DSM-IV

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV, is a manual published by the American Psychiatric Association. DSM-IV categorizes all psychiatric disorders for both children and adults and lists known causes for disorders, epidemiological statistics, prognosis, and treatment approaches. While DSM-IV was created by an American medical society, it is used in many other countries as the standard in mental healthcare and psychiatric diagnosis. In addition, insurance companies, pharmaceutical companies, and health policy makers also use the manual.

The DSM handbook was first published in 1952 and has subsequently gone through five revisions. DSM-IV is considered the last major revision and was published in 1994 with a text revision in 2000 to keep the manual updated with the current literature. DSM-V, the latest incarnation of the handbook, is currently being drafted and due for publication in 2011.

DSM-IV is organized using a multiaxial approach to diagnosis to account for the various ways that mental health can be affected in an individual. As a result, DSM-IV has five levels (axes) that relate to various aspects of disability. Axis I includes clinical disorders, such as major mental disorders, developmental disorders, and learning disorders. Axis II includes underlying pervasive or personality conditions and mental retardation. Axis III incorporates medical conditions that may be relevant to the understanding and treatment of the mental disorder. Axis IV includes psychosocial and environmental factors relating to the disorder. Axis V is a global assessment of functioning measured on a scale of 0 to 100. Common well-known Axis I disorders include depression, bipolar disorder, attention deficit hyperactivity disorder, and schizophrenia. Common Axis II disorders include borderline personality disorder, antisocial personality disorder, and mild mental retardation.

While DSM-IV is widely used in mental healthcare, it also has many limitations. Commonly held criticisms against DSM include the fact that DSM invents illnesses and behaviors using an arbitrary definition for normality. In addition, patients are found to rarely fall into discrete categories of disease according to DSM, further underscoring the criticism of arbitrary definitions of normal. A clear illustration of the arbitrary definition problem can be seen when a well-known fact of the most commonly diagnosed personality disorder is 301.9, Personality Disorder Not Otherwise Specified. Some critics also believe that because treatment is the basis and goal of the psychiatric profession, DSM should be organized according to treatment modalities.