The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM IV is the standard classification of mental disorders used by mental health professionals in the United States. It used for patient diagnosis and treatment, and is important for collecting and communicating accurate public health statistics.
The DSM consists of three major components: the diagnostic classification, the diagnostic criteria sets, and the descriptive text.
The Multiaxial System of Diagnosis in DSM IV Criteria
The DSM uses a “multiaxial” system for assessment. This assessment model is designed to provide a comprehensive diagnosis that includes a complete picture of not just acute symptoms but of the entire scope of factors that comprise mental health.
There are five axes in the DSM diagnostic system, each relating to a different aspect of a mental disorder:
This is the top-level diagnosis that usually represents the acute symptoms that need treatment; Axis 1 diagnoses are the most familiar and widely recognized (e.g., major depressive episode, schizophrenic episode, panic attack). Axis I terms are classified according to V-codes by the medical industry (primarily for billing and insurance purposes).
Axis II is the assessment of personality disorders and intellectual disabilities. These disorders are usually life-long problems that first arise in childhood.
Axis III is for medical or neurological conditions that may influence a psychiatric problem. For example, diabetes might cause extreme fatigue which may lead to a depressive episode.
Axis IV identifies recent psychosocial stressors – a death of a loved one, divorce, losing a job, etc. – that may affect the diagnosis, treatment, and prognosis of mental disorders.
Psychosocial and Environmental Problems
Axis V identifies the patient’s level of function on a scale of 0-100, (100 is top-level functioning). Known as the Global Assessment of Functioning (GAF) Scale, it attempts to quantify a patient’s ability to function in daily life.
ICD DSM IV Criteria
The codes in the DSM are designed to match (with some exceptions) the codes in the International Statistical Classification of Diseases and Related Health Problems. The ICD is the most widely used disease classification system in the world. The ICD has developed alongside the DSM and there is not always agreement on which system to use. According to a 2002 paper, “Comparing the two most visible diagnostic systems, it found that ICD-10 was more frequently used and more valued for clinical diagnosis and training and that DSM-IV was more valued for research.
The Diagnostic Classification of DSM IV Criteria
The diagnostic classification is a list of mental disorders. A DSM diagnosis selects disorders that most closely reflect the patient’s signs and symptoms. Each diagnostic label is associated with a diagnostic code used by institutions for data and billing.
DSM IV Criteria Sets
For each disorder, a set of DSM IV criteria indicates the symptoms and duration that comprise a diagnosis. They are very useful guidelines but must be used in conjuction with the judgement and evaluation abilities of those attempting diagnosis.
Descriptive Text of DSM IV Criteria
The descriptive text that accompanies each disorder is categorized under the following headings: “Diagnostic Features”; “Subtypes and/or Specifiers”; “Recording Procedures”; “Associated Features and Disorders”; “Specific Culture, Age, and Gender Features”; “Prevalence”; “Course”; “Familial Pattern”; and “Differential Diagnosis.”
2000 Revision: DSM IV TR
DSM IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), published in 1994 was the last major revision of the DSM. It was the culmination of a six-year effort that involved over 1000 individuals and numerous professional organizations.
In anticipation of the fact that the next major revision of the DSM (i.e., DSM-V) will not appear until May, 2013 or later, a text revision of the DSM IV called DSM IV TR was published in July 2000. Most of the major changes in DSM IV TR were confined to the descriptive text. Changes were made to a handful of criteria sets in order to correct errors identified in DSM IV. In addition, some of the diagnostic codes were changed to reflect updates to the ICD 9 CM coding system adopted by the US Government.