The Diagnostic And Statistical Manual of Mental Disorders

December 2, 2014

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or DSM-5,published May 18, 2013, represents the American Psychiatric Association’s highly anticipated current statement of best practices and accepted understandings of mental illness. It replaces the fourth edition or DSM-IV and it represents a substantial departure from /reform of the system as it has existed. Prior to the DSM-5 , the four prior versions ( representing some 62 years of peer reviewed scholarship, clinical evidence and medical science) considered each diagnosis ” categorically” separate from health and other diagnosis, drawing artificial lines between illnesses .

Most disorders are now understood to exist and produce symptoms along a spectrum of severity and that many of those disorders produce many of the same symptoms. Disability claimants will appreciate this broader acceptance of the notion that physical, mental, and environmental problems are all, ultimately interrelated .This “enlightened view vindicates many disability claimants and legitimizes so many of their descriptions of the nature and frequency of symptoms. Additionally, even, perhaps those symptoms formerly deemed “out of proportion with the objective findings”

This philosophical evolution has led to a substantial reform and a new diagnostic system. Gone are the Axis I, II & III , known as the “Multiaxial System”. Now, all disorders, both physical and mental are listed together because ” the boundaries between many disorder categories are more fluid over the life course then DSM-IV recognized, and many symptoms assigned to a single disorder may occur, at varying levels of severity, in many other disorders”(1). Similarly Axis IV has been replaced with “significant psychosocial and contextual features”(2) in a further nod to the notion that the individual cannot be accurately understood in a vacuum. Further, the controversial GAF has been eliminated. Formerly the GAF or Global Assessment of Function was a ratings system that sought to attach a numeric answer to the “How bad is it in the moment? “question. The system was widely maligned as subjective and thus unreliable. The elimination of the GAF will eliminate the occasion for the counterproductive practice of third party second guessing. ” The endless speculation and skepticism that the former system engendered was always a confounding and needles distraction.