Opinion on Change of DSM-IV

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The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual published by the American Psychiatric Association (APA).  The manual covers intensively various mental disorders for adults and children using a standardized language for medical practitioners. It is used extensively in the United States and even the rest of the world by researchers, clinicians, policy makers, psychiatric drug regulation institutions, health insurance and pharmaceutical organizations. Firstly, it was published in 1952 and has undergone five major revisions. DSM-IV, the fourth edition, was released in 1994 with a listing of 297 disorders.  The fifth edition (DSM-5) is due for publication in May 2013 after an extensive consultation.

It is important for the APA to consider the reliability and validity of its diagnosis. To a large extent, it should ensure what the DSM-V defines are real conditions affecting people in the world (Dalal, 2009). Adopting a  scientific model of mental disorders is helpful in both research and addressing underlying causes of different mental disorders. Much emphasis is required in understanding Pathophysiological processes and etiology of some kinds of mental disorders. This is complex than it may be imagined. More research is mandatory in order to structure the classification of psychiatric disorders according to etiology (Chodoff, 2005). Adoption of superficial symptoms rather than having an explanatory classification may largely undermine research particularly in genetics.  The new edition should consider cultural and ethnic disparities and eliminate possible Euro-America outlook. This will ensure true representation of diverse cultures and backgrounds therefore enhancing its relevance and adoption (Kleinman, 1999).

The Borderline personality disorder has led to a controversy. In DSM-IV, it is classified as an Axis II disorder. In practice, it is mostly undiagnosed, misdiagnosed or treated inappropriately.  According to The Treatment and Research Advancements National Association for Personality Disorders (TARA-APD), the name BPD is confusing, imparts no relevant or descriptive information and therefore it needs to be reviewed.

The APA should not change Obsessive-Compulsive Disorder (OCD) and Anxiety Disorders to Anxiety and Obsessive-Compulsive Spectrum Disorders. This is unnecessary though harmless. Though it is claimed by some practitioners that OCD has been found to have a neurological basis, research may reveal in the near future that many if not virtually all of the conditions in DSM have a neurological basis. DSM-IV provides two options for those with panic disorder namely Panic Disorder with Agoraphobia and Panic Disorder Without Agoraphobia.  It also provides Agoraphobia Without History of Panic Disorder which is maintained as a separate condition.  APA seems to combine the two separate diagnoses of panic disorders and leave Agoraphobia as a separate condition excluding “Without History of panic Disorder”. This is unacceptable because in practice you can never find a client with Agoraphobia Without Panic Attacks.

In the DSM-IV, Body Dysmorphic Disorder is classified as a Somatoform Disorder, along with Conversion Disorder, Undifferentiated Somatoform, Somatization Disorder, Pain Disorder, and Hypochondriasis.  Changing BDD from the current category of Somatoform Disorders into the new category of Anxiety and Obsessive-Compulsive Spectrum Disorders may be inappropriate since BDD has much in common with OCD and very little in common with most Somatoform Disorders.

DSM is important in guiding clinical and therapeutic procedures. Therefore, APA should nurture a consultative approach to benefit and delineate medication of mental disorders.

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