Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

A reference work developed by the American Psychiatric Association and designed to provide guidelines for the diagnosis and classification of mental disorders.

The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders, widely referred to as DSM-IV, a reference work designed

CLASSIFICATION OF MENTAL DISORDERS

DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE

• Mental retardation
• Learning disorders
• Motor skill disorder
• Communication disorders
• Pervasive developmental disorders
• Attention-deficit and disruptive behavior disorders
• Feeding and eating disorders of infancy or early childhood
• Tic disorders
• Elimination disorders
• Other disorders of infancy, childhood, or adolescence

DELIRIUM, DEMENTIA, AND AMNESTIC AND OTHER COGNITIVE DISORDERS

• Delirium
• Dementia
• Amnestic disorders
• Other cognitive disorders

MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION NOT ELSEWHERE CLASSIFIED

SUBSTANCE-RELATED DISORDERS

• Alcohol-related disorders
• Amphetamine use disorders
• Amphetamine-induced disorders
• Caffeine-related disorders
• Cannabis-related disorders
• Cocaine-related disorders
• Hallucinogen-related disorders
• Inhalent-related disorders
• Nicotine-related disorders
• Opioid-related disorders

PHENCYCLIDINE-RELATED DISORDERS

• Sedative-, hypnotic-, or anxiolytic-related disorders
• Polysubstance-related disorder
• Other, or unknown substance-related disorder

SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

MOOD DISORDERS

• Depressive disorders
• Bipolar disorders

ANXIETY DISORDERS

• Somatoform disorders
• Factitious disorders
• Dissociative disorders

SEXUAL AND GENDER IDENTITY DISORDERS

• Sexual dysfunctions
• Paraphilias
• Gender identity disorders

EATING DISORDERS

SLEEP DISORDERS

• Primary sleep disorders
• Sleep disorders related to another mental disorder

IMPULSE-CONTROL DISORDERS NOT ELSEWHERE CLASSIFIED

ADJUSTMENT DISORDERS

PERSONALITY DISORDERS

OTHER CONDITIONS

to provide guidelines for psychologists and others to use in the diagnosis and classification of mental disorders. The latest edition, DSM-IV, serves as a reference to psychiatrists, other physicians and mental health professionals, psychologists, social workers, and others in clinical, educational, and social service settings.

First published in 1917, each new edition of Diagnostic and Statistical Manual of Mental Disorders has added new categories. With the third edition, published in 1980, the DSM began recommending assessment of mental disorders according to five axes, or dimensions, that together establish an overall picture of a person's mental, emotional, and physical health, providing as complete a context as possible in which to make a proper diagnosis. The diagnostician evaluates the patient according to criteria for each axis to produce a comprehensive assessment of the patient's condition; the multiaxial system addresses the complex nature of more mental disorders.

Axis I lists 14 major clinical syndromes. These include disorders usually first diagnosed in childhood or adolescence (hyperactivity, mental retardation, autism); dementia, amnesia, and other cognitive disorders; substance-related disorders; schizophrenia and other conditions characterized by abnormalities in thinking, perception, and emotion; and sexual and gender identity disorders. Also listed in Axis I are mood, anxiety, somatoform, dissociative, eating, sleep, impulse control, and adjustment disorders, as well as factitious (false) disorders.

Axis II is for assessment of personality disorders— lifelong, deeply ingrained patterns of behavior that are destructive to those who display them or to others. Some examples are narcissistic, dependent, avoidant, and antisocial personality types. This axis also includes developmental disorders in children.

Axis III considers any organic medical problems that may be present. The fourth axis includes any environmental or psychosocial factors affecting a person's condition (such as the loss of a loved one, sexual abuse, divorce, career changes, poverty, or homelessness).

In Axis V, the diagnostician assesses the person's level of functioning within the previous 12 months on a scale of 1 to 100.

One notable feature of DSM-IV is that it dispenses with two previously ubiquitous terms in the field of psychology—" neurosis" and "psychosis"—because they are now considered too vague. The term "neurosis" was generally used for a variety of conditions that involved some form of anxiety, whereas "psychosis" referred to conditions in which the patient had lost the ability to function normally in daily life and/or had lost touch with reality. Conditions that would formerly have been described as neurotic are now found in five Axis I classifications: mood disorders, anxiety disorders, somatoform disorders, dissociative identity disorders, and sexual disorders. Conditions formerly referred to as psychotic are now found in Axis I as well. Besides diagnostic criteria, the DSM-IV also provides information about mental and emotional disorders, covering areas such as probable cause, average age at onset, possible complications, amount of impairment, prevalence, gender ratio, predisposing factors, and family patterns.

DSM-IV contains the results of a comprehensive and systematic review of relevant published literature, including

MULTIAXIAL CLASSIFICATION SYSTEM

• Axis I – Clinical disorders; other conditions that may be a focus of clinical attention
• Axis II – Personality disorders; mental retardation
• Axis III – General medical conditions
• Axis IV – Psychosocial and enviromental problems
• Axis V – Global assessment of functioning.

earlier editions of DSM. In cases where the evidence of a literature review was found to be insufficient to resolve a particular question, data sets were reanalyzed and issue-focused field trials were conducted. These literature reviews, data reanalyses, and field trials that form the basis of DSM-IV have been fully documented, condensed, and published separately as a reference record in a five-volume set entitled DSM-IV Sourcebook. The DSM-IV Sourcebook also contains executive summaries of the rationales for the final decisions relative to inclusion in DSM-IV.