010 What is the DSM IV?

What is the DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS, FOURTH EDITION (DSM IV)?

The purpose of DSM IV is to provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study, and treat people with various mental disorders. (DSM IV, p. xxvii).

The DSM IV provides a means of classifying psychiatric and psychological disorders for treatment and research purposes (American Psychiatric Association, 1994).

The DSM IV employs a multiaxial classification system:

1. Axis I. Clinical disorders and other conditions that may be a focus of clinical attention

2. Axis II. Personality disorders and mental retardation

3. Axis III. General medical conditions

4. Axis IV. Psychosocial and environmental problems

5. Axis V. Global assessment of functioning

The clinical disorders included on Axis I encompass all mental disorders except personality disorders and mental retardation. The Axis I disorders are classified into 15 broad categories, such as mood, anxiety, and adjustment disorders. Nonpsychiatric conditions that may be a focus of clinical attention are noted on Axis I. These conditions include the V codes, which pertain to relational problems, bereavement, identity problems, phase of life problems, academic problems, occupational problems, and other issues often addressed in counseling. Each disorder is defined in terms of specific criteria.

Axis II differs from Axis I by focusing on personality disorders or mental retardation conditions that may underlie the presenting problem. Axis ll disorders are a maladaptive personality function.

Personality disorders (Axis II) refer to lifelong maladaptive behavior patterns that are often triggered by specific events in the person’s life. DSM IV defines a total of 10 personality disorders grouped in three categories as indicated below:

Cluster A: Emotional withdrawal and odd behavior includes paranoid, schizoid, and schizotypal personality disorders

Cluster B: Exaggerated, dramatic emotionality includes antisocial, borderline, histrionic, and narcissistic disorders

Cluster C: Anxious, restive submissiveness includes avoidant, dependent, and obsessive compulsive disorders

Personality disorders represent extreme forms of personality traits (i.e., enduring and pervasive patterns of behavior) that have become dysfunctional for the person. The trait is expressed in such a rigid or inappropriate manner that it interferes with that person’s adjustment.

People with personality disorders usually lack insight into the source of their difficulties. Clients do not usually seek counseling because of a personality disorder itself but because of difficulties associated with the disorder.

The third axis of DSM IV lists any current physical illness or cognition problem of the individual.

The fourth axis identifies psychosocial stressors faced by the client, such as problems with a primary support group or occupational problems.

The fifth axis rates the client’s general level of functioning on a 100 point scale at the time of evaluation.

The five axes together offer an integrated view of a client’s problems from the standpoint of a biopsychosocial model of human functioning.

Mental Disorders

        Inability to function

        Verbalizes in distress

        May be harmful to self or others

3 rules: Mental disorders are:

1. Not due to direct affect of a substance

2. Not due to a medical problem

3. Not due to a significant impairment in function

Affect is a subjective feeling that is overt and another person can see, the feelings change frequently, are transitory, short duration, goes and comes, not permanent.

Mood is more general and pervasive, sustained emotion that is heavy, lasts longer, and affects the body.

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