Introduction
The DSM (Diagnostic and Statistical Manual of Mental Disorders) is one of the most essential diagnostic as well as classification tools used in clinical practice especially in psychiatry, research and other related fields. The tool serves as an authoritative guide in regard to the diagnosis that can used to determine the appropriate the treatment for various mental disorders (Jacob & Patel, 2014). In the light of this, the tool contains various descriptions, symptoms as well as other criteria that is used in the diagnosis of various mental disorders encountered in clinical practice. On the one hand, the tool provides a standard criteria and a universal language that enable healthcare professionals to classify and communicate about the various mental problems witnessed among patients and come up with appropriate treatments. On the other hand, the tool establishes reliable and consistent diagnoses that promotes continuous research relating to the mental disorders aimed at developing appropriate medications as well as other interventions (American Psychiatric Association, 2013). As such, the DSM is usually revised periodically in order to provide appropriate and relevant information that can be used to guide the diagnosis and subsequent treatment of the mental disorders (Jacob & Patel, 2014). In relation to this, the fifth edition of the DSM otherwise referred to as DSM-5 or DSM-V is the latest revised version of the DSM tool that was released in 2013 thereby replacing the previously used edition that was referred to as the DSM-IV-TR. However, even after the release of DSM-V, various corrections, adjustments as well as revisions have been made to this edition. For instance, the diagnosis of the AD (Adjustment Disorder) was revised to include information on whether the resultant symptoms relating to the condition should be classified as chronic or acute. The two classifications (ICD-10 and DSM-V) are quite effective and important in helping healthcare providers in making accurate diagnoses, and in as much as the two approaches to classification may have differences, the two play complementing roles in guiding healthcare providers.
In the light of this, the main goal of the DSM-V is to provide evidence-based information on the various aspects relating to the mental disorders to enable healthcare professionals to correctly diagnose the various mental disorders encountered in clinical practice and subsequently come up with the appropriate treatments (Cosgrove & Suppes, 2013). The changes made in the DSM-V were mainly based on the knowledge obtained from the advancements in research relating to the mental disorders and the clinical information obtained from various professionals involved in the field. In relation to this, the various changes made in the DSM-V shall greatly impact the diagnostic practices especially in mental health as well as other associated fields. Thus, it is essential for the healthcare professionals as well as individuals to clearly understand the highlights in regard to the various changes effected from the previous edition (DSM-IV-TR) to the new edition (DSM-V) so as to attain as well as uphold a collaborative approach in relation to treatment of the mental disorders.
More importantly, the ICD-10 (International Classification of Diseases version 10) is another essential manual that is used in conjunction with the DSM-V. Thus, the use of the aforementioned two manuals enable healthcare professionals to accurately diagnose the various mental disorders presented by patients and subsequently come up with suitable treatments. Essentially, the ICD-10 provides information relating to coding of all the illnesses encountered in healthcare. In relation to mental health, ICD-10 provides the coding information for all the illnesses that are related to mental health. Therefore, it is essential for clinicians to clearly understand the various aspects involved in the two manuals i.e. the DSM-V as well as the ICD-10 in order to correctly diagnose the various mental illnesses and come up with suitable interventions aimed at achieving optimal outcomes and enhance the patient’s wellbeing. This paper seeks to compare as well as contrast the DSM-IV-TR and DSM-V manual by specially focusing on the main changes made in the editions and the clinical implications. In addition, the paper will compare as well as contrast the ICD-10 and DSM-V and evaluate each the manuals can be used in diagnostic processes particularly in mental health.
