Symptoms and the DSM

When someone comes for therapy, among the first questions that are asked involve what the person is feeling and how he or she is acting, thinking. What descriptions are offered help the therapist form an idea of the symptoms that the client is experiencing. For example, the client may say that he or she is very sad or angry, may not be able to eat much compared to usual, is feeling detached, confused, cannot sleep, making poor decisions, feels all powerful. The more that the therapist knows about what the client is experiencing, the better the chance for a good and valid diagnosis. The symptoms that are expressed are collected and compared to models that are designed to represent these specific symptoms. The models and their titles are given in a manual with the title Diagnostic and Statistical Manual of Mental Health Disorders (DSM).

 The DSM began to be made available for diagnostic purposes in 1952. It is published and revised periodically by the American Psychiatric Association, the current one being DSM V. Each revision drops certain titles and adds new ones. For example, certain symptoms that included intelligence, superficial charm, unreliability, insincerity, untruthfulness, manipulation and exploitation of others originally were listed under the category of Sociopath. The current DSM V lists these symptoms under the category of

Antisocial Personality Disorder. This does not mean that one mental disorder disappeared and a new one appeared, but that a new title was added to already existing symptoms of feeling, thinking, and acting. Using the DSM to give title to a diagnosis is required by third party payers such as insurance companies. Although a large committee of mental health professionals create the DSM, there is still criticism of what are considered its shortcomings. It is maintained that there is little scientific proof that the titles or labels that are used are accurate in their depictions and that there is little reliability and validity to the labeling process, itself. Some critics believe that simply describing the client’s symptoms should replace the DSM system. There also is another system used in some countries that is similar to the DSM. It is known as the International Classification of Diseases (ICD), but it includes both physical and mental illnesses.