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A dsm iv diagnosis as applied to

Arman Zhenikeyev Nature and purposes The Diagnostic and Statistical Manual of Mental Disorders is a reference work consulted by psychiatrists, psychologists, physicians in clinical practice, social workersmedical and nursing students, pastoral counselors, and other professionals in health care and social service fields.

The book's title is often shortened to DSMor an abbreviation that also indicates edition, such as DSM-IV-TR, which indicates fourth edition, text revision of the manual, published in 2000. The DSM-IV-TR provides a classification of mental disorders, criteria sets to guide the process of differential diagnosisand numerical codes for each disorder to facilitate medical record keeping.

The stated purpose of the DSM is threefold: The multi-axial system is designed to provide a more comprehensive picture of complex or concurrent mental disorders. According to the DSM-IVTR, the system is also intended to "promote the application of the biopsychosocial model in clinical, educational and research settings.

In other words, the DSM-IV-TR is atheoretical in its approach to diagnosis and classification— the axes and categories do not represent any overarching theory about the sources or fundamental nature of mental disorders.

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The biopsychosocial approach was originally proposed by a psychiatrist named George Engel in 1977 as a way around the disputes between psychoanalytically and biologically oriented psychiatrists that were splitting the field in the 1970s. The introduction to DSM-IV-TR is quite explicit about the manual's intention to be "applicable in a wide variety of contexts" and "used by clinicians and researchers of many different orientations e. DSM notes the existence of an "imperfect fit between questions of ultimate concern to the law and the information contained in a clinical diagnosis.

Clinical disorders, including anxiety disorders, mood disorders, schizophrenia and other psychotic disorders.

  • The term cognitive dysmetria has been used to characterize such disorder found in schizophrenia;
  • Another example is body dysmorphic disorder , which resembles the obsessive-compulsive disorders more than it does the somatoform disorders.

Personality disorders and mental retardation. This axis includes notations about problematic aspects of the patient's personality that fall short of the criteria for a personality disorder. These include diseases or disorders that may be related physiologically to the mental disorder; that are sufficiently severe to affect the patient's mood or functioning; or that influence the choice of medications for treating the mental a dsm iv diagnosis as applied to.

Psychosocial and environmental problems. These include conditions or situations that influence the diagnosis, treatment, or prognosis of the patient's mental disorder. Global assessment of functioning. Rating the patient's general level of functioning is intended to help the doctor draw up a treatment plan and evaluate treatment progress.

The GARF is a measurement of the maturity and stability of the relationships within a family or between a couple. Diagnostic categories The Axis I clinical disorders are divided among 15 categories: The diagnostic categories of DSM-IV-TR are essentially symptom-based, or, as the manual puts it, based "on criteria sets with defining features. A phenomenological approach to classification is one that emphasizes externally observable phenomena rather than their underlying nature or origin.

Such terms as "psychopathology," "mental illness," "differential diagnosis," and "prognosis" are all borrowed from medical practice. One should note, however, that the medical model is not the only possible conceptual framework for understanding mental disorders.

Diagnostic Criteria for 299.00 Autistic Disorder

Historians of Western science have observed that the medical model for psychiatric problems was preceded by what they term the supernatural model mental disorders understood as acts of God or the result of demon possessionwhich dominated the field until the late seventeenth century.

The supernatural model was followed by the moral model, which was based on the values of the Enlightenment and regarded mental disorders as bad behaviors deliberately chosen by perverse or ignorant individuals. The medical model as it came to dominate psychiatry can be traced back to the work of Emil Kraepelin, an eminent German psychiatrist whose Handbuch der Psychiatrie was the first basic textbook in the field and introduced the first nosology, or systematic classification, of mental disorders.

By the early 1890s Kraepelin's handbook was used in medical schools across Europe. He updated and revised it periodically to accommodate new findings, including a disease that he named after one of his clinical assistants, Alois Alzheimer. The classification in the 1907 edition of Kraepelin's handbook includes 15 categories, most of which are still used nearly a century later. Kraepelin is also important in the history of diagnostic classification because he represented a biologically based view of mental disorders in opposition to the psychoanalytical approach of Sigmund Freud.

Nature and purposes

Kraepelin thought that mental disorders could ultimately be traced to organic diseases of the brain rather than disordered emotions or psychological processes. This controversy between the two perspectives dominated psychiatric research and practice until well after the Second World War.

Isaac Ray, superintendent of the Butler Hospital in Rhode Island, presented a paper at the 1849 meeting of the Association of Medical Superintendents of American Institutions for the Insane the forerunner of the present American Psychiatric Association in which he called for a uniform system of naming, classifying and recording cases of mental illness.

The same plea was made in 1913 by Dr.

101133: DSM-IV Made Easy

The Statistical Manual went through several editions between 1933 and 1952, when the first edition of the Diagnostic and Statistical Manual of Mental Disorders appeared. The task of compiling mental hospital statistics was turned over to the newly formed National Institute of Mental Health in 1949. Many of the disorders in this edition were termed "reactions," a term borrowed from a German psychiatrist named Adolf Meyer. Meyer viewed mental disorders as reactions of an individual's personality to a combination of psychological, social, and biological factors.

DSM-I also incorporated the nomenclature for disorders developed by the United States Army and modified by the Veterans Administration to treat the postwar mental health problems of service personnel and veterans. The VA classification system grouped mental problems into three large categories: DSM-III introduced the present descriptive symptom-based or phenomenological approach to mental disorders, added lists of explicit diagnostic criteria, removed references to the etiology of disorders, did away with the term "neurosis," and established the present multi-axial system of symptom evaluation.

