What Is The DSM-V And What Can We Learn From It?
If you are familiar with mental health at all, you’ve probably heard of the DSM-V. Its official title is the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, and it is the book therapists use to diagnose mental health conditions for millions of people in the United States (and much of the world) annually. But how did the DSM come to be? How has the DSM changed from one edition to the next? How dependable is the DSM? Let’s explore all of these questions and more as we delve into the history and use of the DSM-V.
What is the history of the DSM-V?
Before we go into the DSM itself, we should probably look at the DSM in general. It contains the most updated measures of diagnosing abnormal psychology disorders.
The DSM is a manual from the American Psychiatric Association and lists criteria in a common language to help classify different mental health disorders. Psychiatrists, clinicians, health insurance companies, the legal system, and many other people involved with medicine use the DSM to diagnose a patient with a mental disorder.
The need to classify different mental disorders had been around since the 1800s, but that need was because of a different motivation. They divided mental health into mania, dementia, paresis, melancholia, monomania, epilepsy, and dipsomania. It was still simplified, but you can see the improvement.
It wasn’t until 1917 when people wanted a different plan to gather health statistics. The plan was developed by the American Medico-Psychological Association, which is now what is known as the APA. Together with the New York Academy of Medicine, they developed a manual called the American Medical Association’s Standard Classified Nomenclature of Disease, which helped diagnose psychiatric disorders and disorders that are neurological.
The World Health Organization published the International Statistical Classification of Diseases and Related Health Problems. The US Army published its classification system, which looked at soldiers at the end of World War II. The WHO published the ICD-VI, and the Army’s classification influenced this one, adding mental disorders to the list. It had different categories, including psychoses and disorders of one’s behavior or character.
In 1952, a variant of the ICD-VI was published, and this became the DSM. This was the first manual for clinical use. Since then, the DSM has been revised as our understanding of mental illness has evolved. If you look at the DSM’s older editions, you’ll find inaccurate information about mental illnesses, with some content even being offensive in modern times. For example, the DSM once listed homosexuality as a mental disorder of sexual perversion, and it remained in the DSM until being dropped entirely in the DSM-III-R. There are five editions of the DSM and smaller revisions to those versions before the next major edition comes out.
The DSM-V was first published in 2013, making it still recent in the grand scheme of the DSM’s history. This book is the main authority for diagnosing psychiatric disorders, and it is how many healthcare providers will treat a given disorder. The last edition before the DSM-V was the DSM-IV-TR, first published in 2000. It was the result of many years of research and development. Compared to the previous edition, however, there aren’t too many differences between the DSM-IV-TR and the DSM-5, but there are some notable changes.
Here is a brief list of changes the DSM-V has brought us.
- Asperger Syndrome used to be its separate disorder from autism. In fact, many still think it is. But the DSM-V has classified Asperger syndrome as a part of autism spectrum disorder (ASD).
- In depressive disorders, there was once this concept called bereavement exclusion. Here, someone who was experiencing grief from losing someone did not qualify for a depressive disorder diagnosis, as it was believed grief is separate from depression. Since then, it’s been revealed there is a bit more of a connection than originally thought.
- Schizophrenia no longer has subtypes. Used to, there would be multiple subtypes. You have probably heard of paranoid schizophrenia, for instance. Now, the disorder has been simplified.
- Gender identity disorder is known as gender dysphoria, and how it’s treated is now different than it once was as transgender rights are being explored.
- Binge eating disorder is now a unique eating disorder.
As you can see, how we view mental illness is always changing. How we classify a certain mental disorder can change as we learn more about it and understand better ways to treat it. There are many revisions the DSM-V has made, but much of the previous information is still widespread in society, such as misconceptions surrounding what was previously referred to as Asperger’s syndrome. There will probably be another revision in a few years, and one day, a complete overhaul.
Conditions that further need study
There are mental health conditions that are not classified in the DSM but have been listed as future implementation ideas into the DSM. Let’s explore some examples of conditions that need more research.
