Understanding the DSM

Understanding the DSM

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Understanding the DSM

Mental disorders are becoming increasingly common in the world. It is also believed that they were previously not diagnosed properly. Their effects are being studied and since these effects are real and could affect one significantly, proper diagnosis is necessary. With proper diagnosis, better treatment and care is possible. Usually, accepted and evidence based treatments are recommended for such disorders. The rest of this paper seeks to show understanding of the DSM as a manual for the diagnosis of mental health disorders. The paper will deal with explanations and descriptions such that what the DSM is, how it is used, changes that were made over the editions, the differences between some of the diagnosis that can be found there, the GAF axis, NOS and axis II.

What Is DSM how is it used 

The DSM is an initial that stands for Diagnostic and Statistical manual for mental disorders. It contains the symptoms, description and other criteria that can be used for the diagnosis of mental health illnesses. The DSM is not limited to the United States of America, a few other countries use it as well for their diagnosis. The manual provides a common language for the clinicians. This common language can then be used by researchers and other people in the medical profession for the diagnosis and treatment of mental health illnesses. The manual also acts as a guide that may help during future revisions if there is the need for that. Since the DSM is only a guide, it is required that the physicians and other health care providers who provide the diagnosis have some background in mental disorders is necessary (American Psychiatric Association, 2013). Learning the specific way to use it is also important for people who are to use. This is because it deals with psychiatry and psychiatric disorders. These kinds of disorders, unlike physical disorders are usually interwoven into people’s lifestyles and personalities. For the clinician, the best way to use it would be to first create a narrative dimension to the manual. This will enable the clinician to provide the patient with a starting point for diagnosis, which is important. The above only applies to clinicians and people who work for the treatment section of the mental disorders. For researchers, the DSM is used differently. They usually find the common symptoms as listed there and assign a disorder to them. They are mostly responsible with the updating and making sure that all the issues that a person may present in terms of mental health are present there.

`Changes during the third edition of the DSM

The third edition of the DSM was aimed at making the manual better and hence making the diagnosis easier and a bit more accurate. One of the changes that was made was the introduction of an explicit diagnostic criteria. In addition to this, there was the provision for the definition of the term mental disorder.  Another was the introduction of a multiaxial diagnosis assessment and a neutral approach to the causes of mental disorders. The edition also made sure that the diagnosis of the mental health issue would not be limited to the United States of America alone. This edition made the DSM more acceptable world wide. There were other changes, for example, the introduction of new diagnostic characteristics. In some cases, it was a change in the limits of the old diagnostic characteristics. Additionally, there was the introduction of the multiaxial diagnostic format (Frances, 2013). One of the initial aims of the revision and consequent introduction of DSM II was to make the nomenclature of the mental disorders consistent with those of the International Statistical classification of diseases and related health problems. These changes were made with the aim of making diagnosis better. Another aim was to avoid confusion during diagnosis. Finally, there was the aim of making the grouping and administration of medication easier across the international community.

Difference between a monethetic and a polythetic diagnosis

The polythetic diagnosis is the kind where a diagnosis is made even if the presentation includes only a proposition of the symptoms that was used in defining the disorder. This is unlike a monothetic diagnosis where all the symptoms must be present in order for a diagnosis to be made (McPartland, Reichow &Volkmar, 2012).

