The DSM-IV is the Diagnostic and Statistical Manual of Mental Health Disorders, published by the American Psychiatric Association. It provides a holistic approach to mental health by categorising disorders into five axes, that provide a broad range of information about the individual’s functioning, (Sue, Wing-Sue, Sue & Sue, 2012). In distinguishing abnormal from normal, the behaviour must be clinically significant and associated with intensive distress, impairment, social dysfunction or increased personal or public risk, however it must be unrelated to grief caused by recent personal loss, (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000; Holt et al, 2012).
Spitzer and Widiger (1999) examined its effect on the validity of the diagnostic criteria and found that when applied to Major Depression, it was redundant because most of the symptoms associated with it were already causing significant distress. It also increased false negatives by excluding people from diagnosis who have five of the nine expected symptoms, but are not significantly distressed or role-impaired. Finally although it eliminated false positives, simply adjusting the symptom criteria could have achieved this same result.
Honos-Webb and Leitner’s (2001) case study of Steve, who was diagnosed with several disorders illustrates the potential for a DSM-IV diagnosis to aggravate the symptoms and recovery of individuals. According to the self-fulfilling prophecy, individuals who are labelled, in this case as mentally ill or crazy, eventually become these things. Steve began to believe that his perceptions about how he was feeling were irrelevant because everyone thought he was crazy. This inhibited his rehabilitation in therapy as he believed there was nothing he could do to change.
It is evident why the DSM-IV is referred to as the Gold Standard of clinical diagnosis. Despite its structural flaws and the negative effects of diagnostic labels, it remains a versatile document which...