Diagnostic and Statistical Manual of Mental Disorders - Essay Example

Running head: Diagnostic and Statistical Manual of Mental Disorders Name xxxxxxxxxxxxxxxxxxxx Course xxxxxxxxxxxxxxxxxxxx Lecturer xxxxxxxxxxxxxxxxxxx Date xxxxxxxxxxxxxxxxxxx Introduction The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guide or a classification schema for diagnosing mental disorders. The manual is published by the American Psychiatric Association (APA) and is intended to apply to a wide range of mental illness contexts as used by clinicians and researchers working in mental health provision (Fawcett & Kahn, 2007). DSM has diagnostic codes used to ensure the record keeping and reimbursement requirements by professionals in areas such as psychodynamic cognitive, biological, behavioral, family and interpersonal systems. It has been revised severally to meet psychological health needs with the last major revised publication being DSM-IV-TR in 1994. This was published as a result of clinical consensus on the need to address the need for reliability rather validity in mental health care-giving (Tsuang, Tohen, & Jones, 2011). Literature indicates that the next major revision is to be published in 2012 (Regier, 2007). DSM-IV-TR is multiaxial comprising of Axia I to IV, a well defined classification system which is based on oblective and measurable criteria (Nairne, 2009). Clinical disorders, and personality disorders and mental retardation are detailed in Axis I and II respectively. Axis III contains general medical conditions while Axis IV has psychosocial and environmental problems (Nairne, 2009). The use of the manual in the America and some other areas globally has been met with mixed reactions amongst proponents and opponents. There are critics on the strengths or benefits of DSM in categorical pathology-based diagnosis. The purpose of this paper is to review the cited strengths and weakness of DSM-IV. This is relative to how its use influences therapeutic understanding and empathetically approaching issues facing the client. The paper will also critique the strength and weaknesses concerning prognosis clarity, and the choice of treatment and approach one may take with the client. The paper will review recent literature in this critique and will begin with strengths. Strengths and Weaknesses of DSM DSM provides for lifetime data (Kessler et al, 2009) compared to dimensional approaches which is primarily cross-sectional. Practitioners can use this approach when analyzing the behavior of disorder categories as defined by the nosology of DSM (Brown & Barlow, 2005). DSM has utility in mental health care for persons with mild intellectual disability. Though the framework of DSM and other classification systems do not provide for problem behaviors, behavioral phenotypes, pathoplastic effects of intellectual disability on psychopathology (Fletcher, et al, 2008), it provides for the development of Diagnostic Manual-Intellectual Disability (DM-ID) guide and textbook which are adaptations of DSM-IV-TR. Fletcher et al (2008) further on that DM-ID aids a clinician in recognizing symptom profiles in adults and children with intellectual disability. The textbook has diagnostic chapters each with a description of etiology and pathogenesis which is inclusive of biological and psychosocial factors as well as genetic syndromes. Fawcett & Kahn (2007) indicate that the manual was purposed for a multiplicity of settings such as outpatient, inpatient, partial hospital consultation-liaison, private practice, clinical and primary care with community populations and need-groups providing the health professionals with guidelines. There is wide applicability in various areas. Therefore, for practitioners, one does not have to attain specialization in a given situation. It is easier to be empathetic across various settings. Apart from the classification and coding, the manual provides an official diagnostic nomenclature to provide a common language thus minimizing the use of idiosyncratic concepts and influencing how its users conceptualize psychology (Huprich & Richard, 2009). This commonness of language and reference creates a universal platform over which practitioners can share information and respond to mental illnesses. DSM categories facilitate a form of shorthand which facilitates communication amongst practitioners (Eriksen & Kress, 2005). Apart from providing information about likely causes of an illness, the use of labels assists in summarizing patients symptoms so that psychologists will communicate information in one word. Additionally, it is easier to prescribe treatment and predict possible outcomes of the treatment since research has identified treatments (Franzoi, 2011). DSM provides information about the factors related to diagnosis such as course, prevalence, and socio-cultural factors. This is helpful to those struggling with understanding clients’ experiences empathetically (Eriksen & Kress, 2005). There are indications in literature that the diagnostic system provides for effective planning and referral of treatment strategies. This is possible with accurate conceptualization of client’s problems. Weaknesses The restrictions of an entirely categorical method of diagnostic classification are extensively documented. This has been done relative to other diagnostic approaches such as the dimensional rating. This provides for rating of severity and features whose threshold does not match DSM restrictions. Nurses have raised criticism over DSM in that it does not provide adequate information regarding a client’s individual experience (Melillo & Houde, 2005). The diagnostic guidelines do not provide information regarding how patients are functioning in their daily life. This is hinders an empathetic approach to mental health care for the care givers. Literature indicates that diagnostic reliability of many mental illness categories diagnostic disagreements is less related to boundary issues with other categories. It is more due to issues in defining and applying a categorical threshold on the symptoms number, severity and duration (Brown & Barlow, 2005). There are concerns over how DSM defines thresholds to categorise disorders by delineating arbitrary cut-off points for normally distributed variables (Tsuang, Tohen, & Jones, 2011) and