Internet gaming disorder
Also known as video game addiction, internet gaming disorder is based upon the idea that someone can be addicted to playing video games. It was not implemented into the DSM-V, as there was little evidence to support it. However, this concept does spark much discussion. Is gaming addiction its disorder, or just a habitual addiction? It is hard to say.
Caffeine use disorder
Most people wake up with a cup of coffee, and it is needed for them to start the day. That said, what is caffeine use disorder? In large doses, caffeine can be more dangerous, speeding up your heart rate. Those who use caffeine heavily know they should cut back but often experience difficulty doing so. That is the gist of caffeine use disorder in a nutshell. Will it become its disorder? We shall see.
Suicidal behavior disorder
Suicide is one outcome of depression, and there was a proposal to include suicidal behavior disorder in the DSM. Simply put, it’s a way of monitoring one’s behavior to see if one is suicidal. Some of the proposed criteria include:
- The person has attempted suicide in the last couple of years.
- The suicide attempt was not because of a religious or political attempt or because of an altered mental state.
While this behavior disorder could help a therapist figure out whether or not someone is suicidal, such a sensitive topic does require further research. If you or anyone you know is considering harming themselves or others, visit the National Suicide Prevention Lifeline or call 988 at anytime of the day or evening. There are professionals there who are eager to support you and direct you to critical resources.
Persistent complex bereavement disorder
This is another disorder that could have potential, but it needs further review. It’s also known as complicated grief disorder when grief impairs someone after a long time of grieving. This becoming a disorder could help people who can’t move on from extreme grief. While grief can be a healthy way to cope, too much grieving can have some serious consequences.
Criticisms of the DSM-V
How we classify and criticize mental illness is always under scrutiny as more information emerges within the scientific research community. The DSM-V has had five years to receive scrutiny, but criticism developed even before the book was published.
Some believe the information about certain disorders is poor and even contradictory. Some may believe that the drug industry influenced the book and that there are better ways to treat mental disorders than what was provided. There has even been a petition to review the DSM-V from an outsider’s perspective.
There will always be concerns within the field of psychiatry. There’s always room to misdiagnose or overprescribe medications. However, science is always evolving, and how we look at mental illness in 50 years may appear vastly different from how we do it today. It makes the future quite fascinating to think about and a bit terrifying, as we don’t know how mental health conditions will change.
Online therapists also use the DSM-V
One example of how the mental health community has evolved is through the prominence of online counseling. When the COVID-19 pandemic compelled the psychology community to provide more available means of attaining telehealth, that transition enabled people to see the benefits of online therapy.
Through online therapy platforms like MyTherapist, users can schedule virtual meetings with their counselor at convenient times. There is no need to take off work early or sacrifice another important commitment to travel to an in-person therapist’s office. With MyTherapist, you can meet with your counselor from the couch in your living room, your office at work, or even waiting in the carpool line at school pick-up.
Online therapy is effective in treating many mental health conditions outlined in the DSM-V, including depression, anxiety, post-traumatic stress disorder, and substance use disorders. Many people also prefer online counseling because of its tendency to be more affordable than face-to-face therapy.
When you meet with a counselor on MyTherapist, they will work to build a good rapport with you while asking you questions about your background, current lifestyle, relationships, and goals. It is important to keep in mind that online counselors and therapists in general are not just meant to help people overcome mental health conditions. They are excellent resources for working toward a goal or overcoming obstacles in life.
Takeaway
If, after taking a look through the DSM-V, you believe that you or someone you love may be experiencing a mental health condition outlined in the manual, know that support is available. There are caring professionals at MyTherapist who can offer information, analyze responses to questionnaires, and make recommendations for a course of treatment, if applicable. There is never any shame in asking for help, and at least one in five Americans make the choice to seek therapy each year. When you are ready to add another important member to your support system, reach out to MyTherapist.
Frequently Asked Questions
What is the most current DSM manual?
In 2013, the American Psychiatric Association (APA) released the DSM-V after many years of using the DSM-IV. Recent psychiatric news and research and an emphasis on mental health awareness, de-stigmatization, improved cross-cultural study, and sensitivity to transgender rights all influenced the DSM's changes. While the new DSM model is not controversial, it offers some simplified diagnostic criteria and disorder classification that takes a patient’s experiences and comorbid conditions into account.
