What is the DSM-5?

Answer: The Diagnostic and Statistical Manual of Mental Disorders fifth edition is a book used by psychiatrists to establish diagnostic criteria for mental disorders.

The DSM-5 is a handbook published by the American Psychiatric Association in 2013. It is about 950 pages long, and it covers the criteria for diagnosing mental disorders. The most significant advancement put forward in the DSM is establishing criteria for diagnosing mental disorders based on empirical evidence, which is more in line with modern thinking compared to theoretical divisions.

The DSM was first formally published in 1952, even though the groundwork for diagnosing mental illnesses began in the late 1800s. Since then, there have been four major revisions. The most recent revision (DSM-5) was finalized in 2013. The current edition was settled upon by more than hundreds of experts across different fields of mental health. The work was in progress for more than 10 years.

The major difference and advantage of the DSM-5 compared to previous iterations is the consideration of gender in psychopathology, as well as expression of symptoms across different cultural backgrounds.

The current DSM-5 lists 237 different mental disorders.

The DSM is more frequently used among American psychiatric practitioners, whereas a similar handbook, called the International Classification of Diseases, tenth edition (ICD-10) is more often used among European psychiatrists.

Sections of the DSM-5

There are three main sections within the DSM-5.

Diagnostic classification

The first section lists the mental disorders and their corresponding diagnostic code, which is used most often by health care providers and insurance companies for the purpose of record keeping and billing.

For example, the diagnostic code for mild bipolar disorder type I with a most recent manic phase is 296.41, while the diagnostic code for bipolar disorder type II is 296.81.

Diagnostic criteria

In this section, the criteria are given that is used to assess whether the person has said disorder.

For example, schizophrenia is a complex mood disorder. For a psychiatrist to make a positive diagnosis of the disease, the patient must exhibit at least two of the following symptoms:

  • Delusions

  • Hallucinations

  • Disorganized speech

  • Catatonia

  • Negative symptoms, such as a flat affect or loss of interest

Descriptive textual matter

In this section, the DSM-5 outlines the disorders in a full text. For each disorder, this section includes information regarding prevalence of the disease, factors that contribute to altered risk of disease presentation, and the variety of subtypes that make up the disease.

Criticisms of the DSM-5

The main criticism of the DSM-5 is that it has difficulty with diagnostic reliability. Even when using the outline put forward in the DSM-5, one clinicians diagnosis of a patient may not match the diagnosis of a second clinician. Almost all of the psychiatric disorders outlined in the DSM-5 exist on a spectrum, making diagnosis challenging. The goal of the DSM-5 and future revisions is to normalize the diagnosis across the board, which will improve our ability to make predictive outcomes based on the efficacy of therapy.

A second criticism of the DSM-5 is that it establishes diagnostic criteria based on outward presentation of symptoms rather than examining any underlying causes. A big part of this criticism is related to our lack of understanding of the causes in the first place. Most of the mental disorders are highly complex and involve dysfunctions of several systems.

Another criticism of the DSM-5 is that is has a lowered threshold for diagnosing disorders compared with the previous edition, DSM-IV. As a result, psychiatric disorders that went undiagnosed previously would be given a positive diagnosis under the new revision, artificially prompting an "epidemic" of the disorder.