What is the DSM-IV-TR

DSM-IV-TR as the standard diagnostic manual

The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text-Revised) is considered the standard diagnostic manual for establishing the diagnosis of various mental disorders. Of note, in its introduction, a few caveats are outlined.

  • First, mental disorder implies a distinction from physical disorders that is a relic of mind/body dualism.
  • Second, mental disorder lacks a consistent operational definition that covers all situations.
  • Third, the categorical approach has limitations in that discrete entities are assumed when in fact there are no absolute boundaries dividing one disorder from another.
  • Fourth, the criteria for each disorder serve as guidelines only and should not be applied in either a “cookbook fashion” or in an “excessively flexible” manner.
  • Finally, the purpose of the manual is primarily to enhance agreement among clinicians and investigators and is not to imply that any “condition meets legal or other non-medical criteria for what constitutes mental disease, mental disorder, or mental disability”.

It is critical to keep these caveats in mind, as it is easy to get caught in a physician’s diagnosis, believing that it is set in stone, which it is not. As new information is acquired in treatment, the diagnosis and treatment plan may change. Additionally, it is not uncommon for clinicians to disagree on the diagnosis because of the previously mentioned caveats. When reading the various criteria individually, it is easy to identify with many of them and jump to the conclusion that one has the described condition. Only time and the guidance of a skilled clinician who is probing and comprehensive in his or her questioning will help to establish a diagnosis that leads to an effective treatment plan. The ability to establish a diagnosis is important in developing a treatment plan that restores one’s health, and if the treatment plan fails, the first order of business is to reconsider the diagnosis.