What is the purpose of the Diagnostic and Statistical Manual of Mental Disorders?

Classification

Diagnostic and Statistical Manual of Mental Disorders – IV (DSM-IV-TR) lists twelve anxiety disorders: (1) panic disorder with agoraphobia, (2) panic disorder without agoraphobia, (3) agoraphobia without history of panic disorder, (4) specific phobia, (5) social phobia, (6) obsessive-compulsive disorder, (7) post-traumatic stress disorder, (8) acute stress disorder, (9) generalized anxiety disorder, (10) anxiety disorder due to a general medical condition, (11) substance-induced anxiety disorder, and (12) anxiety disorder not otherwise specified Sadock and Sadock (2003).

The ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th revision) describes 5 subtypes of OCD:

predominantly obsessional thoughts or ruminations;

predominantly compulsive acts (obsessional rituals);

mixed obsessional thoughts and acts;

other obsessive-compulsive disorders;

obsessive-compulsive disorder, unspecified.

The Diagnostic and Statistical Manual of Mental Disorders – IV(DSM-IV) have strict criteria:

A. Either obsessions or compulsions:

Obsessionsas defined by 1, 2, 3, and 4:

recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

the thoughts, impulses, or images are not simply excessive worries about real life problems

the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thoughts or action

the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

Compulsionsas defined by 1 and 2:

repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation, however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

At some point during the course of the disorder, the person recognizes that the obsessions or compulsions are excessive or unreasonable. Note: this doesn't apply to children.

The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.

If another Axis I (all mental disorders except personality disorders, mental retardation, and other conditions that may be a focus of clinical attention) disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an eating disorder; hair pulling in the presence of trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphillia; or guilty ruminations in the presence of Major Depressive Disorder).

The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify if:

With Poor Insight: if, for most of the time during the current episode, the person does not recognize that the obsessions and compulsions are excessive or unreasonable

(DSM-IV-TR)

Sexual Function and Dysfunction

The Diagnostic and Statistical Manual of Mental Disorders (DSM) [10] has characterized SD as a disturbance in the process that embodies the sexual response cycle, or pain associated with sexual intercourse. The DSM divides the sexual response cycle into a small number of phases: (1) Desire, which is the desire to engage in sexual activity; (2) Excitement, which is the subjective sense of sexual pleasure culminating in an erection in males, and vaginal lubrication and swelling of external genitalia in females; (3) Orgasm, which culminates in the ejaculation of semen in males, and the contraction of the walls of the vagina in females; and (4) Resolution, which is muscular relaxation and a subjective sense of well-being.

Alcohol Dependence and Alcohol Use Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) described two distinct disorders, alcohol abuse and alcohol dependence (AD), with specific criteria for each. Nevertheless, the latest version which is DSM–V integrates the two DSM–IV disorders, alcohol abuse and AD, into a single disorder called AUD with mild, moderate, and severe subclassifications. AUD can be described as an abnormal pattern of drinking in which the drinker consumes excessive amounts of alcohol and has a continuous urge to drink alcohol. The drinker experiences symptoms such as a reduction in social activities, drinking-search behavior, and continuous drinking regardless of the psychological, social, and physical problems it produces (National Institute on Alcohol Abuse & Alcoholism, 2016).

Definition

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) American Psychiatric Association (2013) classifies schizophrenia as a “schizophrenia spectrum and other psychotic disorders” that involves a “split” been thought and emotion. Notable symptoms include hallucinations, particularly auditory hallucinations, delusions, and disorganized thoughts and/or speech. These symptoms are categorized as “positive symptoms” of the disease. Additional symptoms include the “negative symptoms” such as flat or inappropriate affect, social withdrawal, poverty of speech, avolition, and anhedonia. Cognitive deficits also occur.

The essential features of schizophrenia include psychosis for at least one month (unless controlled by medications), deterioration in baseline mental function, and duration of illness for at least 6 months that may include prodromal, active psychosis, and residual stages Henderson and Goff (2000).

A Definition

The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) defines MLD in terms of a discrepancy between performance on mathematics achievement tests and expected performance based on age, intelligence, and years of education. Although this is a commonsense approach to defining MLD, there is in fact no agreed upon test, achievement cutoff score, or achievement–intelligence discrepancy for defining or diagnosing MLD or LA (Gersten, Clarke, & Mazzocco, 2007; Mazzocco, 2007). A consensus is emerging, however, with respect to the importance of distinguishing between these two groups and the associated achievement patterns (Geary et al., 2007; Murphy et al., 2007). Children who score at or below the 10th percentile on standardized mathematics achievement tests for at least 2 consecutive academic years are categorized as MLD, at least in research studies, and children scoring between the 11th and the 25th percentiles, inclusive, across 2 consecutive years are categorized as LA.

