DSM-IV-TR

The following is a brief summary of the information contained within the DSM-IV and does not represent it in its entirety. The decision to select specific disorders was prompted by areas of general interest. Care has been taken to accurately reflect in an easy to read format the information contained within the DSM-IV. This material was created for information purposes only and should not be used to self-diagnose any psychiatric illness.

The DSM-1 was first published in 1952. Its purpose was to create a common language for psychiatric disorders so that any two people would be talking about the same thing when they used the same words. In 2002 we are using a DSM edition which is between the DSM- IV and V.

There is no laboratory test, x- ray, brain scan or electronic recording available to make a psychiatric diagnosis. Psychiatrists use those things to make sure that what they are seeing is not caused by something else in the brain or any other body organ. Anything one sees in Psychiatry can be the result of something we can detect in the body. If we can detect epilepsy or a thyroid problem, this could be playing a major role in causing the psychiatric symptoms, and if we treat it, the psychiatric symptoms will probably improve or go away. If we can’t detect it with our methods, it simply means it is on a level so refined that our available instruments can’t pick it up. But it is there, and it is part of the way the body works. Until recently, we were very concerned whether it was organic or not, but if you read the above carefully, you will share the newer understanding that everything is organic.

Disorders Usually First Diagnosed in Infancy and Childhood
The DSM takes us on a journey of development, and firstly looks at Disorders Usually First Diagnosed in Infancy and Childhood. Some disorders occur in both childhood and adulthood, but this special group of conditions is seen mostly in childhood, and the funny thing is that the clinician may make one, two or three of them at the same time. It is as if they co-exist in the developing brain, but as development is completed, the brain compensates for one of them. One or more may persist in adulthood. One talks about a mosaic of psychiatric diagnoses in childhood including:

Delirium, Dementia, and Amnesic and other Cognitive Disorders

Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
The DSM considers different ways in which the brain could malfunction due diseases that mainly affect the nervous system. Then it looks at Mental Disorders Due to a General Medical Condition Not Elsewhere Classified.

Substance-Related Disorders
This section has to do with Substance (drug-) Related Disorders. It is remarkable that the large panel of expert authors first finished all these sections before handling Schizophrenia and Other Psychotic Disorders, Mood Disorders and Anxiety Disorders, each in its own section. If you ever get a DSM book in hand, look at the chapter on Substance Related Disorders. In the issue in current use (DSM- IV- TR-tm) there is a table which gives the disorders which can be caused by drugs. If you take a little time to study it, you find that it contains all the diseases listed in the rest of DSM, from the Disorders Usually First Diagnosed in Childhood right through Schizophrenia, Mood Disorders, Anxiety Disorder and the rest, up to the very end. What does this mean? That every psychiatric condition you find could as well be caused by something organic. Prescription and street drugs are organic causes as much as some diseases are. For that reason, any patient who is seen with a psychiatric disorder is not fully investigated until the possibility of such an organic cause has been excluded. Substance-Related Disorders include:

Schizophrenia and Other Psychotic Disorders
A psychiatric disorder of which schizophrenia is the most well known, have in common a loss of context of reality, strictly speaking, apart from the named hereunder and mania psychotic disorders and delirium are also conditions. Paranoid Type, Disorganized Type, Catatonic Type, Undifferentiated Type, Residual.

Delusional Disorder
Brief Psychotic Episode
Psychotic Disorder

Mood Disorders
Mood is one’s most basic feeling. It is either over the even-par line or well under the even-par line, which is marked depression.

Depressive Disorders
Bipolar Disorders

Anxiety Disorders
Natural anxiety is a defence against conditions that justify anxiety. Anxiety Disorders are not appropriate reactions and a cause-and-effect relationship cannot usually be found.

Panic Disorder
Specific Phobia
Social Phobia
Obsessive Compulsive Disorder
Post Traumatic Stress Disorder
Acute Stress Disorder
Generalized Anxiety Disorder
Anxiety Disorder Due to General Medical Condition

Somatoform Disorders
These are disorders where emotional problems are manifesting the body.

Pain Disorder
Hypochondriasis

Factitious Disorders
There are eight further sections. Factitious Disorders have to do with people who make as if they have a psychiatric problem. Dissociative Disorders are seen in young people under severe stress where they lose contact with reality in a variety of ways. Sexual and Gender Identity Disorders cover a fascinating area of society which has been studied far too little. Eating Disorders fill the pages of just about every magazine. Sleep Disorders are very common. Impulse control Disorders get some people into deep trouble. Lastly, Personality Disorders have to do with the way a person usually is. Disorders of the personality are actually recorded as a second diagnosis in many people and they tell us a lot about how an individual is going to react.

Dissociative Disorders
Like in psychotic disorders, contact with reality is lost, but it also involves loss of contact with one’s own identity.

Sexual and Gender Identity Disorders
Disorders of sexual function are:

Sexual Dysfunctions
Paraphilias
Gender Identity Disorders

Sleep Disorders

Impulse-Control Disorders

Not Otherwise Classified Adjustment Disorders

Personality Disorders

Other Conditions That May Be a Focus of Clinical Attention

Psychological Factors Affecting Medical Condition
Medication-Induced Movement Disorders
Relational Problems
Problems Related to Abuse or Neglect

Submitted by Dr. C. J. Blom
Co-written by Tanya P.