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The DSM-IV TR was introduced by the American Association of Psychiatrics to classify abnormal psychology based on their symptoms (Collins, 2001). Through the introduction of the DSM-IV, the total number of registered abnormal psychology cases described in to 250 categories. This has been caused by a new set of sub-classifications of every individual disorder. Among these classifications, the principal categories include mood disorders, sleep disorders, eating disorders, somatoform disorder, personal disorder and anxiety disorders. The incorporation of the DSM-IV facilitated greater changes in a wider psychological view of diagnosis. With the new trend of classification, more people were encouraged to go for diagnosis tests on mental disorders. The main reason behind this ideology is based on the eradication of stigmatization fears (American Psychiatric Association, 2000). The DSM-IV classification modal provides for 16 main categories of maladjustments and about 200 sub-categories. This design has boosted the reliability of diagnosis through observable syndromes. In the DSM-IV classification of abnormal psychology, the current behavioral observations are used (Daniel & Fisher, 2001).
The DSM-IV classifies mental disorders into sixteen categories with more than 200 sub-categories. The DSM-IV main objective is meant to simplify the process of diagnosing people with mental disorders by means of ordinary elaborated steps. The process of establishing a diagnosis of mental disorders should be systematic, based on symptoms and consistent and realistic critical judgment rather than on assumptions (Diagnostic statistical Manuals 1994). This paper explores development process of DSM-IV. It also describes its strong and weak points.
Process of development of the DSM-IV
The purpose of this section is to give insight on the chronological process that led to the establishment and documentation of the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition).
Process of Development
The process started in the 19th century after a national census in the United States. During this period the need to categorize psychological disorders became a priority. In the late 1980s seven classes were recognized : melancholia, mania, monomania, paresis, epilepsy dipsomania, and dementia (DSM-IV-TR, 1994). A similar development adopted by American Psychiatric Association took place in 1917. By 1945 four systems used to classify human psychological disorders were already in place. These were: APA’s revision in 1932, Veteran’s Administration system, the US Army’s system, and the US Navy’s system. There was an official classification criteria ICD. It was introduced in mid 1900 but was later rejected for lack of organization.
As a result of confusion, the US rolled out a research on the Diagnostic Statistical Manual of Mental Disorders. The aim of the research was to see uniformity adopted in the process. It was a research that gave a push for rising of the DSM-I, which was published in the year 1952.
It was officially published in the year 1952 after adoption through a vote of members of the psychological association. The Manual was developed and edited through questioners and aimed to build common means for classifying human disorders based on contemporary beliefs of the society. This list recognized 3 categories with 106 diagnoses. The three categories were: organic brain syndromes, mental deficiency and functional disorders. Of the 106 subcategories only one was applicable to children. The DSM-1 formed the basis of research for DSM-11.
This second edition of the DSM was officially published in 1968.Its aim was to create a common diagnostic platform to be used by professionals. It contained additional diagnostic criteria for children and adolescents. DSM-11 consisted of 11 categories and 185 subcategories of psychological human disorders. These categories included: Hyperkinetic reaction, overanxious reaction, withdrawing reaction, group delinquent reaction , unsocialized aggressive reaction and runaway reaction.
Criticism to DSM-1 AND II
The two documentations were widely criticized for their inadequacy, validity and lack of reliability. Many professionals were not amused with the works . They were not pleased with those involved in the research and documenting of the two statistical manuals. They pointed out that co-authors lacked professionalism. The professionals also mentioned that the manuals were exaggerated since the causes of psychological human disorders were unknown. The manuals were also criticized for the lack of certain details and their use would mislead the medical profession. Critics like Thomson Szasz accused the two manuals in misleading and stated that psychological human disorders were simply problems associated with life. The reliability of the two manuals was questionable. As a result of these disputes they started to work on the third edition.
A task force led by Spitzer, began research on a third edition of the manual under the authority of the Research Diagnostic Criteria (RDC). More interviews and consultative forums were conducted . They formed the basis of the new research. A second task forced by the Diagnostic Criteria for Use in Psychiatric Research also immensely contributed to the creation of the new edition. Two task provided new evidences and validation that formed the basis of the new documentation. DSM –III consisted of 15 categories of psychological human disorders. It was based on new scientific evidences especially because adequate research had been carried out. It differed immensely with previous versions containing new categories and eliminating some new such as homosexuality.
This documentation became popular among professionals and its new criteria were adopted with much easier . The Manual led to the development of American Psychiatric Press. DSM-III consisted of 265 diagnoses in 482 detailed pages.
Problems Associated with DSM-III
DSM –III was considered bulky and therefore difficult to use for professional purposes.The new manual posed international communication challenges due to differences in coding with other models such as the ICD. Other problems associated with the manual included reliability problems due to broad categorization of some disorders.
