Understanding DSM-IV: Classifications, Disorders, and Assessment
General Considerations
General Considerations
- Manual symptomatic inherited from psychiatry (American Psychiatric Association).
- Not based on any psychological theoretical approach (systemic, psychodynamic, humanistic, and cognitive behavioral).
- Instrument made from empirical data and a descriptive methodology.
- DSM-IV applies to disorders that are happening at the moment, not for past disorders.
- DSM-IV is a way of classifying and cataloging symptoms, with no room for questioning or hesitation as far as diagnosis is concerned.
- DSM-IV is a symptomatic study for classifying current symptoms.
- The idea behind the DSM-IV was to establish a common language among those working in mental health, including psychologists, psychiatrists, and those indirectly involved, such as social workers, nurses, and occupational therapists. Ultimately, the goal is to facilitate communication between those working in the mental health area, either directly or indirectly.
- Useful for clinical practice, providing brief and clear delivery criteria for each diagnosis through a clear expression, indicating the diagnostic hypotheses for each group of criteria and/or symptoms.
- Diagnoses made using the DSM-IV are based on symptoms that have clinical significance, such as leading to a deterioration in social or personal functioning. For example, anxiety cannot be analyzed solely from the DSM-IV.
- The goal of DSM-IV is to provide clear descriptions of diagnostic categories so that clinicians and researchers can diagnose, monitor, exchange information, and discuss various mental disorders.
DSM-IV Disorder Categories
DSM IV
- Disorders of infancy, childhood, or adolescence (mental retardation, autism, etc.).
- Delirium, Dementia, and Amnestic and Other Cognitive Disorders.
- Mental disorders due to medical conditions.
- Substance-Related Disorders.
- Schizophrenia and other psychotic disorders.
- Mood Disorders.
- Anxiety Disorders.
- Somatoform Disorders (presence of physical symptoms that suggest a disease but cannot be fully explained by the presence of a disease, substance use, or other mental disorder), e.g., somatization disorder.
- Factitious Disorders (physical or psychological symptoms produced intentionally or feigned, with the aim of assuming the sick role).
- Dissociative Disorders (e.g., amnesia).
- Sexual and Gender Identity Disorders (sexual dysfunctions and paraphilias).
- Eating Behavior Disorders.
- Sleep Disorders (nightmares, sleepwalking, night terrors, etc.).
- Impulse Control Disorders (pyromania, trichotillomania, kleptomania, etc.).
- Adaptive Disorders (development of emotional or behavioral symptoms in response to an identifiable stressor).
- Personality Disorders (antisocial personality disorder, narcissistic personality disorder, etc.).
Multiaxial Assessment
The multiaxial system involves an assessment on several axes. Each of these axes corresponds to a different area of information that can assist the clinician in treatment planning and predicting the outcome of that intervention.
Axis I: Clinical Disorders
Describes the major psychiatric disorders or symptoms present, if no condition is set. (For example, depressive disorder, dementia, substance dependence, schizophrenia, etc.).
Axis II: Personality Disorders / Mental Retardation
Specifies whether there is a personality disorder at the base (or traits of a disorder), a developmental disorder, or mental retardation (For example, borderline personality disorder, autistic disorder, moderate mental retardation, etc.).
Axis III: Medical Conditions
Specifies medical conditions presented by the patient (if any).
Axis IV: Psychosocial and Environmental Problems
Describes psychosocial and environmental stressors in the patient’s life (unemployment, marital problems, grief, etc.).
Axis V: Global Assessment of Functioning
Axis V includes the clinician’s opinion about the general axis of functioning. This information is useful in planning treatment, measuring its impact, and predicting outcome.