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DSM-IV-TR (2000)

Diagnostic and Statistical Manual of Mental Disorders
Fourth Edition
Text Revised

Author of DSM-IV-TR

American Psychiatric Association (2000)

Positive Aspects DSM-IV-TR

• Leads to uniform and improved diagnosis

• Improves professional communication through uniformity

• Provides basis for educational tool

Negative Aspects of DSM-IV-TR

• Can lead to diagnostic labeling

• Provides limited information on the relationship to the environmental considerations and aspects of the condition

• Does not deal with intervention strategies

Mental Disorder

• A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g. painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.

• This syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, i.e. death of a loved one

• Neither deviant behavior or conflicts with society are considered a mental disorder


- mutually exclusive and jointly exhaustive phenomenological subgroups within a diagnosis
- indicated by "specific type" in the criteria set


- Not mutually exclusive nor jointly exhaustive
- Indicated, "specify if..." or "specify" in the criteria set
- Provide an opportunity to define a more homogeneous subgroup of individuals that share a certain feature

Not Otherwise Specified (NOS) Categories

• Client appears to meet general guidelines yet all criteria have not been met

• Symptoms noted affect social and occupational functioning, but not symptoms typical of diagnosis

• Uncertainty of the etiology of the disorder

• Not sufficient information to fully support assigning a diagnosis, but general criteria for the category is evident

DSM-IV-TR Multi Axial System

• AXIS I-clinical disorders and other conditions that may be the focus of treatment

• AXIS II-Personality disorders and Mental Retardation

• AXIS III-General Medical Conditions

• AXIS IV-Psychosocial and environmental problems
- Problems with primary support
- Problems related to social environment
- Educational problems
- Occupational problems
- Using problems
- Economic problems
- Problems with access to health care services
- Problems related to the legal system
- Other psychosocial problems

• AXIS V-Global Assessment of functioning
- Consider psychological, social and occupational functioning
- Do not include impairment functioning due to physical or environmental limitations.

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