DSM-IV is a classification of mental disorders that was developed for use in clinical, educational, and research settings. American Psychiatric Association, DSM-IV-TR, 2000 What the DSM attempts to do is have specific criteria for specific disorders, but at the same time, not have the manual be used in a cookbook fashion. Meaning that the specific diagnostic criteria in the DSM are meant to serve as guidelines concurrently with clinical judgment. As we all know, each disorder included in the DSM has a set of diagnostic criteria that signify what symptoms must be present in order to meet the criteria for a diagnosis. Conversely, there are some disorders where there are symptoms that must not be present in order for an individual to be eligible for the diagnosis. A strong point of this particular set-up of the DSM manual makes finding the disorder and its diagnostic criteria easier because of its conciseness. The use of the DSM diagnostic criteria to diagnose has been shown to increase diagnostic reliability (Mezzich, 2002).
As noted above, the DSM-IV is a manual that helps outline mental disorders. A major strength is that healthcare professionals such as physicians, psychologist, psychiatrists, and others combined their resources and knowledge to create a universal manual (Well in the US anyways) (Speigel, January 3, 2005). Also, the DSM is used for appropriate coding for billing and insurance purposes which, for most psychologists, is imperative in order to receive reimbursement for treatment. Another strength of the DSM is that it allows researchers to gather a group of patients who meet the described criteria for the disorder, try different treatments, and compare the results. For example, a percentage of patients with social phobia might be helped by placebo, and if a greater number will be helped by a psycholeptic, or psychotherapy, or whatever the treatment is in their design, then one of these treatments can be found valuable. This is important because the idea of evidence based treatment appeals to the general public, to the field, and is just common sense. Therefore, it is known that empirical data is more useful than untested theories and endless debates that are not proven by research.
One weakness that I have found is the reoccurrence of including the social effects of disorders in the criteria by which the same disorders are identified (Widiger & Sankis, 2000). It has been argued that when a person meets or exceeds the criteria for a disorder, the DSM does not satisfactorily take into account the context in which a person is living, and to what degree there is a disorder of an individual versus a psychological response to their negative environment (Chodoff, 2005). Therefore, should someone who is in a very poor living situation (emotional or physical abuse, in poverty, ect) these may be the sole factor for some their symptoms, so should it still be assessed in the criteria? Sometimes, an individual’s quantity of impairment is often not correlated with symptom counts, and can stem from various individual and social factors, the DSM’s standard of distress or disability can often produce false positives (Spitzer R. L., & Wakefield J. C., 1999). However, the reality still is that some individuals who don’t meet all the symptom criteria may still experience similar suffering or dysfunction in their life.
The DSM-IV is practically known as a categorical classification system. The categories are models, and a patient with a high relation to the model is said to have that disorder. The DSM-IV (2000) states, â€Å“ there is no assumption each category of mental disorder is a completely discrete entity with absolute boundaries…â€ At the same time, unique, mild, or non-criterion symptoms are not given any importance in the diagnosis (Maser, JD., & Patterson, T., 2002). On the other hand, qualifiers are sometimes used when explaining the level of disorder; for example: mild, moderate or severe forms. For many the disorders, symptoms must be adequate to cause â€Å“ clinically significant distress or impairment in social, occupational, or other important areas of functioning. (APA, DSM-IV-TR, 2000) It has been said that ever since the DSM was created, it has been argued that its system of classification makes indiscrete categorical distinctions between disorders, and uses somewhat random cut-offs between normal and abnormal (Widiger & Coker, 2003, p. 3). I agree that the cut-offs seem a bit arbitrary, and though it is not always voiced, my professors seem to silently have the same opinion. It has been argued that rather than using a categorical approach, a fully dimensional or continuum approach may enhanced the diagnosis people and make it more individualized. (Dalal P. K., & Sivakumar T., (2009).