GAF and the axis it goes to

GAF is an acronym for Global Assessment Functioning. It is a scale from 0 to 100. Higher levels indicate higher levels of functioning. Under this scale, the social functioning, school and work of the patient are considered. The top most scale, 100-91 indicates the best functioning individuals. Here, the individual seems to be doing well in school or work and has meaningful social relationships. Things never seem to get out of hand for such individuals. The next is 90-81. Here, the individual may experience normal anxiety, for example, just before an exam. Next, is 80-71. When the symptoms are present, they are the expectable reactions to psychosocial stressors. For example, the patient could have a hard time concentrating after a family argument. Next is 70-61. The symptoms here are mild, including insomnia and a depressed mood. Next on the scale is 60-51. Some of the symptoms here include panic attacks and difficulty in social functioning, such as conflicts with coworkers.  Next is 50-41. Some of the symptoms here are serious, including suicidal ideation, severe obsession rituals, frequent shoplifting and impairment in social or school functioning. The next range is 40-31. There is a lot of impairment. One can see impairment in reality and communication, for example, incoherent speech or illogical communication. Sometimes, there may be impairment in terms of relationship between the person and his or her family members. The next is between 30-21. Here, the person can be seen to be incoherent, sometimes, there are hallucinations or impairments in judgment and communication. The person may also be suicidal. The next is between 20-11. This is a low functioning person. He or she may pose danger in hurting herself or others. The person may also present an inability to function normally, for example, by staying in bed all day without a job, or a home and no friends. The next is between 10-1. Here, there is persistent danger of hurting oneself or others or gross impairment in communication. Finally, there is 0. Here, there is not enough information. The GAF goes on axis v, which is used for reporting the functioning of the patient at overall levels (GAF, n.d.) 


NOS is an acronym for not otherwise specified. Usually, this is given to patients who do not meet the diagnostic criteria for any of the mental illnesses available. Sometimes, it may mean that the patient is too young, and the clinician wants to avoid labeling. One of the reasons to avoid labeling is because a young patient may go and read about the mental disorder. After reading, he or she may start behaving in a way as to exhibit the said symptoms, even if some of these symptoms would not have previously occurred. Sometimes, the diagnosis is given for a teenager, who may be termed moody. This is because the clinician thinks that the teenager or young adult may outgrow the symptoms of the disorder (Teplin, Abram, MCClelland, Washburn, &Pikus, 2015). The diagnosis is also given with the consideration that diagnosis in most cases are highly flawed and are influenced by many societal and cultural influences. 

Diagnoses on axis II

Axis II is where the personality disorders and diagnosis go. As an addition, intellectual disabilities are placed here. The nature of these disorders is that they are lifelong and that they first arise in childhood. Most of the disorders that fall under this category are accompanied by a lot of societal stigma. This is because a large number of people who suffer from them are usually unable to adapt well into society. Sometimes, this disorders are confused with those in axis one. This is because they may present themselves using a similar set of symptoms. Some of the diagnoses that go on axis II include Antisocial personality disorder, avoidant personality disorder, borderline personality disorder, dependent personality disorder, histrionic personality disorder, mental retardation, narcissistic personality disorder, obsessive compulsive disorder and paranoid personality disorder (American Psychiatric Association, 2013). These disorders are regarded as permanent and usually do not respond to treatment.

In summary, the DSM has been discussed and understood in detail. This paper has dealt mainly with the DSM as it appeared after the third edition. Some of the changes that occurred during this time have been discussed, and the necessity for these changes identified. The essay has also discussed the difference between a monothetic and a polythetic diagnosis in regard to mental health. Some of the axis according to the DSM have been examined, specifically, axis II. The GAF which is a scale from 0-100 has also been discussed. Finally, NOS, or not otherwise specified has been evaluated. The need for this category has been seen. From that, it is possible to understand why some people may receive that as a diagnosis.


American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders(DSM-5) American Psychiatric Pub

Frances, A. (2013) The New Crisis of confidence in psychiatric diagnosis. Annals of internal medicine, 159(3), 221-222

GAF, (n.d.) Retrieved September 21, 2016, from http://www.albany.edu/caps/gaf/ 

McPartland, J. C., Reichow, B., & Volkmar, F.R. (2012). Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. Journal of the American Academy of Child &Adolescent Psychiatry, 51(4), 368-383

Teplin, L.A., Abram, K.M., McClelland, G.M., Washburn, J.J., & Pikus, A.K (2015) Child and Adolescent health. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 83(4), 555-557

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