?Discuss the strengths and weaknesses of DSM-IV TR Essay

DSM-IV TR, which stands for Diagnostic and Statistical Manual of Mental Disorders ( 4th edition ) , Text Revision was published by the American Psychiatric Association in 2000 and serves as a usher book for many wellness professionals to name a patient with a mental upset. It besides helps wellness professionals to find what types of intervention could be carried out to assist the patient. The latest DSM is widely used, particularly in the USA and many European countries.1However, it may non be wholly followed by wellness professionals as they know that there are some failings of the latest version of DSM as good. This essay will discourse the strengths and the failings of the latest DSM and new alterations for the DSM-V, which is expected to be published in May, 2013.

DSM’s strength would be that it standardizes psychiatric diagnostic classs and criteria2, doing the diagnosing of a mental upset comparatively easier than it was in the yesteryear. It allows wellness professionals to name a patient, use the DSM to give them perchance the best intervention and overall, assist them to bring around the patients if the upset is curable. DSM besides has statistical informations such as the prevalence of a certain disease in different genders, age of oncoming of diseases, etc. This allows wellness professionals to hold a really broad scope of cognition which may be really utile for diagnosing and interventions. Besides, the DSM allows a common linguistic communication for discoursing diagnosing. It provides clear standards for certain upsets so that every clinician would come up with the same diagnosing. This makes certain that a individual is non diagnosed with different types of upsets in different clinics.Thus, handling patients more expeditiously.

Compared to the older versions of the DSM, the latest DSM besides has more subtypes and specifiers which increases the diagnostic specificity. As I mentioned earlier, this increases the opportunity of naming a patient with the same upset in different clinics, guaranting that they are diagnosed with the right upset as misdiagnosing them could perchance take to serious harm.

For some upsets, such as bipolar upset, there are severity indexs such as mild, moderate and terrible every bit good. This helps clinician to make up one’s mind the class of the intervention harmonizing to the badness of their upset. This is one of the strength of DSM as utilizing the same intervention for different badness of the same upset will non be really appropriate or efficient. However, this badness index is absent in some upsets such as manic episodes which is one of the failings of DSM-IV TR.

These were some of the strengths of DSM-IV TR. However, we know that another edition of DSM, DSM-V is expected to be published shortly. This is evidently because there are some, or many failings in the current DSM with which people are non satisfied.

One of the major failing of the current DSM and likely all the older editions is “Cultural Bias” . DSMs are chiefly published by Anglo-Americans and most of the behavior that is considered as “normal” in the DSM is really what is considered normal by the Anglo-Americans. That is, some of the behavior that is considered as unnatural in the DSM might be considered as normal in other civilizations. For illustration, in some civilizations, people tend to set a batch of accent and values filial piousness and due to that, they would act in a manner that might non be considered as normal by the Anglo-Americans. Would that sort them as abnormal? What precisely is normal anyways? Harmonizing to the DSM, it it, I believe, what is considered as normal by the Anglo-Americans. This is one of the failings of the DSM which is well-known and I think it is because of this ground that DSM might non be as popular in states where the civilization is much different compared to states like the USA and many European states.

Another failing would be that DSM promotes a mechanical attack to mental upset appraisal. The clinicians may concentrate overly on the marks and symptoms of mental upsets and they might non set much accent on a more in-depth apprehension of the clients/patients jobs. This job have improved but it is still a job caused by the DSM. DSM-IV TR besides does non see patients subjective experience of a upset. That is, the attack is non a dimensional attack as there is no first-person study but instead, observations are normally carried out which may pretermit the more bodily and psychological procedures that underlie the symptoms ( Flanagan, Davidson & A ; Strauss, 2007 ) .3 Besides, DSM causes most clinicians to be chiefly concerned with the marks and symptoms of a upset instead than the implicit in cause by giving a list of certain standards for diagnosing.

