DSM Overview and Five-Axis System

Study Notes

Classifications System

A diagnostic checklist used to identify and establish mental disorders.
Employs a process of elimination to refine diagnoses.

DSM Overview

Stands for Diagnostic and Statistical Manual, a classification system for over 300 mental and behavioral disorders.
Published by the American Psychiatric Association.
Provides a standardized approach for mental health diagnoses.

DSM IV: Five-Axis System

Axis 1: Clinical disorders (e.g., schizophrenia, depression).
Axis 2: Personality and mental retardation disorders (e.g., OCD, autism).
Axis 3: Medical conditions (e.g., brain injuries).
Axis 4: Psychosocial and environmental problems (e.g., poverty, family issues).
Axis 5: Global Assessment Scale measuring daily functioning (scales from 0 to 100).

History of the DSMs

DSM 1 (1952): Focused on soldier treatment, identified 162 disorders.
DSM 2 (1968): Included 182 diagnoses based on psychoanalytic principles and Freudian theories.
DSM 3 (1980): Removed homosexuality as a disorder, expanded diagnosis list to 265 including PTSD, and introduced a 5-axis system.
DSM 4 (1994): Increased diagnoses to 297, incorporated cultural sensitivity and multi-disorder considerations.
DSM 5 (2013): Expanded to over 300 disorders, abolished the 5-axis system, combined several axes into a more detailed structure.

DSM V / DSM-5 Structure

Section 1: Guidance on the new classification system.
Section 2: Categorizes disorders by symptoms and similarities.
Section 3: Proposes new disorders and suggests considering the influence of culture on symptoms.

Making a Diagnosis Using DSM

Relies on structured and unstructured interviews alongside direct observations.
Involves the process of ruling out non-matching disorders, which can be time-consuming.

Reliability of DSM

Measured using Cohen's Kappa, with values closer to 1 indicating better reliability (0.7 is considered good).
Inter-rater reliability reflects consistency across different clinicians.
Pros include improved psychological understanding and increased detail in revisions; PTSD shows a kappa of 0.60, schizophrenia 0.40.
Cons entail variability in reliability across disorder categories; depression has a low kappa of 0.28.

Case Studies on Reliability

Goldstein (1988): High inter-rater reliability found in re-diagnosing 199 patients for schizophrenia using DSM 2.
Brown (2001): Found discrepancies in diagnosing anxiety and mood disorders in a sample of 362 outpatients, highlighting challenges in defining boundary symptoms.

Validity of DSM

Factors assessed:
- Descriptive: Similar symptoms among diagnosed individuals.
- Etiological: Shared causes of disorders.
- Concurrent: Different diagnostic techniques yielding consistent results.
- Predictive: Ability to forecast outcomes based on diagnoses.
Construct validity relates to quantifying mental disorder symptoms effectively.
Pros include strong predictive and convergent validity in diagnosing childhood conduct disorder, with associated risk factors identified.
Cons include potential stigma, misdiagnosis due to cultural assumptions, and inability to determine causes of disorders.

DSM and Cultural Differences

Pros: Validity if disorders have clear definitions; schizophrenia shows consistency across cultures.
Cons: Cultural variations may influence interpretations; certain symptoms (e.g., hallucinations) may be deemed positive experiences in some cultures.

Culture-Bound Syndromes

Defined as disorders limited to specific cultural contexts that may not be acknowledged by the DSM.
Examples include hikikomori (social withdrawal disorder) and latah (dissociative disorder characterized by involuntary laughter and energy bursts).

Description

Explore the Diagnostic and Statistical Manual (DSM) which serves as a vital classification system for over 300 mental and behavioral disorders. Learn about its history, the five-axis diagnostic system, and how it standardizes mental health diagnoses in clinical practice.