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What is the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)?

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Updated June 17, 2014

Question: What is the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)?
Answer: If you've been doing research and reading about bipolar disorder (or pretty much any mental illness), you've probably seen phrases such as, "According to the DSM-IV ..." or "The guidelines in the DSM-IV state ..." But just what is this DSM-IV? It is the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. In the United States, it is the primary system used to classify and diagnose mental disorders.

History of the DSM

The DSM was first published in 1952. At that time, it contained only 66 disorders with short lists of symptoms for each and some discussion of the believed cause of the various disorders (Holmes). In 1968, the number of disorders was expanded to just over 100 with the publication of Edition II. Edition III of the Manual (1979) introduced a multiaxial diagnostic system of five scales (detailed below).

The Axis System of the DSM

Each axis represents a different type of mental illness or a way in which a mental illness may be influenced. In example, major mental illness such as bipolar disorder fall along Axis I. If an episode of depression is caused by or exacerbated through stress such as the continual abuse of a spouse, the disorder will have the added dimension of Axis IV. This allows for a much more detailed diagnosis.
  • Axis I - Clinical Disorders
  • Axis II - Personality Disorders & Mental Retardation
  • Axis III - General Medical Conditions
  • Axis IV - Psychosocial & Environmental Problems (stressors)
  • Axis V - Global Assessment of Functioning

Current Edition of the DSM

The DSM-IV is the current edition of the manual and was first published in 1994. This edition presents nearly 400 disorders. It also improved diagnostic objectivity by adding prototypes or decision trees outlining defining features of disorders, which lead clinicians through sets of questions regarding the presence or absence of symptoms (Holmes; Kendall & Hammen). In June 2000, a text revision was published bringing the DSM current at that point in time with the newer statistics as well as the latest findings in research.

The manual is an extensive compilation of information so it is organized into sections for easier reference. The first section is comprised of instructions about how to use the tools contained in the DSM. The next section is the detailed classification system listing the official codes for each diagnosis. Following the classification is the multiaxial system detailed above. The forth section is encompasses the bulk of the manual providing the diagnostic criteria and description for each disorder. It wraps up with eleven appendixes.

Diagnostic Criteria for Bipolar Disorder

Bipolar Disorder is an Axis I disorder within the category of mood disorders. There are four types of mood disorders – the depressive disorders, the bipolar disorders, mood disorder due to a general medical condition and substance-induced mood disorder. The manual recognizes four types of bipolar disorder. Each specific type of bipolar disorder is distinguished by the others through the nature of episodes experienced.

Future of the DSM

In 1999, the APA partnered with the National Institute of Mental Health to collaboratively compile the DSM-V. However, the task force established for this has met with considerable set-backs and controversies, which have delayed the publication of the next DSM. Currently the target date is 2012.

Sources:

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TRTM).

Holmes, D.S. (2001). Abnormal Psychology. Boston, MA: Allyn & Bacon.

Kendall, P.C., & Hammen, C. (1998). Abnormal Psychology: Understanding Human Problems. Boston, MA: Houghton Mifflin Company.

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