A Critical Evaluation of the DSM-IV - Term Paper Example

 A Critical Evaluation of the DSM-IV The Diagnostic and Statistical Manual of Mental Disorders 4th Edition, DSM-IV, (APA, 1994) is a diagnostic tool published by the American Psychiatric Association for the classification and treatment of mental disorders, such as, autism and depression. There are both strengths and limitations to the DSM-IV that brings into question the effectiveness of this diagnostic tool in clinical settings (Westermeyer, 1985; Cutler, 1991; Wylie, 1995; Smart & Smart, 1997; Clark et. al., 1999; McQuaide, 1999; Klin, Chicchetti & Volkmar, 2000; Lynskey et. al., 2005; Mayes & Horwitz, 2005; Iarocci & McDonald, 2006; Lopez et. al., 2006; Zimmerman et. al., 2006; Boucher, 2008; Chu, 2010; Lux, Aggen & Kendler, 2010). This paper will give a critical evaluation of the DSM-IV with reference empirical evidence. The DSM-IV, it has been argued, is much clearer, concise and more communicative than previous editions and similar manuals (APA, 1994; Zimmerman, et. al., 2006). Furthermore, the DSM-IV can be said to be informative in the sense that it is a symptom-based manual, enabling healthcare professionals to understand and see the variance between mental disorders (APA, 1994; Mayes and Horwitz, 2005; Zimmerman et. al., 2006). Hence, it can be said that the DSM-IV is a useful tool through which healthcare professionals can accurately identify and treat different mental disorders. In addition, Mayes and Horwitz (2005) reviewed the history of the DSM. The authors stated that the third edition of the DSM was the first edition to be symptom-based category of mental disorders in order to improve diagnosis of these disorders. As such, the DSM-III became a more standardized diagnostic tool to identify mental disorders and distinguish them for others (Mayes and Horwitz, 2005). In this sense, the DSM-III and the DSM-IV have become more standardized and so a more reliable tool for diagnosing mental disorders, which should result in better diagnosis and less misdiagnosis/misinterpretation of different mental disorders. The DSM-IV has also been designed so that it can be used across many different settings, such as, primary care unit, hospitals and private practices for example (APA, 1994; Zimmerman, et. al., 2006). As such, it could be argued that the DSM-IV is a highly useful diagnostic tool, as it is able to be used across different settings and thus reach a wider population of patients. In spite of this, it has been claimed that the DSM-III and the DSM-IV have become more pharmaceutically-based in that there is more recommendation for the use of drugs for the treatment of mental disorders, compared to more psychological approaches to treatment, due to the influence of politics and input of pharmaceutical companies (Wylie, 1995; Mayes and Horwitz, 2005). Therefore, if this is the case then the construct validity of the DSM-IV is poor, as it would be unfairly based on the beliefs of pharmaceutical companies, who are wishing to make a profit from patients suffering from mental disorders, rather than the manual focusing on the best ways in which to treat patients. In this light, the usefulness of the DSM-IV comes into question. The more recent editions of the DSM have become progressively more grounded in empirical evidence but that the diagnostic criteria has been subjected to this same type of study (Zimmerman, et. al., 2006). What is more, Lopez et. al. (2006) have claimed that there are serious limitations in the diagnosis criteria of mental disorders covered in the DSM-IV and that this tool is based on fundamentally flawed categories. Moreover, these authors argued that the DSM-IV only covers weaknesses associated with mental disorders. Thus, the definitions of mental disorders described in the DSM-IV fail to account for potential advantages of these disorders, such as, improved mathematical skills for example. Research has demonstrated that the definitions of mental disorders in the DSM-IV do resemble the symptoms displayed by patients. For example, Lynskey et. al. (2005) conducted an interview study of 6265 Australian twins between 1996 and 2000, examining the effective of the DSM-IV criteria for alcohol abuse and dependence. It was found that the symptoms described in the DSM-IV corresponded with those expressed by the interviewees, particularly the male respondents. It was concluded that the DSM-IV is a useful tool to diagnose alcohol abuse and dependence for males but that the criteria requires a more specific definition for females. This demonstrates that the DSM-IV is an excellent tool through which to diagnose alcohol abuse and dependence in males, which assures the ecological validity and reliability of these definitions. However, these findings also highlight that there is need for improvement to the DSM-IV in later editions in order to be more representative and valid for female suffers. In a similar sense, Zimmerman et. al. (2006) performed a review study of empirical research that examined the effectiveness of the DSM-IV criteria for depression and found that the criteria was a valid means through which depression can be diagnosed but that it could be simplified to improve its clinical utility. This finding has been supported by the findings of Lux, Aggen and Kendler (2010) that demonstrated that definitions and severity of major depression proposed in the DSM-IV were valid measures of the disorder. This evidence adds further weight in the form of external reliability to the findings of Zimmerman et. al. (2006) and suggests that the DSM-IV is a valid and reliable diagnostic tool for the diagnosis of depression. On a similar note, Chu (2010) argued that DSM-IV is a good means by which posttraumatic stress disorder (PTSD) can be diagnosed, as it is a useful criteria for diagnosing PTSD and differentiating it from other mental disorders in the diagnostic categories. However, the author further claims that the DSM-IV fails to take into account all of the symptoms of this disorders, such