered which may lead to over diagnosis and unnecessary medication.
Issue #4
There has been a move away from the mandatory recording of psychosocial factors in the diagnosis. This may be focussing too much on biology and not enough on the events in our lives.
Issue #1
There are no biological tests for any disorders, so they are based on the subjective opinion of the psychiatrist. This means cultural and gender bias may creep in.
Evaluating DSM 5
The evolution of the dsm
I pioneered the "moral treatment" of patients. I also used bloodletting and mercury.....
Full transcript