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1
What is in DSM?

What does it contain?

  • Criteria, descriptions, symptoms, and other signs for diagnosing mental disorders.

2
What is in DSM?

What is the purpose?

  • Ensure that a diagnosis is both accurate and reliable
  • as best we can, given our current knowledge

3
What is in DSM

  • What is not offered?

  • reccomendatin on the preferred course of treatment
  • atheoretical 

4
History of DSM

How has the DSM evolved over the years? 

  • 1952: DSM I – 106 disorders
  • 1968: DSM II – 182 disorders
  • 1980: DSM III – 265 disorders
  • 1987: DSM III-R Revised – 292 disorders
  • 1994: DSM IV- 297 disorders
  • 2000: DSM IV-TR – 365 disorders
  • May, 2013 – DSM 5- 367

5
Why is DSM being revised?

To reflect what? 

  • new information in neurobiology, genetics, and behavioral sciences

  • clearer understanding of how the brain works

6
Why is DSM being revised?

What will it help?

  • researchers study how disorders relate to each other

7
Why is DSM being revised?

To guide what?

  •  clinicians in making more accurate and consistent diagnoses

8
Why is DSM being revised?

Being more responsive to...?

  • research findings

9

Four Principles Guided This Revision

  • Clinical utility 
  • Research based…”validators”- what validates your claim that this is a criterion for disorder. 
  • Continuity with prior editions 
  • No “a priori” restraints on the change

10

What is good mental health?

  • ability to recover quickly from stressors of life
  • ability to judge reality accurately
  • ability to see long range effects of choices 
  • ability to love an sustain personal relationships
  • ability to work cheerfully and productively 
  • ability to gratify hunger, thirst, sex urges in. Such a way as to not hurt others or oneself
  • ability to exercise one’s conscience effectively 

11

DSM-5 Diagnostic Classification

  •  Symptoms that satisfy DSM-5 diagnostic criteria for diagnosis(eThe first diagnosis written down is the primary diagnosis
  • Technically, a diagnosis requires completion of all five Axes.  (DSM-IV policy)
  • Symptoms that satisfy DSM-IV diagnostic criteria listed for primary and secondary or dual diagnoses 

12
DSM 5 Diagnostic Classification

Axis I

  •  records every mental disorder except for mental retardation and personality disorder 

13
DSM 5 Diagnostic Classification

Axis II

  •  records mental retardation and personality disorders 

14
DSM-5 Diagnostic Classification

Axis III

  • Records ICD-9 CM
  •  (International Classification of Diseases 9, Clinically Modified)

  • general medical conditions – according to patient

15
DSM-5 Diagnostic Classification

Axis IV 

  •  records psychosocial and environmental problems 

16
DSM-5 Diagnostic Classification

Axis V 

  •  records current and past year Global Assessment of Functioning (GAF) – [GAF Scale is located on page 34 of the DSM IV TR] 

17
DSM 5 Diagnostic Classification:

The History

  • Are these data that supports the diagnosis reliable? 

  • Are there other data that have been over-looked?

  • Are there enough data to make a diagnosis? 

  • Are there other plausible diagnoses that may be over-looked? 

  • Has the diagnosis been unduly influenced by data (age, sex, appearance, etc.)? 

  • Try to disprove your diagnosis: 

18
DSM-5 Diagnostic Classification: The History

Try to disprove your diagnosis: 

  • “Young adult client, dysphoric, tired, socially withdrawn, has little drive to work… recently lost his job due to poor work performance…” 
    • Hypothesis 1: Adjustment Disorder (job loss)
    • Hypothesis 2: Prodromal stage of schizophrenia (socially withdrawn, job problems, young adult)
    • Hypothesis 3: Severe anemia (tired, no drive) 

Rule these out. If you do not have enough information, must find more. 

 

19
DSM-IV TR

DSM 

  • Diagnostic and Statistical Manual of Mental Disorders

20
DSM-IV TR

Manual of Mental Disorders 

  • implies there is a differentiation between an organic disorder and a mental disorder
  • – no such thing exists – a mental disorder has an organic component and vice versa

21
DSM-IV TR

Mental disorder

  • a clinically significant behavioral or psychological syndrome or pattern that occurs and is associated with present distress
    • (a painful symptom) or a disability (an impairment of one or more important areas of functioning- psychological, social or occupational). 
  •  There is no mental disorder that is not also physiological. 
  •  It is not a mental disorder if it is not clinically significant 

22
DSM-IV TR

DSM IV myths:

  • It dehumanizes people – it looks at five areas of functioning in a person –
  • a broad range of disorders described, not people [“alcoholism” not “alcoholic”] 
  • Does not help with treatment - it gives guidance – points out what needs to be remedied 
  • Too complicated to be useful – No it’s not.   

23
DSM IV TR

Limitations

  • you either have the disorder or you don’t 
  • There are real world​ challenges with categorical symptoms
  • DSM IV is a categorical system

  • Categorical systems have construct validity problems because they don’t/can’t capture the clinical complexity of a patient’s experience

24
Limitations to DSM IV

DSM IV is a categorical system

  • Categorical systems do not always fit with the range of symptoms of a specific client
    • Client with schizophrenia can have several other symptoms not included in the criteria set

    • Depression, anxiety, insomnia, suicidal ideation

    • There was no way to directly assess the level or severity of these other symptoms (dimensions)

    • So, Dimensional Assessments were added in DSM 5 

25

What does DSM 5 do for categorized diagnoses?

  • Doesn’t replace it, but adds a dimensional option

26
Creating DSM 5

The workgroups were tasked to

 

  • Clarify boundaries between specific mental illness and normal functioning in specific cases
  • Clarify the boundaries between mental disorders
  • Consider “cross-cutting” symptoms (Dimensions)
  • Symptoms that are common across different diagnoses
  • Anxiety/depression, etc.
  • Provide research justification for all recommendations (validators)

27
DSM 5

Process Timeline

  • 1999-2007: white paper monographs published
  • 2007: 13 workgroups appointed to study 20 categories of disorders
  • April 2010 – December 2011
  • first drafts submitted for public review and revised
  • Field trials occurred and were followed by revisions 
  • These revisions were put on the Internet for feedback
  • December 2012
  • Final draft presented to APA and approved
  • May 22, 2013
  • DSM 5 launched

28
The 3 Sections of the DSM 5

Section 1

  • Introduction on use (Please read intro)

29
The 3 Sections of the DSM 5

Section 2

  • the 20 Chapters of categorical disorders

30
The 3 Sections of the DSM 5

Section 3

  • conditions that require further research, assessment instruments (greater emphasis on measurement on DSM-5) (proposal personality disorders, these have been left unchanged form DSM-IV