What is the DSM IV?

The DSM IV is the fourth edition of the Diagnostic and Statistical Manual, the much relied upon and contested diagnostic tome of mental health treatment in the US and in other places. As of 2013, it will be replaced by the DSM V. The book is still very useful, offering comprehensive evaluation, diagnosis and classification of mental disorders.

It’s not easy to read the DSM IV without some sense of its structure, and even then, the average layperson may find the medical terms difficult. Principally, the book is split into five sections, or "axes," and each axis approaches a different subject. The five axes discuss different major issues in diagnosis, and are divided as clinical syndromes, personality and developmental disorders, physical illnesses, the stress of psychosocial factors, and evaluation of patient functioning levels.

The first two axes may be the most often used, while the latter three help to make diagnosis more detailed. It really depends on the condition, and not everyone uses the DSM IV all that regularly. It may be helpful in deriving codes for diagnosis and billing, since most codes used in the book align with those used by insurance industries. This isn’t always completely accurate and some psychotherapists or psychiatrists use other coding manuals instead.

Most people working in the mental health profession would concede to the usefulness of the DSM IV, but might also argue that it’s still an imperfect document. There exist strong arguments about placement of certain disorders or the definitions of other ones. People were deeply pleased that the DSM-IV dropped certain unsavory and prejudicial definitions that previous editions held, such as defining homosexuality as a mental disorder. There has also been much discussion on how to categorize autism, and it has been moved from Axis II to I in recent years. People frequently propose new disorders or newer criteria that don’t always make it into the DSM, and this can cause annoyance or consternation.

An additional argument sometimes leveled against the DSM IV and its prepossessors is that it expresses extreme clinical bias against some depth psychological or modern psychodynamic approaches, which are opposed to automatic diagnosis prior to getting to know a patient. This criticism actually speaks to a much larger issue in the world of mental health, where clinicians either find themselves anxious to diagnose initially or deeply concerned about the disease model of patients that comes from this premature activity, and its effect on the therapeutic alliance. The DSM, as concerned as it is with the most scientifically accurate means of diagnosis, is sometimes viewed with disdain because it appears to strongly support the former view.