History

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines pica as the persistent eating of nonnutritive substances for a period of at least 1 month, without an associated aversion to food. The behavior must be developmentally inappropriate and not part of a culturally sanctioned practice, and severe enough to warrant clinical attention. Some clinicians argue that a diagnosis of pica can include the compulsive consumption of certain foods, blurring the distinction between pica and food cravings. Pica is most frequently reported in pregnant women, patients of lower socioeconomic status, and children. It is also found in some cases of iron-deficiency anemia as well as in deficiencies of other nutrients, such as zinc. In some cultures, pica is considered therapeutic and is used in treating maladies such as anemia and anxiety. Interestingly, the range of reported items of consumption has not changed much during the past four centuries. Pica of dirt and clay was known to the Greeks and the Romans and was recorded in a thirteenth century Latin work. Pica was first addressed in a medical book in 1563, in which geophagia was described in pregnant women and in children.

What Is Dyslexia?

The Diagnostic and Statistical Manual of Mental Disorders (DSM V) of the American Psychiatric Association plans to use the term dyslexia rather than reading disorder (RD) which was used previously. DSM V defines dyslexia as difficulties in the “accuracy or fluency of reading that are not consistent with the person's chronological age, educational opportunities, or intellectual abilities” that “without accommodations, significantly interferes with academic achievement or activities of daily living that require these reading skills.”

The definition of dyslexia used by the International Dyslexia Association (IDA), on the other hand, highlights both the neurological and cognitive underpinnings of the disorder as well as its symptoms. The IDA defines dyslexia as “a specific learning disability of neurological origin which is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities” resulting from “a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction.” In line with this, a recent government review in England led by Sir Jim Rose also highlights difficulties in phonological awareness, verbal memory, and verbal processing speed as being characteristic of dyslexia.

Mini-Dictionary of Terms

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Diagnostic and statistical manual of mental disorders: Edited by the American Psychiatric Association; designed to augment the diagnosis and treatment of mental health disorders.

Muscular dysmorphia: Individuals (most commonly males) generally feel they are too small in physique, insufficiently muscular, or insufficiently lean.

Gastric dumping: Food lost through rapid transportation from stomach to the small intestine, voided as diarrhea.

Psychosocial: Psychological development interacting with social environment.

Axis I psychiatric disorders: Axis I is part of the DSM “multiaxial” system for assessment. Axis I conditions represent acute symptoms that need treatment.

Monoamine oxidase inhibitors (MAOIs): Antidepressants that prevent the breakdown of neurotransmitters such as noradrenaline (norepinephrine) and serotonin.

Selective serotonin reuptake inhibitors: Work as antidepressants by inhibiting reuptake of serotonin, thus making more serotonin available as a neurotransmitter.

Tricyclic antidepressants: Cyclic antidepressants that are designed to block the activity of the neurotransmitters serotonin and noradrenaline (norepinephrine) in the brain.

Cognitive behavioral therapy (CBT): Talking therapy designed to explore current behaviors as opposed to seeking causes of psychological stress related to the past.

Obsessive–compulsive disorder (OCD): Obsessive thoughts and compulsive activity that cause feelings of anxiety, disgust, or unease.

Definition of Addiction

The Diagnostic and Statistical Manual of Mental Disorders defines substance use disorders (SUD) as “a maladaptive pattern of substance use leading to clinically significant impairment or distress.” Substance abuse is a pattern of hazardous use, such as repeated legal problems, use in hazardous situations, inability to meet obligations, and use despite social or interpersonal conflicts. Substance dependence, or addiction, is characterized by loss of control over use that leads to significant impairment in functioning, and may include tolerance, withdrawal, continued use despite negative consequences, reduction of important activities, using at greater levels than intended, or spending a great deal of time than using. Environmental factors typically drive substance initiation, whereas genetic factors have a greater influence on sustained and escalated use.

Accurate diagnosis of SUDs can point to appropriate interventions but can be less accurately applied with adolescents. Teenagers are less likely to experience many of the negative consequences of use, such as failure to meet obligations or reducing activities, physical or psychological problems related to use, or using at greater levels than intended. Therefore, adolescents who use heavily may not necessarily meet diagnostic criteria for SUD. The quantity and frequency with which a teenager uses may be more important for understanding neurobiological consequences. Although many studies described examined teens with SUD, others focused on adolescents who used heavily, regardless of diagnostic status.

What is major depression?

The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) classifies MDD as a mood disorder, which relates to disorders that exhibit extreme ranges in mood. In MDD, mood extremes can include a loss of energy, sadness, anhedonia (an inability to experience pleasure), thoughts of suicide, and a general impairment of sleep, concentration, attentiveness, or decision making. MDD diagnosis requires a major depressive episode (MDE), defined as a discrete and pervasive period of these symptoms; however, heterogeneity exists in the context in which MDEs occur, and the specific symptoms inherent in each may differ, suggesting that considerable heterogeneity may exist in the underlying architecture of the DSM-IV classification of MDD. For example, up until puberty the rates of MDD are relatively equivalent between males and females, after which rates for females double or triple [2–4]. Postpartum depression (PPD) is a specific class of female-specific mood disorder where MDE occurs within 4 weeks of giving birth. The onset of MDD after the age of 50 to 60 has been termed late-life depression (LLD). These separate classes of depression may share common genetic and environmental foundations to confer risk, but they may also have distinct etiologies resulting in their different presentation. Where applicable throughout the chapter, evidence to this effect will be highlighted.