Sunday, August 16, 2009


Objectives of DSM -
1. It clearly identifies and separates one particular bhr from the other.
2. It helps to make different groups of problems under different major groups.
3. It helps us to understand the nature, cause and treatment of a particular problem.
4. It helps us to discuss professionally to have more understanding about the problem.

Process of DSM -
1. It classifies each maladaptive bhr according to the symptoms and signs.
2. It groups different syndromes into major categories according to the common symptoms they exhibit .
3. It also considers the severity,the nature of the causes in it's classifications.

History of DSM -

1. DSM I appeared in 1952 in the background of the mental breakdowns of millitary personnel in WWII

2. DSM II published in 1968. DSM I and II have identified some mental diseases and defined it, but the problem was it was too narative and vague, the mental health professionals could not agress on their meanings and definitions therefore, the reliability of classifications was very much limited.

3. DSM III appeared in 1980 it used operational definitions to remove subjective interpretation. Operational definition is based on the exact observations for each disorder to be identified a specific number of symptoms from a designated list must be present. This approach was more accepted and continued in indentifying more disorders. In 1987 a revised version of DSM III appeared which is named as DSM III R and in 1994 DSM III R again revised and named as DSM IV. We have new syndromes and sub-divisions of early diagnosed syndromes in DSM I to DSM III R. In 2000, the test is again revised and is named as DSM IV TR

4. DSM IV TR specifies what sub-types of mental disorder are currentlyand officially recognised. It provides a set of rules for defining criteria. It is very categorical and draws sharp boundary line between one disease from another. It classifies the mental disorders into signs and symptoms.

About DSM IV TR - [This one is Carson and Butcher and Mineka Gyaan + Fr. V Notes]

Since the advent of DSM III in 1980, DSM IV evaluates an individual according to five foci or "axes". The first three axes assess as individual's present clinical status or condition:

Axis I - The particular clinical syndromes or other conditions that may be a focus of clinical attention. This would include schizophrenia, generalised anxiety disorder, major depression and substance dependence. Axis I conditions are roughly analogous to the various illnesses and diseases recognized in general medicine.

Axin II - Personality disorders. A very broad group of disorders that encompasses a variety of problematic ways of relating to the world, such as paranoid personality disorder, anti-social personality disorder and histrionic personality disorder. These disorders are considered as a long standing mal-adaptive personality trait that may or may not be involved in the development of Axis I disorder. Mental retardation also can added in Axis II.

Axis III - General medical conditions. It is situation which refers to some chronic medical diease which in turn causes any disorder of Axis I.

On any of these first three axes where the pertinent criteria are met more than one diagnosis is permissible, and in fact encouraged. That is, a person may be diagnosed as having multiple psychiatric syndromes, such as, panic disorder and major depressive disorder; disorders of personality, such as, Dependent or Avoidant; or poyentially relevant mediacal problems, such as Cirrhosis and Overdose, Cocaine. the last two DSM IV axes are used to assess broader aspects of an individual's situation.

Axis IV - Psychosocial and environmental problems. This group deals with the stressors that may have contributed to the current disorder, particularly those that have been present during the prior year. The diagnostician is invited to use a check list approach for various categories of impinging life problems -- family, economic, occupational, legal, etc

Axis V - Global assessment of functioning. This is where clinicians note how well the individual is coping at the present time. A 100-point rating scale, the Global Assessment of Functioning (GAF) Scale, is provided for the examiner to assign a number summarising a patient's overall functionability.


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