Another failing and argument about the DSM is that it is an unscientific system and it is the sentiment of a few powerful head-shrinkers. This has raised a batch of inquiries and have caused people to oppugn the cogency and dependability of the diagnostic classs as good. The cogency and dependability were particularly questioned after the Rosenhan experiment in the 1970s in which it was concluded that the sane could non be distinguished from the insane in psychiatric infirmaries. Therefore, even though the dependability and cogency has improved now when compared to the 1970s, it is still a failing which I believe could non be wholly fixed. However, cogency jobs of the diagnostic standards particularly arise when kids or striplings are involved.

For illustration, the DSM-IV TR standards for bipolar and frenzied upset were originally developed for grownups but right now, after a few alterations, it is used for kids every bit good. This increases the opportunity of misdiagnosing kids with bipolar upset. This information is supported by the fact that in the last 10 old ages, there has been a 40 % 4 addition in the figure of kids diagnosed with bipolar upset. It is believed that there is non a crisp addition in the figure of kids with bipolar upset but instead that the clinicians have been using the diagnostic standards ( which were originally developed for grownups ) much more sharply to children.5This is one of the failing of DSM-IV TR that needs to be improved in the hereafter as the effects could be lay waste toing.

One of the failing, which I believe is non really important but still is a job and which is really questioned by people is the definition of the mental upset. This was besides mentioned in the talks. Harmonizing to DSM-IV TR, a mental upset is “associated with present hurt or disablement or important increased hazard of decease, hurting, disablement and of import loss of freedom” . This raises the question.. what about those persons who engage in activities that threatens their lives but they really bask it? Such as mountain climbers, aqualung frogmans, etc. Obviously they are no considered as unnatural but harmonizing to the definition of the DSM, they are considered as holding a mental upset. But we know that this is non right. Therefore, there is a job with the definition of the word ‘mental disorder’ .

There are many other failings every bit good such as with Personality Disorder diagnosing. It is believed that the description of symptoms is really wide. This means that patients diagnosed with the same upset could really hold really different clinical presentations. For personality upsets, DSM uses a categorical approach6. However, it would be better to utilize a dimensional attack so that the different types/ grade of upset could be distinguished and therefore, could be given different and more efficient interventions.

Another major failing of the Axis II personality upset is that there is a really high grade of overlapping or co-occurence with each other. This is besides a job for Axis I mental disorders.7

There are many other failings with specific upsets of DSM particularly about the diagnosing standard and some other issues such as whether ‘Paraphilias’ should be included or non. Most of the major 1s has been discussed above. Now, the new alterations for DSM-V will be discussed.

There are many new alterations for the DSM-V. I will chiefly advert those that are related to the failings mentioned above. However, the new alterations are discussed, the 4 rules behind the current procedure for revising DSM should be discussed. ( Obtained from APA DSM-V Development’s functionary web site )

1 ) Clinical Utility- the manual should be utile to those who diagnose and treat patients with mental unwellnesss
2 ) Recommendations should be guided by grounds
3 ) DSM-V should keep continuity with old editions whenever possible
4 ) No priori restraints should be placed on the degree of alteration permitted between DSM-IV and DSM-V


From these 4 rules, it becomes clearer to us why DSM-IV is being revised and what alterations should be expected. One of the alterations is that in order to better measure the badness of symptoms, a dimensional appraisal will be included. For illustration, other factors such as sleep quality, temper, etc will be considered irrespective of the diagnosing. This will assist to cut down the job of “mechanical approach” as mentioned before. They will besides assist to turn to symptoms that are non included within the diagnostic standards for specific unwellnesss ( e.g. the job of insomnia for patients diagnosed with Schizophrenia ) .

DSM-V might besides include something that could work out the job of how to manage patients with co-occuring upsets, which is a major failing of DSM-IV TR. Besides that, DSM-V will besides hold improved diagnostic standards that are non precise in DSM-IV TR.

Besides, a few words would be changed every bit good in the new DSM. For illustration, the word “Mental Retardation” would be changed to “Intellectual Disability” . Another alteration that would besides be included would somehow, indirectly address the job of cultural prejudice. In the new DSM, careful consideration would be given to the gender, race and ethnicity. This, I believe could assist to decrease the badness of the cultural job as mentioned before.