Comparison between DSM-V and DSM-IV-TR
Essentially, the key changes made in the overall structure of the manuals include the modified order pertaining to the various levels relating to specific disorder as well as the termination of the previously used multi-axial system. As such, the DSM-V terminated the use of the multi-axial system that was used in the previous edition (DSM-IV-TR) and adopted a dimensional approach (Jacob & Patel, 2014). Hence, the approach adopted in the DSM-V shall provide an opportunity for various modifications to be enacted thereby allowing the inclusion of genetic as well as neurobiological factors in the latest edition. More importantly, the DSM-V terminated the use of the multi-axial system since it was rarely used particularly in clinical practice as well as research. In relation to this amendment, the previously used axes i.e. axes I-III were incorporated into a singular system. Moreover, axis IV that was previously used in DSM-IV-TR was replaced with contextual features and significant psychosocial while axis V was terminated.
Furthermore, in order to clarify the purpose for a specific diagnoses and enhance specificity, a clear distinction was made in latest edition (DSM-V) between the OSD (Other Specified Disorders) and unspecified disorders. In regard to this, the term OSD is used primarily to denote the various syndromes not included in the DSM-V such as passive-aggressive personal disorder (APA, 2013). On the other hand, unspecified disorder is used to represent cases that do not match any of the syndromes specified in the manual. Previously, the DSM-IV-TR had only the “Not Otherwise Specified Disorders”, thus the distinction made in the latest edition shall enable clinicians to clarify the purpose for a specific diagnosis as well as enhance specificity. Additionally, in the DSM-V, additional coding was provided for some disorders based on their associated symptoms and severity. Age, culture and gender are some of the aspects that were considered in the diagnostic aspects in DSM-V (Regier et al., 2013).
In regard to the changes made on the disorder level, the diagnostic classification in the latest edition (DSM-V) embarks on a structure of diagnostic classes based on their evolution criteria, manifestation as well as the similarity of their characteristics. Thus, in DSM-V the diagnostic classification of the various classes uses a chronological criterion. In relation to this, the diagnosis are categorized in a specific order i.e. from those that are initially made during early childhood stages to those made during the adolescent stages and those made during the adult stages. Some of the main diagnostic classes used in DSM-V include; neurodevelopmental disorders, other psychotic disorders as well as schizophrenia spectrum, depressive disorders, anxiety disorders and obsessive compulsive as well as the related disorders.
In relation to neurodevelopmental disorders, the DSM-V stressed that the diagnostic criteria used in intellectual disability or IDD (Intellectual and Developmental Disability) should be based on the assessment of an individual’s adaptive functioning as well as cognitive ability. This change was made based on the clinicians’ perception in regard to deficits in adaptive functioning as well as IQ. For example, in the latest edition (DSM-V), the severity of an individual’s intellectual disability is usually rated by level of the individual’s adaptive functioning instead of using the IQ score as previously used in the DSM-IV-TR. Hence, the concept of mental retardation that was previously used in DSM-IV-TR was replaced with intellectual disability in the latest edition. Additionally, in DSM-V, language disorder, childhood-onset fluency disorder, social-communication disorder as well as speech-sound disorder are categorized as communication disorders (Cosgrove & Suppes, 2013). This categorization shall enable clinicians to distinguish social-communication disorder form the spectrum of autism.
In regard to ASD (Autism Spectrum Disorder), the DSM-V classifies the four disorders i.e. asperger’s disorder, autistic disorder, persuasive-developmental disorder (Not otherwise specified) and childhood-disintegrative disorder as a single condition (ASD) (Lai et al., 2013). Previously, the four disorders were categorized as separate disorders in the DSM-IV-TR. However, the DSM-V recognizes these disorders as a single condition with varying levels in regard to the severity of the symptoms based on two domains. Hence, ASD is mainly characterized by the deficits in social interaction as well as social communication, the RRBs (Restricted Repetitive Behaviors), interests and activities (Tandon et al., 2013). Thus, all the aforementioned components are necessary in diagnosing an ASD while lack of RRBs is indicative of a social-communication disorder. In regard to ADHD (Attention-Deficit/Hyperactive Disorder), the diagnostic criteria used in ADHD is almost similar in both DSM-V and DSM-IV-TR. Thus, both manuals use the same eighteen symptoms in diagnosis of ADHD. However, the criteria for the diagnosis of ADHD has somewhat been modified, especially to stress that ADHD can continue even into adulthood. Notably, the DSN-V emphasizes the need for cross-situational assessment for various symptoms among adults in order for an individual to be diagnosed with the disorder (Rodríguez-Testal, Senín-Calderón & Perona-Garcelán, 2014). This implies that an individual cannot be diagnosed with the disorder if it occurs only in one particular setting like in the workplace.
