The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual that is used by psychologists and therapists for diagnosing mental disorders. Today we are on the fourth edition of this manual, DSM-IV-TR, and the fifth is expected in the year 2011.
There is a European version called the ICD, which is basically the same thing, but more strict on the criteria
There are some wonderful articles written here on Helium about the history of the DSM and what it is.
Let me shed a light on the upsides and the downsides of such a manual.
The reasons that the DSM came into life were:
– Creating a manual that people could use around the world, independent of their psychological school
– Creating a manual that would give a single diagnose,
– And creating a manual where different psychologists would get the same diagnose.
Now, did the mission succeed?
The DSM is not used around the whole world, but mostly in the Western world and is also very Western colored. It does make it easier for people to communicate, a schizoid personality disorder is one in Paris, just as it is in Texas. People across borders know what they are talking about when they hear something like that.
Is it independent of the school? Not really. In psychology we see a lot of “fashion”. Some disorders are more “popular” during certain times, and certain institutions will diagnose independent of that also more disorders of a certain kind. This is something that no manual can put a stop to.
The dream of a single diagnose also did not come true. Using the DSM, one person might have different disorders, what we call co-morbidity. This can be a problem for the treatment.
Also, taken one person, different psychologists may give the same person different diagnoses, using that same manual. Why you might ask?
The criteria inside the DSM are often chosen very arbitrary. For a certain disorder, a person has to have for example 5 out of 10 characteristics given by the manual. Why there have to be 5 but not 4 or 6, is not very clear. What if that person has 4, but very intrusive ones? For many institutions, the amount of grands they get, is dependent on the amount of certain diagnoses in their clinic… what do you think they will do? Also, there can be a very big difference between a person that has the first 5 characteristics, compared with an other person that has the last 5. This are all very important things if you want to choose a therapy for that person.
Conclusion? Our current DSM-IV-TR is a handy instrument for broad diagnostics. It has a lot of flaws though, and it can not be used standing on his own.
