DSM-IV TR, which usually stands for Diagnostic and Statistical Manual of Mental Disorders (4th edition), Text Revising was posted by the American Psychiatric Connection in 2000 and is a guide book for many medical researchers to detect a patient which has a mental disorder. It also helps health professionals to determine what types of treatment could be completed to help the patient. The latest DSM is widely used, especially in the UNITED STATES and many Europe. 1However, it may not be entirely followed by health professionals as they know that there are some weaknesses of the more recent version of DSM as well.
This essay is going to discuss the strengths as well as the weaknesses of the latest DSM and fresh changes pertaining to the DSM-V, which is likely to be published in May, 2013.
DSM’s power would be that this standardizes psychiatric diagnostic types and criteria2, making the diagnosis of a mental disorder relatively simpler than it had been in the past. That allows medical researchers to diagnose a patient, make use of the DSM to offer them probably the best treatment and overall, help them to cure the patients if the disorder is curable.
DSM also has record data including the prevalence of a specific disease in various genders, associated with onset of illnesses, etc . This permits health professionals to possess a very wide range of knowledge which can be very useful pertaining to diagnosis and treatments. Besides, the DSM allows one common language to get discussing prognosis. It provides very clear criteria for certain disorders so that every clinician would come up with the same diagnosis. This makes sure a person is certainly not diagnosed with several types of disorders in different clinics. Thus, treating sufferers more efficiently.
In comparison to the older versions in the DSM, the most up-to-date DSM also has more subtypes and specifiers which enhances the diagnostic specificity. As I discussed earlier, this enhances the chance of figuring out a patient with the same disorder in different treatment centers, assuring that they can be diagnosed with the proper disorder since misdiagnosing these people could possibly result in serious harm.
For some disorders, such as zweipolig disorder, you will discover severity symptoms such as mild, moderate and severe too. This helps clinician to decide the course of the treatment according to the severity of their disorder. This is one of the strength of DSM as using the same treatment for different severity of the identical disorder will never be very ideal or efficient. However , this severity signal is absent in some disorders such as manic episodes which is one of the weaknesses of DSM-IV TR.
These were some of the advantages of DSM-IV TR. However , we know that an additional edition of DSM, DSM-V is supposed to be published soon. This really is obviously because there are some, or many disadvantages in the current DSM with which individuals are not satisfied.
One of the main weakness with the current DSM and almost certainly all the older editions can be “Cultural Bias”. DSMs are mostly published by simply anglo-Americans and most of the behaviour that is regarded as “normal” in the DSM is really what is regarded as normal by anglo-Americans. That is certainly, some of the conduct that is viewed as abnormal in the DSM could possibly be considered as normal in other civilizations. For example , in a few cultures, people tend to set a lot of emphasis and values sucursal piety and due to that, they would respond in a way that may not be considered as regular by the anglo-Americans. Would that classify all of them as unnatural? What exactly is normal anyways? Based on the DSM, this it, I really believe, what is considered as normal by the anglo-Americans. This is certainly one of the disadvantages of the DSM which is popular and I think for the reason that of this cause that DSM might not be because popular in countries where the culture is a lot different when compared with countries such as the USA and lots of European countries.
One more weakness will be that DSM promotes a mechanical approach to mental disorder assessment. The clinicians might focus too much on the signs or symptoms of mental disorders and so they might not put much emphasis on a more in-depth understanding of the clients/patients complications. This problem have improved nonetheless it is still a trouble caused by the DSM. DSM-IV TR also does not consider patients subjective experience of a disorder. That is, the approach is not just a dimensional approach as there is not any first-person report but rather, observations are usually carried out which may neglect the more somatic and emotional processes that underlie the symptoms (Flanagan, Davidson & Strauss, 2007). 3 Likewise, DSM triggers most clinicians to be mainly concerned with the signs and symptoms of the disorder rather than the underlying trigger by giving a directory of certain requirements for analysis.