How often is the DSM revised?
Since the first version in 1952, the DSM was updated every ten years or so. However, the DSM-IV, released in 1994, was the longest-running version. It wasn’t until 2013 that the American Psychiatric Association (APA) released a new version of this diagnostic tool, published through American Psychiatric Publishing, the premier source of psychiatric news and academic articles.
The DSM-IV introduced several core concepts, such as the multi-axial system to categorize disorders and the requirement that symptoms cause “clinically significant distress or impairment” to be considered a mental illness. For the new version, the DSM-V task force took those concepts and applied the latest psychiatric news and research, especially for previously misunderstood conditions such as Asperger’s (now considered part of autism spectrum disorder), gender dysphoria (previously called gender identity disorder), and schizophrenia (now considered one disorder rather than multiple subtypes).
What Is The DSM-V used for?
Psychologists, psychiatrists, and licensed clinical social workers use the DSM-V to identify mental illness symptoms and how they intersect in a patient. Previous versions were not entirely reliable because there were no clear standards for diagnosis. The manual lists symptoms common to a disorder, allowing the mental health professional to compare diagnostic criteria with the patient’s symptoms. Obviously, there is more to it than this, as they must also take their observations and the patient’s self-reported conditions into account. Still, the DSM is a helpful tool in identifying potential mental illness and guiding a treatment plan.
What is the dsm-v’s definition of a mental disorder?
The American Psychiatric Association defines a psychological disorder or mental illness as “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual [and] is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of death, pain, disability, or an important loss of freedom.”
How many disorders are listed in the DSM-V?
Officially, 157 disorders are listed in DSM-V. However, the current scheme works by linking related conditions, allowing for comorbid diagnoses and subtypes. This means that the effective number of disorders could be closer to the 297 disorders listed in the DSM-IV.
What are the three sections of the DSM-V?
The first section of the DSM-V gives a background to the revisions and explains the new changes to the multi-axial system. It also guides how to use the diagnostic manual, i.e., DSM-5 FAQs. Section II contains the diagnostic categories, divided into neurodevelopmental disorders, schizophrenia and psychosis, bipolar, depressive disorders, anxiety, OCD, trauma- and stress-related disorders, dissociative disorders, and neurocognitive conditions, personality disorders, eating and intestinal disorders, addiction, gender dysphoria, sexual dysfunction, and sleep disorders. The third section presents a potential new diagnostic model to guide future research.
Is The DSM-V Reliable?
While DSM has been subject to much criticism over time, the latest version is intended to provide more reliability and cross-cultural sensitivity. After all, science is based on validity and verifiability, so the American Psychiatric Association (APA) aims to support those in DSM-V. The DSM-V task force integrated the latest research and psychiatric news and reclassified some disorders and criteria to avoid cultural bias. The new version, released by American Psychiatric Publishing, strives to resolve the criticism of previous versions.
However, the DSM-V is ultimately just one tool in the clinical psychologist’s toolkit. It is geared toward diagnosis rather than research. Other systems include RDoC, which emulates a medical model. Both the DSM-V and RDoC are meant to help psychologists better understand their patients’ needs.
Is the DSM an effective tool?
The DSM is essentially a compilation of the latest research about mental disorders, broken down into categories, disorders, and identifiable symptoms. This can help avoid misdiagnosis.
For example, a psychologist may speak with a highly irritable patient, negative toward themselves and the world, and unable to control their temper, and conclude that they have a borderline personality disorder. However, the DSM also lists an unstable sense of self as the defining criterion for BPD, but the patient does not present this symptom. Instead, they have low self-esteem and avoid social contact. These are negative criteria for borderline personality disorder and positive criteria for a trauma disorder.
The psychologist concludes that the patient likely has complex PTSD or another trauma disorder by comparing these benchmarks. In the hands of a qualified mental health professional, the DSM can help build a treatment plan.
What kind of information is the dsm incapable of providing?
what institutions are not using the dsm anymore?
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