Besides that, another ‘proposal’ is that, the standards should be more rigorous for the diagnosing of bipolar upset in kids. This besides addresses one of the failing mentioned earlier. This is a really of import proposal as I believe it is non really humanist to misdiagnose kids with “Mental Disorders” . It could impact their life significantly.

Another major alterations is in the appraisal and diagnosing of personality upsets. As mentioned before, a dimensional attack will be used instead than a categorical attack. This can assist to find the different badnesss of upsets and find the ‘subtypes’ more accurately. Overall, it would do the diagnosing much more accurate and therefore, more efficient intervention could be used.

These alterations were chiefly in response to the failings mentioned supra. Other alterations include making a new class called “Behavioural addiction” . This class is entirely based on chancing. Internet dependence was besides proposed. However, due to the deficiency of research in that field, it was rejected. This shows that they somehow followed rule 2 which emphasizes on the importance of grounds. Another class called the “Risk Syndromes” is besides being considered. This will assist clinicians place earlier phase of mental upsets. The class of substance maltreatment and dependance will be removed and it would be replaced by a new class called “Addiction and Related Disorders” . This is done to assist clinicians separate between similar types of upsets more easy and lower the opportunity of misdiagnosis ( e.g. dependance is frequently confused with compulsive drug-seeking behavior dependence ) . 8Another alteration is that the standards for some eating upsets such as Anorexia Nervosa has been improved.

Overall, the diagnostic standards for many upsets has been improved and a dimensional attack is being used in DSM-V instead than the categorical attack used in the old editions. All of these alterations, together with many other minor 1s, purpose to better the diagnosing procedure and therefore, ensures that people are saved from misdiagnosis ( which could take to lay waste toing effects ) and so that they can have better intervention which would increase their opportunities of being cured ( if the upset is curable ) .

Bibliography

Berman, J. ( n.d. ) . Understanding the DSM-IV TR. Retrieved on 15th March, 2013, from hypertext transfer protocol: //www.ceuschool.com/librarydocs/SOC222.pdf Dombeck, M. , Hoermann, S. , Zupanick, E.C. ( 2011 ) . Personality Disorders: Problems with current diagnostic system. MentalHelp. Retrieved on 14th March, 2013, from hypertext transfer protocol: //www.mentalhelp.net/poc/view_doc.php? type=doc & A ; id=569 Flanagan, E. , Davidson, L. & A ; Strauss, J. ( 2007 ) . “Issues for DSM-V: Incorporating
Patients’ Subjective Experiences.” Am. J. Psychiatry, 164 ( 3 ) , 391 – 392. Kleinplatz, P.J. , Moser. C. ( 2005 ) . DSM-IV-TR and the Paraphilias: An Argument for Removal. Retrieved on 14th March, 2013, from hypertext transfer protocol: //www2.hu-berlin.de/sexology/GESUND/ARCHIV/MoserKleinplatz.htm Kronemyer, D. ( 2009 ) . Phenomenological Psychology. Retrieved on 14th March, 2013, from hypertext transfer protocol: //phenomenologicalpsychology.com/2009/06/how-can-dsm-iv-be-improved-as-it-transitions-to-dsm-v/ American Psychiatric Association. ( 2000 ) . Diagnostic and statistical manual of mental upsets ( 4th ed. , text rev. ) . Washington, DC. Bipolar Disorder in Children. Wikipedia. Retrieved on 14th March, 2013, from hypertext transfer protocol: //en.wikipedia.org/wiki/Bipolar_disorder_in_children Diagnostic and Statistical Manual of Mental Disorders. Wikipedia. Retrieved on 14th March, 2013, from hypertext transfer protocol: //en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders DSM-5. Wikipedia. Retrieved on 14th March, 13 from hypertext transfer protocol: //en.wikipedia.org/wiki/DSM-5 DSM-5 development: Frequently Asked Questions. American Psychiatric Association.Retrieved on 14th March, 2013, from hypertext transfer protocol: //www.dsm5.org/pages/default.aspx Rosenhan Experiment. Wikipedia. Retrieved on 14th March, 2013, from hypertext transfer protocol: //en.wikipedia.org/wiki/Rosenhan_experiment

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