continuous measures such as disorder extent. Raters agree about the presence of the key features of a symptom but disagree on the sufficiency of these features in causing distress matching the DSM threshold for clinical disorder. This mismatch affects the clarity of the prognosis which may in effect influence treatment administered for conditions such as social phobia. The concern of threshold limit dictated by DSM is also highly evident in the ‘not-otherwise-specified’ (NOS) diagnoses. DSM categorizes patients who do not fit in the formal categories as NOS. The disagreement in the NOS feature when all raters indicate the presence of disorder concerns, but one is less indicative of one of the symptom due to insufficient threshold about the number, severity and duration of the symptom. This is common with major depressive disorder and generalized anxiety disorder (GAD) (Brown & Barlow, 2005). The disagreement and its effects are bound to be extensive given that NOS diagnoses are more prevalent than a number of the specifically named disorders (Tsuang, Tohen, & Jones, 2011). DSM has been criticized for imposing categories on dimensional phenomena indicated as causing substantial loss of important clinical information. This is because it allows inadequate coverage for clinically important symptoms which do not match the criteria for the formal diagnostic categories (Brown & Barlow, 2005). NOS diagnoses result due to this phenomena and are noted as current of lifetime conditions. As such, it features as an inadequate guideline for practice and one may need additional reference. Mental health care givers using DSM solely may not plan adequate treatment. There may be under diagnosis given that DSM does not provide a sufficient mechanism to record the severity of disorders. It does provide for the recording of symptom features but not the disorder. Brown and Barlow (2005) indicate that due to adherence to DSMs set of hierarchical exclusions and differential diagnostic decision rules that ensure reliability significant information is lost leading to misleading conclusions. This is so if there are overlapping disorders such as GAD occurring in the course of a mood disorder. As such the GAD will not be diagnosed. Tsuang, Tohen, & Jones (2011) indicate that DSM has an uncertain future given that it is organized based on, operationalized sets of categorical criteria based on signs and symptoms from clinical observations and research but not on the pathogenesis of disorders. Its assemblage results from arbitrary committee evidence rather than scientific evidence (Richard & Huprich, 2009; Phillips, First, & Alan, 2003). Psychiatric disorders result from compound multi-factorial and poly-genetic etiologies which are characterized by interaction of genes under environmental influence. There are numerous studies linking genes to psychological disorders and wellness. These include the successful linking of Schizotaxia and Shozophrenia to genetic lines in non-psychotic individuals. An understanding of the underlying factors leading to a condition is vital in clarifying prognosis, planning administering and assessing treatment of mental health patients. Hence, over reliance on the sole use of DSM in practice is thus eventually detrimental since its consideration is one-sided. As such, mental illnesses get approached and treated as clusters of symptom to be cured, not life problems to be sorted and solved (Whooley, 2010). Conclusion The critics of DSM-IV-TR are far and wide, relating to how it influences all spheres of mental health care. This is visible relative to dimensional systems. The wide acceptability of the model as a psychiatry ‘bible’ is linked to the lack of literature detailing on the benefits, its use and limitations in clinical psychology and social sciences. The implications have necessitated the revision of DSM-IV-TR into DSM-IV. In addition, DSM need be used alongside other tools and guidelines. This paper concurs with Lerner & Overton (2010) citing APA (2000) that dimensional systems may eventually get accepted as clinical and research tools. This is with continued research and familiarity. References Brown, T., & Barlow, D. (2005). Dimensional Versus Categorical Classification of Mental Disorders in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders and Beyond: Comment on the Special Section. Journal of Abnormal Psychology 114 (4) , 551-556. Eriksen, K., & Kress, V. (2005). Beyond the DSM story : ethical quandaries, challenges, and best practices. California : Sage. Fawcett, J., & Kahn, A. (2007). The Encyclopedia of Mental Health 3rd Ed. New York: Facts On File. Fletcher, R. e. (2009). Clinical Usefulness of the Diagnostic Manual-Intellectual Disability for Mental Disorders in Persons with Intellectual Disability: Results from a Brief Field Survey Vol. 70. Journal of Clinical Psychiatry , 1-8. Franzoi, S. (2011). Psychology : a discovery experience. Australia : South-Western Cengage. Huprich, S., & Richard, D. (2009). Clinical Psychology : Assessment, Treatment, and Research. Amsterdam: Elsevier/AP. Kessler, R., & al, e. (2009). The global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys 18(1). Epidemiology Psychiatry Society , 23-33. Lerner, R. E., & Overton, W. E. (2010). The Handbook of Life-Span Development, Volume 1, Cognition, Biology, and Methods. Hoboken: John Wiley & Sons. Melillo, K., & Houde, S. (2005). Geropsychiatric and Mental Health Nursing. Sadbury: Jones and Bartlett Publishers. Nairne, J. (2009). Psychology. Belmont, CA: Wadsworth. Phillips, K., First, M., & Alan, H. (2003). Advancing DSM : dilemmas in psychiatric diagnosis. Washington, D.C: American Psychiatric Association. Regier, D. (2007). Dimensional approaches to psychiatric classification: refining the research agenda for DSM-V: an introduction. International Journal of Methods in Psychiatric Research 16 (S1) , S1-S5. Richard, D., & Huprich, S. (2009). Clinical Psychology : Assessment, Treatment, and Research. Boston: Elsevier. Tsuang, M., Tohen, M., & Jones, P. E. (2011). Textbook of Psychiatric Epidemiology 3rd Ed. . Chichester: Wiley-Blackwell. Whooley, O. (2010). Diagnostic ambivalence: psychiatric workarounds and the Diagnostic and Statistical Manual of Mental Disorders. Sociology of Health & Illness 32(3) , 452-469. . Read More