With respect schizophrenia, in DSM-V the criteria used in diagnosing schizophrenia has changed significantly. As such, the diagnostic subtypes (paranoid, undifferentiated, catatonic and residual type) previously used in schizophrenia diagnosis were eliminated mainly due to low reliability, inadequate diagnostic stability as well as poor validity. Therefore, in DSM-V the criteria used in diagnosing schizophrenia has significantly changed and has become more specific whereby the criteria includes one or more positive symptoms like disorganized speech, hallucinations or delusions (Regier, Kuhl & Kupfer, 2013). In relation to bipolar disorders, in DSM-V the criteria used in the diagnosis of bipolar disorders mainly focuses on the various fluctuations in energy, mood as well as the energy levels.
Moreover, in DSM-V the DMD (Disruptive Mood Deregulation) is categorized as a depressive disorder and is included in this category. Hence, DMD may be diagnosed among children as well as adolescents up to the age of eighteen years. This change was effected to address the various concerns related to the treatment and over-diagnosis of bipolar disorder among children. Another notable change made in DSM-V in relation to depression is the removal of the bereavement exclusion. Previously, the DSM-IV-TR had an exclusion criterion particularly for a MDD (Major Depressive Disorder) that was mainly applied to various depressive symptoms that lasted for less than two months after the loss of a loved one. Hence, the removal of this exclusion was guided by the previous implication that postulated that the bereavement period is only two months while it is widely acknowledged that the period lasts for at least one to two years. In addition, bereavement is widely acknowledged as a psychological stressor that may precipitate the occurrence of MDD among vulnerable individuals (Balazs et al., 2013). However, the diagnosis should be based on clinical judgment.
Additionally, in the DSM-V, PTSD (Post Traumatic Stress Disorder) and OCD (Obsessive Compulsive Disorder) were categorized under new sections whereby highlights some of their differences from the anxiety disorders. Thus, various new diagnosis such as excoriation disorder, hoarding disorder as well as medication or substance induced OCD have been included in the criterion for ODC diagnosis. More importantly, the DSM-V has included various specifies into the OCD section to evaluate the level of knowledge an individual has in relation to their symptoms (Volkmar & Reichow, 2013). Therefore, this shall enable healthcare workers providing care to individuals with these diagnosis to come up with suitable interventions based on the patient’s unique abilities and needs. With respect to PTSD, the DSM-V focuses mainly on the behavioral symptoms accompanying the disorder.
Thus, the DSM-V includes the four predominant symptoms accompanying the disorder i.e. arousal, re-experiencing, avoidance and persistent alterations in mood and cognitions. Additionally, in DSM-V, PTSD is categorized as developmentally sensitive whereby the diagnostic threshold is relatively lower for adolescents as well as children. Moreover, a separate criteria is included particularly for children with six years of age or below with PTSD. Some of the other notable changes made in the DSM-V included the inclusion of gambling disorder under the substance induced disorder category. Additionally, premenstrual dysphoric disorder as well as binge eating disorders are recognized as clinical diagnosis under the DSM-V. Overall, the various changes made in DSM-V focused on providing a more reliable and appropriate diagnostic tool that reflects the cultural as well as the societal changes.
