The DSM is an abbreviation for the Diagnostic and Statistical Manual of Mental Disorders. The book holds the diagnostic criteria for all mental health disorders.
The DSM is published by the American Psychiatric Association and is currently in the fifth edition, released in 2013. The book is used by clinicians and other mental health professionals to determine if a person meets the specific criteria for a mental disorder. The DSM is not difficult to use, however, extensive training, education, and testing are required before people should start to make a formal diagnosis.
History of the DSM
Over time, the DSM has added and removed certain disorders, for a variety of reasons. Awareness, outlier diagnostic rates (too many people being diagnosed, or not enough), similarity to other disorders, and other factors can influence the inclusion or exclusion in the DSM.
First Edition
- Published: 1952
- Number of disorders: 106
- Needed improvement on clarity of disorders
Second Edition
- Published: 1968
- Number of disorders: 182
- Added many disorders and clarified categories
Third Edition
- Published: 1980 (revision 1987)
- Number of disorders: 265 (revision 292)
- Homosexuality was is in essence renamed and classified before being completely removed in 1987 on the reprint
Fourth Edition
- Published: 1994 (Revision 2000)
- Number of disorders: 297
- Added the all important, “clinically significant distress or impairment in social, occupational, or other important areas of functioning” to half of the disorders
Fifth Edition
- Published: 2013 (Revision in 2022)
- Number of disorders (Roughly 300)
- Several new categories, now 20, of mental disorders. Severity of disorders is now more clear. Not nearly the updates that should have occurred and some disorders are outdated and should have never been included.
Authors
The DSM is published by the American Psychiatric Association, commonly called the APA. The APA has a mission to, “Advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives.” American Psychiatric Association. The group is made up of many professionals from the field and experts in psychology. It is also important to note that the DSM is written by a panel where 70% of members receive kick-backs from pharmaceutical companies. This absolutely plays a role in the writing of this book and matters to potential bias and motivation.
Things to remember
First, it is extremely important to remember that the entire context of a person’s life needs to be evaluated and understood. Understanding, biological, social, relationships, and other factors is crucial to fully grasping a person. Gather as much information about a person as possible before making a diagnosis, circumstances can have great influence on a person’s mental health and should be factored in.
Also, it is essential to recognize that mental health disorders fall on a continuum. There are levels of severity usually mild, moderate, and severe. Every case is unique, the issues a person may experience will vary, as will the intensity, duration, and frequency.
How to use the DSM
The DSM is not difficult to use, but it should be treated with respect as diagnosis is a serious process that can have consequences. To understand how to use the DSM start by thinking of it is as a checklist. The book is broken down into categories, with similar disorders and traits common among them. This is how a clinician starts the process, analyze behaviors, go to that section and figure out the specific disorder in that category a person may have, if any.
For each disorder there are a specific set of criteria that the APA has identified as symptoms for each disorder. Usually there will be X amount of symptoms identified (like 9) and a person must show Y amount of those symptoms (like 4 out of 7, or 5 out of 9). Each disorder has unique criteria, read carefully to understand the traits required to make an accurate diagnosis.
Some disorders will have specific criteria that identify how severe the disorder is. Often it will say there needs to be a certain number of criteria, or severity, this will help a clinician to better understand severity and risks with that particular disorder.
Here is the criteria, according to the DSM for Histrionic Personality Disorder:
A pervasive pattern of excessive emotionality and attention seeking beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Is uncomfortable in situations which he or she is not the center of attention
- Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
- Displays rapidly shifting and shallow expression of emotions
- Consistently uses physical appearance to draw attention to self
- Has a style of speech excessively impressionistic and lacking in detail
- Shows self-dramatization, theatricality, and exaggerated expression of emotion
- Is suggestible (easily influenced by others and circumstance)
- Considers relationships to be more intimate than they actually are
(American Psychiatric Association, 2023, p 756)
When considering a diagnosis, the clinician would go through each piece of criteria to determine if a person does meet the requirements. Analyzing each piece of criteria and deciding yes or no (or sometimes) then counting up the amount of each “yes” determines if a person meets the criteria for a diagnosis.
Gathering as much information, including from family, friends, teachers, or others (when possible) is best practice. Diagnosis is not brain surgery, it is actually very basic and to the point. Determining if a person meets the criteria or not should be done responsibly and only by licensed professionals for everyone’s safety and well being.
Remember, diagnosis should be done by professionals. Diagnosing yourself and family members when not qualified can have major consequences and backlash. Self diagnosis and diagnosis by non-clinicians can be extremely dangerous. Speak with a professional if you are having concerns about your own mental health, and have him or her talk through everything with you before jumping to conclusions.
References
American Psychiatric Association. (2022). The Diagnostic and Statistical Manual of Mental Health-5th Edition-Text Revision. Washington, DC.: American Psychiatric Association.