2. CONTENTS
I
• Introduction
• History / Short story of DSM
II
• Improvement in DSM-5 over DSM-IV TR
• Structure of DSM-5
III
• Similarities and Difference – DSM & ICD
• Current controversies & Limitations.
3. INTRODUCTION
What is DSM ?
Diagnostic manual used by counselors,
psychologists and psychiatrists;
Help guide diagnostic decision making;
Only classification system addressing mental
disorders in current widespread use in most
professional settings;
5. STORY OF DSM
1st version of 1952 and had 60 disorders;
1st & 2nd edition (1968) based on psychoanalytic
traditions;
3rd version in favor of biomedical model (1980);
DSM-III-R (1987) changed diagnostic criteria for several
mental illness;
DSM-IV (1994) had a interim text revision called DSM-
IV-TR (2000) before it has now taken shape as DSM-5
(2013);
6. IMPROVEMENTS IN DSM-5 OVER
DSM-IV TR
Reflect developmental and life span approach;
Gender-cultural issues integrated; Introduced new cross-
cultural symptom measures; Guidelines for cultural
formulation interviews;
Latest evidence from genetics & neuroimaging taken into
account to improve disorder descriptions;
Substance abuse disorders restructured for clarity-consistency;
Introduced a dimensional approach to diagnosis since many
disorders are now thought to exist along a continuum than as
distinct categories;
Multi-axial system of DSM-IV eliminated in DSM-5;
Global Assessment of Functioning Scale which had poor
reliability and validity replaced with Disability Assessment
Schedule;
7. IMPROVEMENTS IN DSM-5 OVER
DSM-IV TR (CONT…..)
Added optional alternative model for diagnosis of personality
disorders;
Restructured order of chapters;
Aspergers and PDD consolidated into ASD as there was no
evidence to support their separation;
Diagnostic criteria for bipolar and depressive disorders
streamlined;
New diagnostic categories include: Disruptive Mood
Dysregulation Disorder; Hoarding Disorder; Binge Eating
Disorder; Excoriation Disorder;
Revised Diagnosis: Internet-use Gaming Disorder; Non-
suicidal self injury; Suicidal Behavior Disorder;
Rejected proposed disorders: Anxious Depression;
Hypersexual Disorder; Parental Alienation Syndrome;
Sensory Processing Disorder;
8. STRUCTURE OF DSM-5…
Section 1
includes an introduction and instructions on how to use
the new version;
Section 2
covers the diagnostic categories;
Section 3
includes conditions that need additional research, a
glossary of terms, and other important information.
9. DSM & ICD: SIMILARITIES...
Both are diagnosis and categorizing manuals require two
or more symptoms to make a diagnosis;
Both are NOT self diagnosis manuals; Intended for use
by qualified health professionals, more specifically
psychiatrists;
Both are officially recognized manuals used to
categorize and diagnose mental disorders;
Attempts are on to further harmonize between the two
systems of disease classification;
10. DSM & ICD: DIFFERENCES…1
Internationally, DSM used mainly in the USA;
ICD is larger manual, encompasses all types of diseases/disorders; Only chapter V is
relevant for mental disorders;
DSM is purely for mental disorders;
ICD brought out of international collaboration;
ICD produced by a global health agency with a constitutional public health mission;
DSM issued by single national professional body-American Psychiatric Association;
ICD primary focus on classification is to help countries to reduce burden of mental
disorders. Its development is global, multidisciplinary and multilingual; DSM
primary constituency is U.S. Psychiatrists;
ICD approved by World Health Assembly comprising of 193 member countries;
DSM approved by assembly of APA members;
ICD is low cost and available free on internet;
DSM is copyrighted and generates income for APA;
11. DSM-ICD DIFFERENCES…2
DSM criteria very specific and detailed
ICD more of prototype descriptions with less detailed criteria and
minimum background information to guide diagnosis;
DSM always been multi-axial except now.
ICD always been non-axial;
DSM used by licensed mental health professionals with advanced
degrees;
ICD accessible to wide rage of health care professionals with wide
educational backgrounds;
Conceptual differences; Ex: Bulimia nervosa is characterized by
’morbid dread of fatness’ while DSM requires ‘self evaluation’; PTSD
is much broader in ICD-10 than DSM5;
Differences can cause problems in research comparisons;
ICD-11 expected in 2017
12. CURRENT CONTROVERSIES..1
Dimensional vs. Categorical Approaches; Do mental
disorders really exist? Single disorders rarely exist in
pure text book form; Separate disorders vs. sub types;
Diagnosis of mental disorders is dubbed as subjective;
No biomarkers or genetic markers, lab tests, blood tests,
brain scans as basis for diagnostic criteria;
Mostly based on patient self reports or key informant
reports; Subjectivity is inevitable to some extent;
Financial implications of revising diagnostic
classifications;
Manual is based on the biomedical model;
No clear line of demarcation between normal-abnormal;
Manual itself says that it should not be used as
‘cookbook’;