Chapter 3.2 Clinical Assessment and Diagnosis - DSM

Diagnostic and Statistical Manual of Mental Disorders

The most widely used classification system in the United States is the __________ produced by the American Psychiatric Association (APA, 2013).

International Statistical Classification of Diseases and Related Health Problems (ICD).

Alternative for DSM produced by WHO

1952

The first edition of the Diagnostic and Statistical Manual (DSMI) is published.

60

The first DSM contained about ____ disorders and was based on theories of abnormal psychology and psychopathology

1968

DSM-II is published. Changes in the DSM-II included eleven major diagnostic categories,

185

Total number of total diagnoses for mental disorders for DSM-II

1980

DSM-III is published.

265

DSM-III provided specific diagnostic criteria for ____ diagnoses.

1987

DSM-III R is published.

297

How many diagnoses does DSM III-R have?

1994

DSM-IV is published

365

How many diagnoses does DSM IV have?

2000

• DSM-IV-TR is published.

• This volume is heavily researched based and includes information about the etiologies of the disorder.

2013

DSM-V is published.

312 diagnoses

How many diagnoses does DSM-V have?

Diagnostic Criteria and Descriptors, Subtypes and Specifiers, Principal Diagnosis, Provisional Diagnosis

4 key elements of a diagnosis

Diagnostic Criteria and Descriptors

• guidelines for making a diagnosis.

• When the full criteria are met, mental health professionals can add severity and course specifiers to indicate the patient’s current presentation. If the full criteria are not met, designators such as “other specified” or “unspecified” can be used.

• If applicable, an indication of severity (mild, moderate, severe, or extreme), descriptive features, and course (type of remission – partial or full – or recurrent) can be provided with the diagnosis.

• The final diagnosis is based on the clinical interview, text descriptions, criteria, and clinical judgment.

Subtypes and specifiers

Since the same disorder can be manifested in different ways in different individuals, the DSM uses ___________ to better characterize an individual’s disorder.

Subtypes

denotes “mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis.” (APA, 2013)

Principal Diagnosis

• used when more than one diagnosis is given for an individual (when an individual has comorbid disorders).

• the reason for the admission in an inpatient setting or the reason for a visit resulting in ambulatory care medical services in outpatient settings

• generally the main focus of treatment.

Provisional Diagnosis

If not enough information is available for a mental health professional to make a definitive diagnosis, but there is a strong presumption that the full criteria will be met with additional information or time

Neurodevelopmental Disorders

A group of conditions that arise in the developmental period and include intellectual disability, communication disorders, autism spectrum disorder, motor disorders, and ADHD.

Schizophrenia Spectrum and other Psychotic Disorders

Disorders are characterized by one or more of the following: delusions, hallucinations, disorganized thinking and speech, disorganized motor behavior, and negative symptoms.

Bipolar and Related Disorders

Characterized by mania or hypomania and possibly depressed mood; includes Bipolar I and II, cyclothymic disorder.

Depressive Disorders

Characterized by sad, empty, or irritable mood, as well as somatic and cognitive changes that affect functioning; includes major depressive and persistent depressive disorders.

Anxiety Disorders

Characterized by excessive fear and anxiety and related behavioral disturbances; Includes phobias, separation anxiety, panic attack, and generalized anxiety disorder.

Obsessive-Compulsive and Related Disorders

Characterized by obsessions and compulsions and includes OCD, hoarding, and body dysmorphic disorders.

Trauma and Stressor Related Disorders

Characterized by exposure to a traumatic or stressful event; PTSD, acute stress disorder, and adjustment disorders.

Dissociative Disorders

Characterized by a disruption or disturbance in memory, identity, emotion, perception, or behavior; dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder.

Somatic Symptom and Related Disorders

Characterized by prominent somatic symptoms to include illness anxiety disorder somatic symptom disorder, and conversion disorder.

Feeding and Eating Disorders

Characterized by a persistent disturbance of eating or eating-related behavior to include bingeing and purging.

Elimination Disorders

Characterized by the inappropriate elimination of urine or feces; usually first diagnosed in childhood or adolescence

Sleep-Wake Disorders

Characterized by sleep-wake complaints about the quality, timing, and amount of sleep; includes insomnia, sleep terrors, narcolepsy, and sleep apnea.

Sexual Dysfunctions

Characterized by sexual difficulties and including premature ejaculation, female orgasmic disorder, and erectile disorder.

Gender Dysmorphia

Characterized by distress associated with the incongruity between one’s experienced or expressed gender and the gender assigned at birth.

Disruptive Impulse Control and Conduct Disorders

Characterized by problems in self-control of emotions and behavior and involve the violation of the rights of others and cause the individual to be in violation of societal norms; Includes oppositional defiant disorder, antisocial personality disorder, kleptomania, etc.

Substance-related and Addictive Disorders

Characterized by the continued use of a substance despite significant problems related to its use.

Neurocognitive disorders

Characterized by a decline in cognitive functioning over time and the NCD has not been present since birth or early in life.

Personality Disorders

Characterized by a pattern of stable traits which are inflexible, pervasive, and leads to distress or impairment.

Paraphilic Disorders

Characterized by recurrent and intense sexual fantasies that can cause harm to the individual or others; includes exhibitionism, voyeurism, and sexual sadism.