As a result of new research informed by complains a new edition documented in 1987.The edition was a shorter version of DSM-III and consisted of 297 diagnoses. The new edition was simply a modification of the previous edition. It was composed of new additions and eliminations of old information from the previous edition. Disorders such as premenstrual syndrome, paraphilic rapism disorder, and masochistic personality disorder had been discarded due to social controversies associated with them. Additional categories from the previous version included trichotillomania among others. Criticism to this manual was a result of the some scientifically questionable evidences it provided .These evidences required new researches. They launched a new study to counter new challenges.
DSM-IV was a result of a research conducted and compiled by 27 member direction-finding committee including 4 psychologists. The research conducted since 1987 took place in three crucial steps: literature review, research data analyses and tests conducted for verification. The new edition was multi axial in nature, inclusive and more elaborative than all previous versions. The 886 paged manual consisted of 365 distinct diagnoses. It was characterized by: information on individual disorders, decision trees, source books and glossaries.
The DSM-IV is a manual that offers guidance during: diagnosis, classification, and treatment of human psychological disorders . the American Psychiatric Association first adopted this documentation in 1994 in the United States. Since then It has spread around the rest of the world and is currently the most popular model for classifying and diagnosing psychological human disorders.
The manual is organized in an alphabetical order to make it clear to use. This manual published by the American Psychiatric Association provides a guideline to almost all psychological human disorders. The manual provides diagnostic criteria for both children and adults. This manual also lists probable causes of psychological disorders and helps initiate research into actual causes and helps to choose a proper treatment .DSM-IV also gives an explanation on the effects of age, gender, environment and physical health of the human psychology.
Criticism on DSM-1V
Critics complained about its length, some details and lightly doubted its reliability. The 1987 documentation was considered too long to use in the medical profession. The documentation required familiarity to use it effectively and ; that would call for more training. Like earlier versions it consisted of too many biological explanations inviting critics were bent on discouraging its use. It was accused of laying its bases on previous versions and not proposing solutions to controversial psychological human disorders. Such disorders were listed among those requiring further research. As a solution to the criticism a new version of DSM-IV was adopted. DSM –IV-TR was published in 2000.
New publication did not address many issues raised in the earlier version and only attempted to solve speech problems creating ambiguities in DSM-IV. New changes in DSM-IV reflected new researches and sorted the information to clarify textual problems rather than content.
Today DSM-IV is the most popular model used in the classification and diagnosis of psychological human disorders. It is applicable in counseling, medicine, as well as in religious functions.
Strengths of DSM-IV
The most profound strength of DSM VI is based on its allowance of various sub classifications. As a result of its implementation, DSM-IV provided a wider range of categories of psychological disorders. This ideology helped to make clear out classification of disorders in a well structured platform of distinction. Through DSM-IV disorders with closely related symptoms can easily be demarcated for the right reaction in effect. In addition, DSM-IV provides compact encapsulation of description focused on each disorder. These disorder descriptions are supported by a strapping empirical back up.
An equally strong strength of DSM-IV lies in its strategic design. The design of DSM-IV takes an exhaustive care of all the inpatients, partial hospital and outpatients. Other strategic achievements are based on a design and include application in clinics, private practice, consultation liaison and primary care. DSM-IV is equally meant for counselors, nurses, therapists and professionals in the mental health departments. The fundamental strength of this design is based on the ability of DSM-IV to allow diversities related to psychological disorder solutions. All the mentioned institutions would find the manual pivotal in assisting their clients at their respective service areas. Counselors would find DSM-IV beneficial in assisting their clients based on their behaviors. DSM-IV provides enough information based on the categories and sub categories of disorders. On the same perspective, the DSM-IV is well strategized to be used by specialists attending mental sector.
An additional strength of DSM-IV is captured in its statistical solution approach . In relation to statistical data, DSM-IV acts as a vital tool meant for the collection and communication of accurate statistical data based on the health sector. A further strength of DSM-IV captivates on the basic analysis provided in a tabulated form to clearly demarcate diagnostic process and the possible description. The major components of DSM-IV consist of a tabulated classification of diagnostic classification, criteria sets and descriptive manuscript.
DSM-IV equally provides well laid standards diagnostic tool for researches. It allows medical professionals to analyze comprehensively the psychological composition of an individual. Based on its design, DSM-IV is widely applied in varied orientations. It provides a proper categorization of basic diagnostic information systematically. The information provided would therefore assist psychiatrists to extremely diagnose individuals. The whole idea is based on behavioral similarities that exist in various mental disorders.
In respect to this ideology, an extra strength of DSM-IV is founded on the simplicity. The manual presents its points in a well realistic manner that can be well understood by the users. This results into affectivity in application. DSM-IV can be easily used by researchers and clinicians in a more effective way. It is based on the simple nature and plan of points contained in the manual.
Another importance of DSM-IV factors about its hopes to derive higher levels of consensus without any need of making assumptions related to psychological disorders. DSM-IV provides exhaustive information necessary for providing basic diagnostic information. In addition, DSM-IV has recently proved being highly effective and reliable in providing vital diagnostic information. DSM-IV provides a comprehensive list highlighting possible symptoms that disqualify a mental disorder. This information helps psychiatrists in giving diagnostic information for particular mental conditions.
