Tips

The DSM-IV system

The DSM-IV system. This system originally comes from the United States, is spread worldwide and is also widely used in Flanders and the Netherlands. The DSM-IV is a system for describing problems of individuals and classifying them into so-called disorder categories. The assessment is made on five separate axes, each of which refers ,to a different domain of knowledge that can help develop a treatment plan and predict outcome,

Different axes

  • Axis I: clinical disorders and other conditions that may be a cause for concern;
  • Axis II: personality disorders and mental retardation;
  • Axis IIII: somatic disorders;
  • Axis IV: psychosocial and environmental problems;
  • Axis V: overall assessment of performance.

 

Example:

The criteria for oppositional defiant disorder. A total of eight core symptoms are distinguished in this disorder. These are the criteria:

  • A. A pattern of negativistic, hostile, and overtly disobedient behavior lasting at least six months in which four (or more) of the following are present:
    • is often quick-tempered;
    • often quarrels with adults;
    • is often rebellious or refuses to comply with adult requests or rules;
    • often deliberately annoys others;
    • often blames others for own mistakes or misbehavior;
    • is often irritable and easily annoyed by others;
    • is often angry and irritated;
    • is often spiteful and vindictive.
  • B. The conduct disorder causes significant impairment in social, school, or occupational functioning.
  • C. The behaviors do not occur exclusively during the course of a psychotic or mood disorder.
  • D. The criteria for a conduct disorder (Conduct Disorder, CD) are not met and, if the person concerned is 18 years or older, the criteria for antisocial personality disorder are not met.

 

Advantages of DSM IV

  • the wide distribution, also outside the United States, and the strong historical tradition;
  • all possible behavioral problems are included in the disorder categories;
  • the system is regularly reviewed and updated;
  • the disorder categories are empirically substantiated through scientific research. Defining disorder categories and describing criteria promote communication between professionals (clinicians, researchers);
  • the existence of training modules that should facilitate the use of the system and increase inter-rater reliability.

 

Cons

  • the model used is a ‘top-down’ model, which means that disorders are first defined by convention and only then is it examined whether these disorders have any empirical validity;
  • the all-or-nothing view of problems and disorders;
  • the strong correlation or comorbidity between disorders, with the result that many problems, especially from childhood, are very difficult or impossible to classify;
  • the risk of labeling and stigmatization of persons or groups;
  • the danger of overmedicalization of human problems.

An additional disadvantage of the DSM classification is that it is not always clear whether the disorder categories used are valid in other cultures. The system is based on Western concepts about illness, deviant behavior and psychopathology.