as, problems with emotional regulations, relationships and perceptions, for example. In addition, the DSM-IV is not a useful tool for the dealing with this complex disorder in clinical settings. As such, it can be said that the DSM-IV has poor clinical utility for PTSD. Hence, the DSM-IV is a useful starting point through which to diagnose PTSD but that further work is needed in order to effectively treat this mental disorder, as the DSM-IV cannot account for the behavioral complexity of this disorder. From this evidence, it is certainly clear to see that there are both strengths and weaknesses of the DSM-IV in that this diagnostic tool has been improved on compared to earlier editions but that there is still a requirement for future editions where revisions have been made. There has been a great deal of research that demonstrates that the DSM-IV fails to take into account important social and psychological factors that influence the diagnosis and prevalence of mental disorders, such as, the inclusion of cultural and/or ethnic variables (Westermeyer, 1985; Kleinman, 1997; Widiger & Sankis, 2000). Thus, it has been contended that the DSM-IV and those preceding it are based on Western diagnosis and conception of mental disorders in the belief that the characteristics of these disorders are universal (Kleinman, 1997). Moreover, culture may be an important factor in mental disorders, particularly in light of differences in symptom-reporting between cultures (Westermeyer, 1985). Thus, culture-bound disorders may be absent from the DSM-IV due to its lack of inclusion of cultural beliefs and form of symptom-reporting. In light of this, it can be said that the DSM-IV is culturally biased, based on Western egocentrism, which could result in many important cultural factors being ignored and mental disorder misdiagnosed. In contrast to this evidence, Smart and Smart (1997) have claimed that the DSM-IV has some significant improvements/revisions relating to cultural specific features of mental disorders. Therefore, it can be said that there is contention as to the inclusion of cultural beliefs and cultural expression of symptoms of mental disorders covered in the DSM-IV. Nevertheless, the DSM-IV can be seen as attempting to be more inclusive than previous editions but that this still does not cover the complexity of cultural-specific expression of mental disorders. Hence, future editions of the DSM-IV need to be based on these beliefs, as opposed to ideals of universality in the symptoms of mental disorders. One particular mental disorder, autism, demonstrates the inconsistencies with the DSM-IV. For example, there are a range of symptoms that characterizes autism that form the classification of the DSM-IV, such as, repetitive behaviors and the need for routine, for example (Boucher, 2008), and problems in communication, such as, impaired language production, which feature as part of the definition of autism in the DSM-IV. In addition to this, another feature of autism is impaired social interaction, as seen by withdrawal and self-isolation in social situations (Boucher, 2008; Klin et. al., 2000, p.163-176; Rapin & Dunn, 2003, p.166-172). This feature also forms a basis for the DSM-IV definition of autism. On the other hand, the DSM-IV fails to take into account many important symptoms of autism, such as, sensory-perceptual processing (Hutt et. al., 1964, as cited by Iarroci & McDonald, 2006, p.77), and enhanced perception to detail (Dakin & Frith, 2005, as cited by Iarroci & McDonald, 2006, p.77-90). It is certainly the case that without explicit reference to this in the DSM-IV, healthcare professionals cannot accurately diagnose and treat different disorders. Moreover, the DSM-IV also fails to take into account the longevity of autism (Boucher, 2008). Therefore, as such information is omitted from the DSM-IV, this tool cannot be a useful means through which this disorder can be accurately identified. In light of this, the DSM-IV could be said to take a reductionist stance in its definition of the autistic disorder because it gives a limited view of the spectrum of autism, as it fails to account for every aspect of the disorder. Hence, such a problem has led to misdiagnosis of mental disorders, such as, autism. Consequently, future editions of the DSM-IV are required to resolve these problems in order to improve its effectiveness and clinical utility. A further problem of the DSM-IV as a diagnostic tool for autism is that of co-morbid disorders in that the symptoms of this disorder are also present in other disorders, such as, ADHD, children with ADHD often display symptoms of the autistic disorder, such as, problems with social interaction and repetitive behaviors (Clark et. al., 1999, p.50-55). This finding has been supported by a number of empirical studies (Iarroci & McDonald, 2006, p.77-90), adding external reliability and improves the power of this research. As such, these findings are high in usefulness to the wider population, particularly patients and healthcare professionals, which can lead to better diagnosis of mental disorders in future editions (Boucher, 2008). This problem demonstrates that this diagnostic tool is not wholly adequate in assessing mental disorders. In conclusion, it can be seen from the evidence discussed in this paper, that the DSM-IV is a useful diagnostic tool through which many mental disorders can be diagnosed and distinguished from other disorders. Thus, it can be argued that such a tool is highly useful for healthcare professionals, high in validity and applicable to many clinical settings, such as, hospitals and clinics. On the other hand, the effectiveness of the DSM-IV is questionable due to the problems associated with this diagnostic tool, such as, poor reliability, cultural bias and the problems diagnosis of co-morbid disorders like autism. As such, the DSM-IV has poor clinical utility and a limited usefulness for helping individuals suffering from mental problems. 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