This blog looks to give a short description and analysis of the DSM and its purposes and ways of classifying mental illness. The Diagnostical Statistics Manuel of Mental Disorders or DSM is a series of editions that looks to help mental health professionals diagnose mental pathology. It lists numerous types of psychopathologies and looks to classify and aid mental health professionals through the diagnostic process. It is meant as an aid not necessarily a replacement of one’s professional acumen.
Please also review AIHCP’s mental and behavioral health certifications for clinical as well as non clinical professionals.
DSM
The first edition of the DSM appeared in 1952 (DSM-V-TR, 2022). Since then there have been five editions with the most recent appearing in 2022. This edition is the revised text of the fifth edition which appeared in 2013. In 1999, the American Psychiatric Association (APA) launched an extensive evaluation of strengths and weaknesses of the previous DSMs. In efforts with the World Health Organization (WHO), as well as the National Institute of a Mental Health (NIMH), the revision began to correlate closer with the International Classification of Diseases (ICD). This led to sharing the same codes with ICD-11 instead of separate coding for mental health and diseases (DSM-V-TR, 2022). This led a better harmonization with the ICD and a regrouping of mental disorders to correlate with developmental and life span considerations of mental disorders (DSM-V-TR, 2022). The DSM-V also removed its previous multiaxial system of diagnosis which involved assessment on various axes which referred to different domains. Axis I was previously clinical disorders, Axis II included personality disorders and intellectual development disorders, Axis III included other medical disorders, and Axis IV included psychosocial factors.(DSM-V-TR, 2022). These axis are no replaced in the DSM-V with diagnosis and conditions correlated with the ICD z coding. The final axis V which included Global Assessment and Functioning was replaced by the WHO Disability Assessment Schedule (DSM-V-TR, 2022) (McRay, B., et al., 2016).
Emphasis is also placed within the new revision of cultural and social norms and the danger of abnormality being measured universally without proper context of different cultures and expression. In addition, the new revision calls for a greater focus on mental issues caused by biases and prejudices caused by race, gender, sexual orientation and culture.
The new edition also defines key terms regarding diagnosis. This includes the differences between a primary diagnosis and provisional diagnosis. Within a primary diagnosis, the diagnosis deals with the presenting issue or reason for visit. This diagnosis is based on the inpatient setting and the available information. A provisional diagnosis occurs when current information is insufficient at the time to make an official diagnosis based on needing more records or more time to unfold according to the DSM for a particular disorder to manifest (DSM-V-TR, 2022).
Important terminology for diagnosis also explains the etiology or origin of the disorder. In some cases, it will be attributed to substance abuse or medical disorders and in other cases independent mental disorder. Instead of past diagnosis with labeled disorders as organic or physical versus nonorganic or purely of the mind, current systems utilize these labels to help understand the etiology of the disorder (DSM-V-TR, 2022).
If a clinician were to review a patient’s symptoms and cross reference it with the DSM-V-TR, they would discover various headings to help one further a diagnosis. First, the Diagnostic Criteria heading lists the various symptoms that must manifest and how many the patient must possess. Second, Diagnostic Features, as well as Associated Features, Development and Course, and Risk and Prognostic Factors all provide more insight and information for the clinician to review and refresh upon. In addition to the primary diagnosis, the manual also has headings for Comorbidity and Differential Diagnosis which illustrates other possible disorders to review that are related to the patient as well as possible concurrent disorders that can co-exist with the primary disorder (DSM-V-TR, 2022).
Classification and Etiology
Many modern psychopathologies are classified according to different schools of thought but ultimately, psychopathology is a complex system. Nosology refers to the scientific process of categorizing phenomena (McRay, B., et al., 2016). Three approaches to classification involve the monothetic approach, the polythetic approach and the dimensional approach. The monothetic diagnosis is based on a “yes” or “no” classification if the agent meets the model of criteria for something or not. The polythetic which is more attuned to the true nature of psychopathology permits for a broader criteria of prototype for membership of a particular class or disorder. Criteria is more than merely pathognomonic but due to correlation, can fit some of the criteria to be included and hence creating a more heterogeneity class membership (McRay, B., et al., 2016). Dimensional models are also more diverse because they do not merely focus on qualitative distinctions between normal and abnormal but more so on a continuum of health that reviews extremes of traits (McRay, B., et al., 2016).
