Martin Dorahy
Department of Psychology
University of Canterbury
2 systems used to classified
Psychiatric disorders:
- ICD-10

DSM
Classification Issues
 Critical issues

 Reliability
 DSM tries to increase
reliability to ensure
everyone who sees client
diagnoses the same thing
 Validity
 Work to increase validity
by trying to ensure the
key symptoms actually
classify the disorder.
 Need to balance reliability
and validity
Purposes and benefits

Communication
Prognosis
Treatment
planning
4
Criticisms of
DSM/Classification
Comorbidity
Emphasize reliability, sometimes at the
expense of validity
Complexity of categorizing
psychopathology
Pathologising normal
behaviour

6

A Caution About Labeling
and Stigma
Problems and pitfalls with
labels
Negative connotations
Stigmas
Reification
DSM-I (1952)

132 pages
Definitions were
simple,
brief paragraphs
with prototypical
descriptions
DSM-II (1968)

134 pages
 Users encouraged to
record
multiple psychiatric
diagnoses
(in order of importance)
and associated physical
conditions
 Coincided with ICD-8
(first time ICD included
mental disorders)
DSM-III (1980)
494 pp
 Descriptive and neutral
“atheoretical”) regarding
etiology.
 Coincided with ICD-9.
 Multiaxial classification
system.
 Goal to introduce
reliablilty.

DSM-III-R (1987)
567 pp
Some relabelling
and reorganisation

DSM-IV (1994)

886 pp
 Inclusion of a clinical
significance criterion
 New disorders
introduced
(e.g., Acute Stress
Disorder, PTSD
Bipolar II Disorder,
Asperger’s Disorder),
 others deleted
(e.g., Cluttering,
Passive-Aggressive
Personality Disorder).
DSM-IV-TR (2000)

943 pp
Text revision – no
change to
diagnostic criteria
DSM-IV and DSM-IVTR
The Five DSM-IV Axes
I – Major disorders
II – Stable, enduring problems
III – Medical conditions (related)
IV – Psychosocial problems
V – rating of adaptive functioning
DSM-5 (2013)

947 pp
“5” instead of “V”
Anticipates change
e.g. DSM 5.1 … 5.2 …
12 year process
DSM-5

22 Chapters
DSM-IV
17 Chapters
Positives of DSM5

1.
Broad Collaboration
2.
Inclusion of Cultural Considerations
3.
More Descriptive Diagnosis
4.
Reorganized to reflect etiology & shared
factors
18
Positives of DSM5

5. Recognition of life span issues related to
specific disorders.
6.
Gender & cultural notes for individual
diagnosis.
7.
Removed diagnostic criterion not relevant
across cultural groups.
8.
30% international in each work group
19
Major Changes of DSM5

1. Elimination of 5 Axis Diagnosis
2. Significant overlap with ICD-10/11
2. Integration of emerging genetic &
neuroimaging research
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Lanius et al., 2010
Dissociative subtype of PTSD

Three Major Sections

1.
The Basics
2.
Diagnostic
Criteria & Codes
3. Emerging
Measures & Models 22

DSM-5 disorder categories

Neurodevelopmental disorders
 Schizophrenia spectrum and other psychotic
disorders
 Bipolar and related disorders

Depressive disorders

Anxiety disorders

Obsessive-compulsive and related
disorders

Trauma- and stressor-related disorders

Dissociative disorders

DSM-5 disorder categories
Somatic symptom and
related disorders

Feeding and eating disorders
 Sleep–wake disorders
 Sexual dysfunctions

Gender dysphoria

Disruptive, impulse-control, and conduct
disorders

Substance-related and addictive disorders

Neurocognitive disorders

Paraphilic disorders

Personality disorders
Specific phobia criteria DSM-5

Marked fear or anxiety about a specific object or
situation (e.g., flying, heights, animals, injections)
The phobic object/situation almost always
provokes immediate fear
The phobic object/situation is actively avoided or
endured with intense fear.
Fear is persistent ≥ 6 months
Causes sign. distress or impairment (social,
occupational functioning)
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Thoughts?

What are the benefits for us as counsellors
with the DSM?
What are the deficits/limitations/concerns
for us as counsellors with the DSM
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