Comparison between DSM-V and ICD-10
Essentially, the ICD-10 is a universal diagnostic tool used in health management, epidemiology as well as clinical practices. As such, the tool is used especially by various healthcare professionals and researchers to classify various diseases as well as health problems. The tool mainly comprises of various codes used to denote diseases, abnormal findings, symptoms as well as signs, social circumstances and complaints. In mental health, the ICD-10 and DSM-V are used as companion publications to foster accurate diagnosis of the various illnesses and mental problems encountered in clinical practice. However, the ICD-10 provides the diagnostic codes for all the illnesses pertaining to human health while DSM-V provides diagnostic information relating only to the mental health illnesses. In addition, the ICD-10 is documented and produced by an international health agency (WHO) while the DSM-V is documented, produced as well as approved by a single professional agency i.e. the APA (American Psychiatric Association).
As such, the ICD-10 utilizes varied opinions drawn from various clinicians all over the world while DSM-V utilizes the opinions of the experts drawn from a single professional agency. Thus, ICD-10 provides more reliable information relating to diagnosis of illnesses that reflects the global cultural as well as societal changes as compared to DSM-V (Maenner et al., 2014). Nonetheless, both classifications i.e. DSM-V and ICD-10 are typically nomenclatures that are primarily based on the similarity of symptoms. Hence, the two classifications do not have an upper limit in regard to the disorder that may be theoretically included. On the other hand, both classifications do not have certain evidence in regard to their validity since the two classifications are formulations that are based on the professional judgment instead of extensive empirical evidence.
Thus, healthcare professionals as well as researchers should explore and analyze the empirical justification in regard to the diagnostic criteria of the two classifications especially in relation to mental illnesses in order to enhance their validity. Furthermore, the diagnosis procedure in the two classifications mainly depend on the similarity of symptoms whereby this encourages healthcare professionals to reify the mental illnesses as well as make diagnoses based on the diagnostic criteria (Wilson et al., 2013). Thus, illnesses are either considered to be absent or presented since there is no substantial distinction made in the classifications about the varying degree in regard to the severity of the mental disorder. For instance, if an individual presents symptoms that fall short of the diagnostic criteria, the individual is considered to be “normal”. Thus, various adjustments should be made on both classifications to include various aspects such as different etiologies of the illnesses so as to enhance diagnosis of the various disorders.
Moreover, the ICD-10 comprises of a more robust description in regard to the severity, complications, manifestations, comorbidities, sequel, causes as well as the other parameters that characterize the condition of a patient as compared to DSM-V (Morey & Skodol, 2013). Additionally, both classifications do not have a clear distinction in relation to diagnosis of some of the mental conditions. Thus, a single code used in diagnosis could be used to represent different conditions. For instance, in ICD-10, the diagnosis code for bipolar disorder is F31.64 whereby there is no distinction on the variants of bipolar disorder. Thus, it is essential for clinicians to embark on a more detailed and intensive clinical documentation in order to come up with accurate diagnosis (Frances & Nardo, 2013).
Overall, the ICD-10 comprises various diagnostic codes that are used in the DSM-V as well as in healthcare practice to monitor the mortality as well as the morbidity statistics by various health agencies and foster appropriate diagnosis of the mental illnesses. Hence, the classifications contain significant compatible information related to diagnostic procedures for mental illnesses and they are mainly used as companion publications. More importantly, the APA (American Psychiatric Association) works closely with various healthcare professionals drawn from the CMS, WHO as well as CDC-NCHS to foster maximum compatibility of the two classifications (Stein, Lund & Nesse, 2013).
Conclusion
In conclusion, the two classifications provide valuable evidence-based information in regard to the diagnosis criteria of the various mental illnesses encountered in clinical practice. This enables clinicians to come up with suitable treatment plans whereby this promotes optimal outcomes and improves the patient’s wellbeing. Thus, healthcare professionals should clearly understand the various aspects involved in the classifications so as to come up with accurate diagnosis as well as suitable interventions. However, the classifications mainly rely on the professional judgment instead of intensive empirical evidence. Thus, healthcare professionals should engage in continuous research in order to come up with diagnostic procedures that are guided by research evidence so as to enhance the validity of these classifications. Overall, the classifications provide valuable information that promotes diagnosis of various mental health disorders.
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