Another weak spot and controversy about the DSM is the fact it is an unscientific system and it is the judgment of a few effective psychiatrists. It has raised a whole lot of concerns and have triggered people to issue the quality and reliability of the diagnostic categories too. The quality and stability were specifically questioned following the Rosenhan try things out in the 1970s in which it was concluded that the sane could not always be distinguished from your insane in psychiatric hostipal wards. Thus, however the reliability and validity offers improved now when compared to the 1972s, it is even now a some weakness which I imagine could not become entirely set. However , validity problems with the diagnostic conditions especially happen when kids or teenagers are involved.
For example , the DSM-IV TR requirements for bipolar and mania disorder were originally created for adults but right now, after having a few changes, it is employed for children as well. This boosts the chance of misdiagnosing children with bipolar disorder. This information is definitely supported by the truth that within the last 10 years, there have been a 40%4 increase in the amount of children identified as having bipolar disorder. It is presumed that there is not a sharp increase in the number of children with bipolar disorder but rather that the clinicians have been making use of the diagnostic criteria (which were originally developed intended for adults) far more aggressively to children. 5This is one of the some weakness of DSM-IV TR that should be improved down the road as the effects could be damaging.
One of the weak point, which I believe that is not too significant but nevertheless is a issue and which can be actually asked by persons is the definition of the mental disorder. It was also mentioned in the lectures. According to DSM-IV TR, a mental disorder is definitely “associated with present stress or impairment or significant increased risk of death, discomfort, disability and important decrease of freedom”. This raises problem.. what about those individuals who engage in activities that threatens their very own lives however they actually have fun with this? Such as huge batch climbers, scuba divers, etc . Obviously they may be no considered as abnormal yet according to the meaning of the DSM, they are regarded as having a mental disorder. But we know that this is simply not correct. As a result, there is a issue with the definition from the word ‘mental disorder’.
There are numerous other weak points as well just like with Individuality Disorder analysis. It is thought that the description of symptoms is very wide-ranging. This means that patients diagnosed with the same disorder may actually have different clinical demonstrations. For persona disorders, DSM uses a categorical approach6. Nevertheless , it would be preferable to use a dimensional approach in order that the different types/ degree of disorder could be known and thus, could possibly be given distinct and more efficient treatments.
An additional major weak point of the Axis II personality disorder is that there is a quite high degree of overlapping or co-occurence with each other. This is also a problem intended for Axis My spouse and i mental disorders. 7
There are many other weaknesses with specific disorders of DSM specifically about the diagnosis standards and some different issues just like whether ‘Paraphilias’ should be included or not really. Most of the key ones continues to be discussed previously mentioned. Now, the brand new changes to get DSM-V will probably be discussed.
There are plenty of new changes for the DSM-V. I will mainly talk about those that happen to be related to the weaknesses stated previously. However , the newest changes are discussed, the 4 principles behind the existing process to get revising DSM should be reviewed. (Obtained via APA DSM-V Development’s established website)
1) Clinical Utility- the manual should be helpful to those who analyze and deal with patients with mental illnesses
2) Recommendations should be guided simply by evidence
3) DSM-V should preserve continuity with previous editions whenever possible
4) Not any priori restraints should be placed on the level of alter permitted between DSM-IV and DSM-V
From these 4 concepts, it becomes more clear to all of us why DSM-IV is being modified and what changes can be expected. One of the alterations is that to be able to better measure the severity of symptoms, a dimensional evaluation will be included. For example , elements such as sleeping quality, disposition, etc will probably be considered regardless of diagnosis. This will help to reduce the problem of “mechanical approach” as i have said before. They will also help to addresses symptoms that are not included within the diagnostic criteria for specific illnesses (e. g. the problem of sleeplessness for patients diagnosed with Schizophrenia).
DSM-V may additionally include something that could fix the problem of how to handle patients with co-occuring disorders, the major weak point of DSM-IV TR. Besides that, DSM-V will also have improved analysis criteria which are not precise in DSM-IV TR.