This sweeping change originated in an effort begun in the early 1970s by a group of psychiatrists at the medical school of Washington University in St. Louis to improve the state of research in American psychiatry.

  1. Intermediate disorders would be represented by events with mixed symptoms of depression and anxiety.
  2. Personality disorders and mental retardation.
  3. The cerebellum coordinates cognition, language and motor skills.
  4. This is the reason why many patients are given many different diagnosis simultaneously, once the symptoms overpass the rigid borders the manual proposes. The diagnostic categories of DSM-IV-TR are essentially symptom-based, or, as the manual puts it, based "on criteria sets with defining features.

Louis group began by drawing up a list of "research diagnostic criteria" for schizophrenia, a disorder that can manifest itself in a variety of ways. The leaders of this transformation were biological psychiatrists who wanted to empty the diagnostic manual of terms and theories associated with hypothetical or explanatory concepts.

The transition from an explanatory approach to mental disorders to a descriptive a dsm iv diagnosis as applied to phenomenological one in the period between DSM-II and DSM-III is sometimes called the "neo-Kraepelinian revolution" in the secondary literature. Another term that has been applied to the orientation represented in DSM-III and its successors is empiricalwhich denotes reliance on experience or experiment alone, without recourse to theories or hypotheses.

By the early 1990s, most psychiatric diagnoses had an accumulated body of published studies or data sets. Conflicting reports or lack of evidence were handled by data reanalyses and field trials. The field trials recruited subjects from a variety of ethnic and cultural backgrounds, in keeping with a new concern for cross-cultural applicability of diagnostic standards.

The textual revisions that were made to the 1994 edition of DSM-IV fall under the following categories: They include the following observations and complaints: The medical model underlying the empirical orientation of DSM-IV reduces human beings to one-dimensional sources of data; it does not encourage practitioners to treat the whole person.

The medical model perpetuates the social stigma attached to mental disorders. The symptom-based criteria sets of DSM-IV have led to an endless multiplication of mental conditions and disorders. The unwieldy size of DSM-IV is a common complaint of doctors in clinical practice— a volume that was only 119 pages long in its second 1968 edition has swelled to 886 pages in less than thirty years.

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The symptom-based approach has also made it easier to politicize the process of defining new disorders for inclusion in DSM or dropping older ones. The inclusion of post-traumatic stress disorder PTSD and the deletion of homosexuality as a disorder are often cited as examples of this concern for political correctness.

The criteria sets of DSM-IV incorporate implicit implied but not expressly stated notions of human psychological well-being that do not allow for ordinary diversity among people. Some of the diagnostic categories of DSM-IV come close to defining various temperamental and personality differences as mental disorders.

The DSM-IV criteria do not distinguish adequately between poor adaptation to ordinary problems of living and true psychopathology. One byproduct of this inadequacy is the suspiciously high rates of prevalence reported for some mental disorders. One observer remarked that ". For example, PTSD has more in common with respect to etiology and treatment with the dissociative disorders than it does with the anxiety disorders with which it is presently grouped.

Another example is body dysmorphic disorderwhich resembles the obsessive-compulsive disorders more than it does the somatoform disorders. The current classification is deficient in acknowledging disorders of uncontrolled anger, hostility, and aggression. Even though inappropriate expressions of anger and aggression lie at the roots of major social problems, only one DSM-IV disorder intermittent explosive disorder is explicitly concerned with them.

In contrast, entire classes of disorders are devoted to depression and anxiety. The emphasis of DSM-IV on biological psychiatry has contributed to the widespread popular notion that most problems of human life can be solved by taking pills. Alternative nosologies A number of different nosologies or schemes of classification have a dsm iv diagnosis as applied to proposed to replace the current descriptive model of mental disorders.

Three of them will be briefly described. The dimensional model Dimensional alternatives to DSM-IV would replace the categorical classification now in use with a recognition that mental disorders lie on a continuum with mildly disturbed and normal behavior, rather than being qualitatively distinct.

For example, the personality disorders of Axis II are increasingly regarded as extreme variants of common personality characteristics. In the dimensional model, a patient would be identified in terms of his or her position on a specific dimension of cognitive or affective capacity rather than placed in a categorical "box.

A biochemist who was diagnosed with schizophrenia and eventually recovered compared the reductionism of the biological model of his disorder with a dsm iv diagnosis as applied to empowering qualities of holistic approaches.

He stressed the healing potential in treating patients as whole persons rather than as isolated collections of nervous tissue with chemical imbalances: This entails focusing on the individual and building a sense of responsibility and self-determination. This model identifies four broad "essences" or perspectives that can be used to identify the distinctive characteristics of mental disorders, which are often obscured by the present categorical classifications.

The four perspectives are: This perspective works with categories and accounts for physical diseases or damage to the brain that produces psychiatric symptoms. It accounts for such disorders as Alzheimer's disease or schizophrenia. This perspective addresses disorders that arise from the combination of a cognitive or emotional weakness in the patient's constitution and a life experience that challenges their vulnerability. This perspective is concerned with disorders associated with something that the patient is doing alcoholism, drug addictioneating disorders, etc.

This perspective focuses on disorders related to what the patient has encountered in life, such as events that have injured his or her hopes and aspirations.

In the Johns Hopkins model, each perspective has its own approach to treatment: Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, 2000. A Century of Psychiatry. American Psychological Association, 2000. The View from Johns Hopkins. A Brief Historical Note. National Institute of Mental Health. Where Should We Be? Other articles you might like: