The DSM-IV is the Diagnostic and Statistical Manual of Mental Health Disorders, published by the American Psychiatric Association. It provides a holistic approach to mental health by categorising disorders into five axes, that provide a broad range of information about the individual’s functioning, (Sue, Wing-Sue, Sue & Sue, 2012). In distinguishing abnormal from normal, the behaviour must be clinically significant and associated with intensive distress, impairment, social dysfunction or increased personal or public risk, however it must be unrelated to grief caused by recent personal loss, (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000; Holt et al, 2012).

The distinct criteria and descriptive information in the DSM-IV, enables clinicians to make quick diagnoses based on an individual’s symptoms. It can also be used in legal proceedings, to determine the mental state of individuals and ensure they receive appropriate sentencing in psychiatric care rather than prison. It is versatile and the only manual that strictly focuses on mental health which is why it is referred to as the Gold Standard of clinical diagnosis. The DSM-IV has also played a vital role in the development of research and treatments for mental health, which has improved many patients’ quality of life.

Keenan et al. (2007) examined the reliability of the DSM-IV oppositional defiant and conduct disorder symptoms, in 3-5 year old children. The mothers were interviewed about their children’s current symptoms and results showed that the reliability of symptoms, measured by interrater and test-retest reliability, was moderate to high. However, the DSM-IV-TR (2000) 4th ed., text rev. emphasises that the diagnostic criteria are only guidelines and reliability is therefore determined primarily by the clinician’s interpretation of the information provided.
In the development of the DSM-IV, the clinical significant criterion was applied to some of the diagnostic criteria sets to decrease false positive diagnoses. Spitzer and Widiger (1999) examined its effect on the validity of the diagnostic criteria and found that when applied to Major Depression, it was redundant because most of the symptoms associated with it were already causing significant distress. It also increased false negatives by excluding people from diagnosis who have five of the nine expected symptoms, but are not significantly distressed or role-impaired. Finally although it eliminated false positives, simply adjusting the symptom criteria could have achieved this same result.

Honos-Webb and Leitner’s (2001) case study of Steve, who was diagnosed with several disorders illustrates the potential for a DSM-IV diagnosis to aggravate the symptoms and recovery of individuals. According to the self-fulfilling prophecy, individuals who are labelled, in this case as mentally ill or crazy, eventually become these things. Steve began to believe that his perceptions about how he was feeling were irrelevant because everyone thought he was crazy. This inhibited his rehabilitation in therapy as he believed there was nothing he could do to change.

It is evident why the DSM-IV is referred to as the Gold Standard of clinical diagnosis. Despite its structural flaws and the negative effects of diagnostic labels, it remains a versatile document which has proved to be indispensable to various professionals. The DSM-IV has saved lives through diagnosis, treatment and modified prison sentences, to say it is useful would be an understatement.

(532 words)

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Holt, N., Bremner, A., Sutherland, E., Vliek, M., Passer, M., & Smith, R. (2012). Psychology: The science of mind and behaviour (2nd ed.). UK: McGraw-Hill Education.

Honos-Webb, L. Leitner, LM. (2001). How Using the DSM Causes Damage: A Client's Report. Journal of Humanistic Psychology. 41, 36-56. doi: 10.1177/0022167801414003.

Keenan, K. Wakschlag, LS. Danis, B. Hill, C. Humphries, M. Duax, J and Donald, R. (2007). Further Evidence of the Reliability and Validity of DSM-IV ODD and CD in Preschool Children. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 457-468. doi: 10.1097/CHI.0b013e31803062d3

Spitzer, RL. Wakefield, JC (1999). DSM-IV Diagnostic Criterion for Clinical Significance: Does It Help Solve the False Positives Problem? The American Journal of Psychiatry, 156, 1856-1864.

Sue, D., Wing-Sue, D., Sue, D., & Sue, S. (2012).Understanding Abnormal Behaviour (10th ed.).USA: Wadsworth.