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DSM-IV-TR in ActionReview - DSM-IV-TR in Action
by Sophia F. Dziegielewski
John Wiley & Sons, 2002
Review by Geneva S. Reynaga, M.A.
Nov 13th 2003 (Volume 7, Issue 46)

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the manual utilized by most mental health professionals to diagnose clients. The most recent edition is the fourth edition, text revised (DSM-IV-TR). The DSM-IV-TR in Action by S. F. Dziegielewski was "…designed to support the practitioner with the current application principles relating psychopathology to clinical mental health practice" (p. xvii). Dziegielewski is successful in her goal, as this is a fabulously useful resource for the practicing clinician. It provides countless helpful hints in assessment, diagnosis, record-keeping, ethics, confidentiality, and issues of cultural competency. It is written for mental health professionals, with a writing style that is technical but simple enough that even an inexperienced clinician could understand.

The author provides a thorough history of the DSM (Chapter 1), including its current uses and controversies. She continually keeps the clients' best interests in mind, making it clear that clinicians must be sensitive and remember "…that categorizing an individual with a mental health disorder can result in a psychiatric label that is difficult to remove" (p. 9). The author describes how assessment and diagnosis are continual processes and that any given diagnosis must be related to the client's needs.

In Chapter 2, the author cautions against careless labeling of clients that may occur with diagnosis: "Consideration should always be used to ensure that terms are not used incorrectly and that individuals who suffer from a mental disorder are not referred to or treated in a careless or derogatory manner. It is important to guard against this type of labeling and to remind others of this as well" (p. 24). She makes the relevant and important point of discussing how both mental health professionals and their clients have their own cultural background that influences them.

Chapters 3 and 4 are useful resources for mental health professionals. Chapter 3 clearly explains the current multiaxial system and how to diagnose on each axis. Dziegielewski also discusses how to code culturally-related behaviors and symptoms, defense mechanisms, and clinical presentations suggestive of a medical diagnosis. All these are incredibly relevant to the practicing clinician and the author makes them very clear and easy to understand.

Chapter 4 deals with the topic of record-keeping, giving good examples of formats, including information on confidentiality issues when storing records on computer. The rest of the book (Chapters 5 through 12) describes specific clinical disorders and how to best assess and treat them. The disorders covered include Reactive Attachment Disorder, Conduct Disorder, Alcoholism, Anorexia Nervosa, the Psychotic Disorders, Obsessive-Compulsive Disorder, Bipolar Disorder, and Borderline Personality Disorder. Each chapter contains information unique to that disorder, with sample treatment plans and interventions. These chapters are incredibly useful to mental health professionals, as the disorders listed often pose both diagnostic as well as treatment challenges.

Although the author includes various aspects of clinical practice that are relevant with regard to assessment and diagnosis, she skims over topics that certainly deserve greater attention. These topics include treatment approaches and theoretical orientations. For example, Dziegielewski focuses on time-limited approaches with an apparent bias against long-term treatment approaches. Although many clinicians utilize short-term approaches, especially in the modern world of managed care, long-term approaches continue to be practiced by many mental health professionals. Furthermore, she seems to focus more on assessment than treatment. This becomes an area of concern if the reader considers only her limited information for treatment references. One wonders if it is advantageous to include such topics at all and hopes that the reader understands further study is required in order to fully grasp their depth. Despite these few shortcomings, the author provides a handy reference tool for mental health clinicians. Her focus maintains respect for the population served and includes the relevant issues facing professionals today. DSM-IV-TR in Action is a resource integral to every practicing clinician's collection.

 

2003 Geneva S. Reynaga

 

Geneva S. Reynaga, M.A. is currently a pre-doctoral intern at the Department of Mental Health located at the Correctional Medical Facility in Vacaville, CA. She is a doctoral candidate at Pepperdine University in West Los Angeles, CA. Interests include neuropsychological assessment, psychoanalysis, and ethnic minority issues. She is nearing the completion of her theoretical dissertation entitled, “Toward a Culturally Relevant Model for the Assessment of Psychopathology in Mexican-Americans.”


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