What I feel would make the next version DSM superior comes from a suggestion by Dr. Kraemer at the American Psychiatric Association 2007 Annual Meeting, in San Diego, California. (Busko, June 14, 2007) She stated that the purpose of a diagnostic system of mental health disorders, such as the DSM, is not to say what is normal or acceptable but to describe the presentation of a person who comes to get clinical help. The point being made is when a healthcare professional uses the DSM they have to answer this question, Does the patient fit this mental disorder category? Right now, there are only 2 options: Yes or No, which makes the DSM very categorical. However, a dimensional diagnosis, would give us 3 or more potential values that can be ordered. An example, provided by Dr. Kraemer was:
While I think that having more than a binary option is a good idea, I am not sure about this Absolutely Sure or Unsure categorization that is presented. Yes, the diagnostic classification should lead to a diagnosis that is reliable and valid, but it should also trust in the professionals’ life experiences and knowledge in determining how any one disorder is presented in an individual. At the same time, I am cautious about having a classification system that starts running into subclinical diagnosis. I feel that this would lead into everyone leaving a psychologists or psychiatrists office with a disorder. One side note I would like to add, is that as it has been presented by the APA, the DSM-5 is leaning towards making Asperger’s Syndrome a combined disorder with Autism Spectrum Disorder. As a person who has a brother with Aspeger and having worked with the general Autistic community, I feel abhorred that such a thing would be considered. They are similar, but not the same thing. Especially when we are discussing an individual’s ability to live independently and function in their community. For me, this would be like combining Schizoid personality disorder and Schizotypal personality disorder. Well, I will just stop my rambling for now.
Hello Ms. XD, I hope you are doing well. After our evaluation and my consultation with my supervisor, we have determined that you have Panic Disorder with Agoraphobia. Within Panic Disorder, you can have panic attacks. A panic attack can described as an event of very intense fear or uneasiness that comes on rather quickly. People can experience Panic Disorder in different ways, but some of the symptoms are: chest pain, feeling like you are choking, a feeling like you might be dying, feeling like you may have not control of your emotions. You can also have hot flashes, chills, nausea, numbness, shortness of breath, sweating. fast heartbeat, or you may start shaking. Once again, these symptoms can start all of a sudden and usually gets more intense as time goes on, but these feelings usually peak within 10 minutes. You also have Agoraphobia along with your Panic Disorder. This means that you may have a strong fear of being in a difficult or embarrassing situation that you cannot escape from. Some people who have severe agoraphobia may not want leave home. There may be certain locations or situations that may make you concerned that you will have a panic attack. These feelings can have a big impact on your social, work, or educational life. It may make it difficult for you to be around others because you may be concerned that you will have another panic attack.
Panic Disorder with Agoraphobia is one of the most common anxiety disorders. Approximately 1-2% of the general public have this disorder. Panic Disorder with Agoraphobia can start at anytime during someone’s life, but it usually starts in adolescence and mid 30’s. It is rare to have Panic Disorder with Agoraphobia over the age of 45. So you fit the within common age range of occurrence. Also, with Panic Disorder with Agoraphobia, females are 3 times more likely than males to have it. If someone in your immediate family also has this disorder, you are 8 times more likely to get it. Panic Disorder with Agoraphobia is generally considered chronic. This means that it is not likely to go away in the near future. However, the severity can go from very low to very high while you have Panic Disorder with Agoraphobia. You may eventually stop having panic attacks, but it is common to still have the symptoms of agoraphobia.
There are many reasons on how Panic Disorder with Agoraphobia happens, but there is no one direct cause. Some think there is only a genetic reason why this happens. That means that it is in your genes that were transferred on from your parents. It is also believed that panic disorder may be a learned behavioral response to stressful situations. This means that you may have learned at some point during your life that, maybe unconsciously, it was okay for you to react in a certain way and that is what has lead you to have panic attacks. It is also thought that some people’s brains are wired in a way that makes it easier and more common for them to have a panic attack. These are all possibly reasons why you have Panic Disorder with Agoraphobia, but the important thing now is to look into what the best way to treat it. There are many different options. For medications, there are a variety to choose from, but the most common medicine to use is called an SSRI. Some medicines that you have heard of before, such as Prozac and Zoloft, are SSRIs. You have about a 60% chance of being panic attack free if you stick with your meds. However, if you don’t, it is very likely that you will have more panic attacks. Another choice is using a specific kind of psychotherapy called Cognitive Behavioral Therapy. CBT is a type of therapy that helps you focus on how you think about things and how you behave. Within CBT is something called Panic Control Treatment. This would meant that you would experience the symptoms of a panic attack in a safe environment. Along with this you would learn deep breathing and relaxation. I highly recommend that you go with this therapy. Therapy and medicine can be combined, but that is up to your physician or psychiatrist to decide. Ms. XD, I hope the best for you and please let me know you if you have an issues or concerns.
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