Also, a number of words will be changed too in the fresh DSM. For instance , the word “Mental Retardation” can be changed to “Intellectual Disability”. Another change that would also be included would in some manner, indirectly treat the problem of cultural opinion. In the new DSM, consideration would be given to the gender, race and ethnicity. This kind of, I believe may help to lessen the severity from the cultural issue as mentioned before.
Besides that, another ‘proposal’ is that, conditions should be even more stringent for the associated with bipolar disorder in children. This as well addresses among the weakness described earlier. This is certainly a very important pitch as I still find it not very humane to misdiagnose children with “Mental Disorders”. It could have an effect on their existence significantly.
One other major improvements is in the assessment and associated with personality disorders. As mentioned ahead of, a dimensional approach to be used rather than a particular approach. This can help to determine the distinct severities of disorders and determine the ‘subtypes’ more accurately. Overall, it might make the diagnosis much more exact and thus, more efficient treatment could possibly be used.
These types of changes had been mainly in response to the weak points mentioned above. Other changes incorporate creating a fresh category named “Behavioural addiction”. This category is usually solely based on gambling. Internet addiction was also proposed. However , due to the lack of research in that field, it had been rejected. This kind of shows that they somehow adopted principle a couple of which focuses on on the need for evidence. One more category named the “Risk Syndromes” is usually being considered. This will help clinicians identify previous stage of mental disorders. The category of substance abuse and dependence will be removed and it would be substituted by a new category named “Addiction and Related Disorders”. This is completed help clinicians distinguish between identical types of disorders easier and lower the chance of misdiagnosis (e. g. dependence is often mistaken for compulsive drug-seeking behaviour addiction). 8Another alter is that the criteria for some anoresia or bulimia such as Anorexic Nervosa continues to be improved.
Overall, the diagnostic criteria for many disorders has become improved and a dimensional approach is being used in DSM-V rather than the particular approach found in the previous versions. All of these improvements, together with a great many other minor types, aim to increase the diagnosis process and thus, ensures that people are salvaged from misdiagnosis (which could lead to devastating effects) and so that they can receive better treatment which usually would increase their chances of being cured (if the disorder is curable).
Berman, L. (n. m. ). Understanding the DSM-IV TR. Retrieved upon 15th Drive, 2013, coming from http://www.ceuschool.com/librarydocs/SOC222.pdf Dombeck, M., Hoermann, S., Zupanick, E. C. (2011). Personality Disorders: Issues with current analysis system. MentalHelp. Retrieved upon 14th March, 2013, coming from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=569 Flanagan, E., Davidson, L. & Strauss, J. (2007). “Issues for DSM-V: Incorporating
Patients’ Very subjective Experiences. ” Am. J. Psychiatry, 164(3), 391 – 392. Kleinplatz, P. M., Moser. C. (2005). DSM-IV-TR and the Paraphilias: An Argument for Removal. Gathered on fourteenth March, 2013, from http://www2.hu-berlin.de/sexology/GESUND/ARCHIV/MoserKleinplatz.htm Kronemyer, Deb. (2009). Phenomenological Psychology. Recovered on 14th March, 2013, from http://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 disorders (4th ed., text rev. ). Washington, DC. Bipolar Disorder in Kids. Wikipedia. Retrieved on 14th March, 2013, from http://en.wikipedia.org/wiki/Bipolar_disorder_in_children Diagnostic and Statistical Manual of Mental Disorders. Wikipedia. Retrieved in 14th Drive, 2013, via http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders DSM-5. Wikipedia. Gathered on 14th March, 13 from http://en.wikipedia.org/wiki/DSM-5 DSM-5 development: Frequently Asked Questions. American Psychiatric Connection. Retrieved in 14th March, 2013, from http://www.dsm5.org/pages/default.aspx Rosenhan Experiment. Wikipedia. Retrieved on 14th March, 2013, coming from http://en.wikipedia.org/wiki/Rosenhan_experiment
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