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Related Topics
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TRReview - Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR
Fourth Edition, Text Revision
by American Psychiatric Association
American Psychiatric Association, 2000
Review by Robert W. Hotes, Ph.D., DACC, DABPS
Oct 8th 2000 (Volume 4, Issue 41)

The production of the Diagnostic and Statistical Manual for Mental Disorders (DSM-I) in 1952 marked a milestone in the development of diagnostic protocols for use by mental health clinicians. As was the case with DSM-II and III, DSM-IV continued the linkage of the Manual with subsequent developments of the International Classification of Diseases (ICD). While linked to the United States standard of diagnostic practice, ICD-9 CM (Clinical Modification), DSM-IV preparation was coordinated with Chapter V of the World Health Organization's ICD-10. DSM-IV-Revised Text updates the descriptive and textual material while retaining the DSM-IV's philosophy and structure.

According to the authors of DSM-IV, the first version of the DSM was a variant of the ICD-6. This publication in 1952 heralded the selection of an approach to the diagnosis and treatment of mental disorders recognized as conditions that are interrelated with physical disease, but distinct in both etiology and possible treatments. However, the DSM makes a distinction between the concepts of mental disorder and the delineation of physical disease. The title of the volume itself reinforces an attempt to provide a method of classification that is neutral with respect to etiology of the disorders described. The DSM is frankly based upon a mind-body dichotomy exemplified in its multi-axial coding system.

DSM IV has served as the standard reference for mental health clinicians since 1994. Because of the dynamic nature of behavioral medicine and psychology, production of DSM V has been underway since that time. Since the DSM has become not only a tool to aid in diagnosis and the preparation of treatment plans, but as an educational resource as well, it was felt to be important to ensure that the textual matter that supports the DSM classification system reflect the most current trends and findings in behavioral science research.

The editors note that the time between the publication of the DSM IV and the appearance of DSM V is anticipated at more than 12 years. For this reason, updating the text seemed to be essential for the integration of theory into practice. With the exception of the change of color for the cover (gray) the format of the volume remains the same. This reviewer perceived a more legible typeface in the DSM-IV-RT, perhaps as an accommodation to the graying therapeutic community.

The goal of the Revised Text is to update the didactic value of the volume in light of recent clinical and scientific advances. This edition recognizes that the DSM has become an essential reference tool for the community of clinical mental health professional mental health professionals. Acceptance that the DSM is not only a tool for clinical practice but also a foundation textbook and source for education has shaped the preparation of a "revised text" version of the volume. Although it is often repeated that it is not absolutely necessary for clinicians to use the DSM in making preliminary diagnoses of mental disorder, the very acceptance of the need to produce a revised-text edition of the test prior to the anticipated release of DSM V underscores the acceptance that the work has came to enjoy in the mental health community. The RT version of the DSM IV thus provides a means for clinicians to integrate the more recent currents of psychological and psychiatric research into the realities of every day practice.

According to the DSM editorial team, there were five goals for the revision: First, factual errors that were identified in the DSM IV text were to be corrected. Secondly, a review was to ensure that the information presented was up to date. A third goal was to make changes to the DSM to reflect new information developed since the completion of the DSM IV literature reviews in 1992. A fourth goal focused on improvements that would enhance the educational value of DSM-IV. Finally, diagnoses in ICD-9-CM (Clinical Manual) that were changed since the 1996 coding update would be considered.

Good news for DSM-IV users is that there are no new disorders, subtypes or appendix categories in the DSM-IV RT. Changes to the text portions only (Associated Features and Disorders and Prevalence). Changes in the criteria sets were not considered, and the DSM- IV structure and operational principles of use are retained. While there are 943 pages in the fat gray volume, the majority of the 57 new pages are in an appendix summarizing the changes to the text materials.

In the opinion of this reviewer, most of the collateral materials published as learning tools for use with the DSM IV will still be effective with the DSM-IV-RT. Since there are no essential changes to the structure of the DSM represented in the DSM-IV-RT, is it worth $45-$50 to replace the well-worn red volume with the thicker gray tome? From the point of view of clinical patient/client care, the answer is affirmative. A less-expensive option might have been considered. But the difficulty of collocating the revised text with the existing diagnostic structural apparatus would have been significant. Excellence in service requires that clinicians utilize up-to-date tools in order to meet the gold standard in patient diagnosis and care. To reach this end, every mental health clinician should have access to the DSM-IV-RT.

Robert W. Hotes, Ph.D., DACC, DABPS, Executive Director, The American College of Counselors


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