Introduction of DSM-IV helped to provide scientific exactness. It was missing in the previous editions. It gave solutions to various aspects of mental problems based on the scientific facts. In connection to the scientific facts, most patients comply with the information provided about their conditions. It can be concluded that the scientific approach makes DSM-IV principles quite sound and illustrative in providing evidence.
Strengths of DSM-IV
The introduction of the DSM-IV affected people’s points of view (NIMH, 2008) and perspectives on psychological human disorders classification and influenced the society in the following spheres:
Improved Pastoral Counseling
This has been achieved through changing the point of view of religious leaders concerning psychological human disorders. The model equips trainers of counselors with the content and diversity of human disorders (Kessler & Zhoa, 1994). Diversified methods of treating affected persons include the participation of religious leaders in the process.
Medicine and Nursing
This is shown by changing training of medical doctors and nurses and incorporating new views, hence equipping them with the capacity to offer diagnosis and treatment to abnormal psychology. This fastens the process of treatment and establishing diagnoses of psychological human disorders. The diagnostic process is subdivided into five principal groupings, namely clinical disorders, acute physical and medical disorders, environmental and abnormal psychology, global valuation disorders, intellectual and personality disorders (Widiger, 2000).
Self-Esteem and Identity
Understanding causes and diagnosis of psychological human disorders helps to boost oneself image. The DSM –IV, unlike earlier models, identifies a variety of causes of abnormal psychology giving an affected person the capacity to understand and improve his or herself image (Ozarin, 1998).
Weaknesses of DSM-IV
The first biggest weakness realized with DSM-IV is that it provides a superficial judgment to symptoms. In return to this situation the manual some other extremely important possible factors are ignored during diagnosis. As a result, DSM-IV can give misleading diagnostic results. In case such results are responded, then the affected patients would not realize proper corrective measures.
The introduction of DSM-IV in the diagnostic process only provides operational definitions. It is unfortunate that DSM-IV assumes etiological understanding of the mental disorders. The inherent weaknesses shown by the manual lack evidential classification based on the paradigm integration. In the actual data analysis based on DSM-IV model, there are various pieces of information that do not have comprehensive contributions towards diagnosis of mental illness. Firstly, the information that children with some particular psychological problems were to be thrown into a water bath had no basis. Based on the research work carried out to prove the validity of this diagnostic method, it was realized that this forms a basic mislead in seeking medical solutions.
In addition, the incorporation of political approach of insisting on the correctness ought not to dominate the fundamentals of DSM-IV. It is evidently portrayed by the module in support of the model that an element of weaker points exists in DSM-IV. The political analysis used by DSM-IV to entice medical practitioners to focus on its ideologies portrays a sense of discontentment. In addition, political approach has been incorporated in persuading psychiatrists to venture into trainings. The main problem in relation to this weakness is based on the present time span. The information provided by DSM-IV is well analyzed to extent that political approach ought not to prevail at all. The current times allow individual with mental disorders to view themselves the essence upon their diagnosis.
DSM-IV is modeled in a tunnel like version addressing mental disorders as a diagnosis factor. It is not so exhaustive in terms of symptoms coverage. As a result, only those diagnostic cases that fit in the model are factored. All the other perspectives that left out are eventually ignored in the entire process of diagnosis. Another weakness of DSM-IV is that it only provides the symptoms and diagnosis. There are however various examples of solution means including medication formalities not mentioned in DSM-IV.
DSM-IV is distinctly based on operational diagnosis related to specific definitions instead of pathogenesis. This weakness is based on the fact that this module captures only basic symptoms for a particular diagnosis. It is evident that DSM-IV limits any further thinking in respect to diagnosis. The use of more than one diagnosis criterion is widely pronounced in DSM-IV implementations. The physical medicine practitioners cite this as a weakness showing a higher level of misunderstanding.
The final weakness of DSM-IV document is based on its length. The text is well thought-out to be extensive for use in the medical profession. Like earlier versions it consists of too many biological explanations discouraging its use. It is evident, if it was not strongly based on previous versions and proposed solutions to controversial psychological human disorders, DSM-IV would have corrected all the weaknesses shown in the previous versions of diagnosis. There were some disorders listed requiring further researches .
The DSM-IV classifies mental disorders into sixteen categories with more than 200 sub-categories. Its main objective is to simplify the process of diagnosing people with mental disorders by taking simple elaborated steps. The diagnostic process of mental disorders should be systematic, based on symptoms and consistent and realistic critical judgment rather than assumptions (Diagnostic statistical Manuals 1994). The DSM-IV is the most popular tool for classifying human disorders and is universally accepted with few exceptions. It is the most inclusive model of classifying psychological human disorders offering a wide range of symptoms and causes. The application of the DSM-IV mode of classifying human disorders aims at identifying a disorder and its symptom, forecasting its future sequence, administering treatment of the affected person and initiating investigation into its causes. Psychological human disorders are caused by a variety of factors, which include human dynamics, psychological state, social factors and genetic factors (American Psychiatric Association, 2000).
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