Most theoretical classifications fall under various schools of thought. Ultimately a multidimensional approach is critical and is what the DSM utilizes. Among theoretical perspectives there are biophysical theories which emphasize physiological factors that determine psychopathology. Included also are intrapsychic which primarily assume psychological factors, phenomenological factors which stress experience and perception, and behavioral theories which focus on how a person’s learning and personality was determined by reinforcement (McRay, B. et al., 2016).
The primary foundations for all mental illness finds itself in four broad models of psychopathology: Biological, psychosocial, socio-cultural, and spiritual. Biologically, mental maladies can be due to genetics and physiological factors. Psychosocial reviews the formation of psychopathy from the numerous branches of psychology. Whether from a psychoanalytic perspective, or a behavioral perspective, or even a humanistic perspective, psychopathology and illness is an expression of underlying personality dynamics, environmental factors, internal thinking processes or learned habits that create pathology (McRay, B., et al, 2016). The socio-cultural pinpoints where some psychopathologies can emerge due to cultural and family aspects of development and how they play a role in a person’s mental health. This includes the role of social labels and roles, as well as social connections and support play in the development of one’s mental health. Finally, spiritual models look at the power of identity, meaning and existential realities and how these spiritual practices help or hinder a person’s mental health (McRay, B., et al, 2016).
Caution when Utilizing any Diagnosis
The DSM-V-TR when used by untrained professionals can be dangerous. Also, even for trained individuals, it is important to understand that the DSM-V-TR despite based on a wealth of knowledge, empirical research, as well as multiple health organizations is still limited in diagnosis. According to McCray, DSM V categories are more descriptive than explanatory. He also points out that diagnostic labeling needs to be done with sensitivity and care to avoid damaging the self worth of an individual (2016). Ultimately, the field of psychotherapy is not an exact science and false diagnosis can occur. While the most current DSM is the premiere resource, it is only as reliable as the trained user utilizing and applying it. Humility and thoroughness in assessment and diagnosis is key, as well as a Rogerian sensitivity in discussing an mental disorder. A person should not be a seen as “this” or “that” but a person exhibiting traits of “this” or “that” or suffering from “this” or “that”. This prevents labeling, mental stigma, and including the identify of the person with the disorder itself.
Conclusion
The DSM-V-TR is the most current edition of the DSM at the time of this blog. As science and the medical field discovers more, new editions will emerge. As new strategies and ways of viewing mental illness emerge, new editions will incorporate them as well. In the meantime, those in behavioral health and the clinical side must adhere to the best and most current ways of understanding, diagnosing and treating mental health.
It is important to remember that non-clinical members of AIHCP who may be certified are not entitled to diagnosis and treatment. Individuals in grief counseling who are not licensed need to refer clients to the appropriate professionals. Please also review AIHCP’s healthcare certifications for both clinical and non-clinical counseling in grief, stress, anger, crisis, trauma informed care, spiritual and Christian counseling programs.
References
McRay, B., Yarhouse, M., & Butman, R. (2016). Modern psychotherapies: A comprehensive Christian appraisal (2nd Ed). IVP Academic
DSM-V-TR. Access here
Additional AIHCP Blogs
Diagnosing Psychopathology. Access here
Additional Resources
DSM-5. Cleveland Clinic. Access here
First, M., et al. (2022). DSM‐5‐TR: “Overview of what’s new and what’s changed”. World Psychiatry. May 7;21(2):218–219.
doi: 10.1002/wps.20989
Fritscher, L. (2026). Advantages and Disadvantages of the Diagnostic Statistical Manual. VeryWellMind. Access here
APA. DSM-5-TR Online Assessment Measures. Access here