Introduction to the DSM-IV-TR
Overview of the Diagnostic & Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM) refers to manuals published by the American Psychiatric Association (APA). The current DSM is a diagnostic tool aimed at health professionals, and is used in several countries. Early versions of the DSM incorporated statistics, hence “statistical” in its title.
What Is the DSM-IV-TR?
There have been four manuals (DSM I, II, III and IV) and a text revision of the fourth manual, the DSM-IV-TR, which included some changes to the descriptive text. The DSMs, including the most recent versions, have been subject to much debate amongst health professionals and researchers.
The DSM-IV-TR lists mental disorders and the associated diagnostic criteria for both children and adults. It includes diagnostic codes, which may be required by health insurers or used for research purposes. Each disorder also comes with a description of the following:
- Diagnostic features
- Subtypes and/or Specifiers
- Recording Procedures
- Associated Features and Disorders
- Specific Culture, Age and Gender Features
- Prevalence
- Course
- Familial pattern
- Differential Diagnosis
The DSM-IV-TR Multiaxial System
The multiaxial system (sometimes referred to as multidimensional) is used to promote an all-inclusive evaluation of client function. The axes are as follows:
- Axis I: Clinical Disorders. The first axis describes symptoms of clinical disorders, such as mood disorders and eating disorders.
- Axis II: Personality and Mental Retardation. The second axis describes symptoms of disorders that cannot be accounted for on axis one, such as personality disorders.
- Axis III: Medical Conditions. This axis includes medical conditions that may affect disorders of the previous axes, such as brain injury.
- Axis IV: Psychosocial and Environmental Problems. This axis refers to social or environmental stressors that may impact on the client’s function, such as bereavement.
- Axis V: Global Assessment of Functioning. This axis is used to evaluate the client’s function overall.
Who Uses the DSM-IV-TR?
Although the APA is an organisation representing US psychiatrists, the DSM-IV-TR is intended for use by health professionals and researchers from various backgrounds and settings. While it may well be used by a psychiatrist working in primary care, it may also be used by a biology student. However, not all professionals using the DSM-IV-TR will be qualified to make diagnoses.
The Evidence Behind the DSM-IV-TR
The APA say the DSM-IV and DSM-IV-TR are informed by empirical evidence. In a review of the DSM-IV-TR in the British Journal of Psychiatry in 2001, author John Cooper points out that the manual does not include a reference list to support this claim, making it more difficult for readers to trace and investigate the source information. The APA publish separate sourcebooks, which they claim covers this information.
Will There Be a DSM-V?
In July 2007, the APA issued a press release that the expected date of the DSM-V’s release is May 2012.
For more information, the DSM section on the American Psychiatric Association’s website includes a general FAQ, the history of the DSM and information on the development of the DSM-IV.
Sources
Diagnostic and Statistical Manual of Mental Disorders (4th edition & text revision), published: 2000, authors: American Psychiatric Association.
DSM section, American Psychiatric Association, accessed 4th August 2008, no authors specified
