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Limitations of the DSM IV-TR
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Application to clients I
Applies only to individuals.
This is for individuals not something you apply to a group.
Application to clients II
Apply cautiously to people from non-Western cultures.
Appendix I: Cultural formulation and
some specific culture-bound syndromes.
This manual is based on white, male, western concepts of mental health. People have different cultures and values.
not a cookbook.

It is only a psychiatric interpretation
of a person’s experience
It is acontextual as well as atheoretical
Diagnoses are meaningless unless context is taken into
Basic Features: Boundaries
For the Classification of Mental Disorders.
Boundaries for mental disorders are not clear.
Mental affects Physical and Physical Mental.
Basic Features Grouping Disorders
Disorders are whose etiology is unknown are group according to shared clinical features.
Clinicians can/often do disagree on diagnoses.
Basic Features: Clinically Significant
Causing noticeable problems they need treatment for.
Basic Features: Mental Disorder Definition
In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a 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. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned
response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual.
Basic Features: Descriptive in approach
Atheoretical except when causation is known

Descriptions are based on identifiable behaviors.
Not based on any type of theory. If they know there is a biological cause they will group them together. Most of what is in the book they don’t really know the causes.
DSM Origins
Based on the ICD-9/10-CM.

ICD-9/10-CM official coding system for all diseases in the United States.
DSM is a manual for learning the diagnostic criteria for psychiatric diagnoses.
Has been translated into 22
ICD- CM- international coding of diseases cm- clinical modification.
DSM Disorders are compatible with the ICD 10
Limitations of the categorical classification system.
In DSM-IV, there is no assumption that each category of mental disorder is a completely discrete entity with Absolute boundaries dividing it from other mental dis¬orders or from no mental disorder.
There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways.
that individuals sharing a diagnosis are likely to be heterogeneous even in regard to the defining features of the diagnosis and that boundary cases will be difficult to diagnose in any but a probabilistic fashion. This outlook allows greater flexibility in the use of the system, encourages more specific attention to boundary cases, and emphasizes the need to capture additional clinical information that goes beyond diagnosis.
Limitation: Clinical Judgment
The diagnostic categories, criteria, and textual descriptions are meant to be employed by individuals with appropriate clinical training and experience in diagnosis. It is important that DSM-IV not be applied mechanically by untrained individuals.
Limitations: Forensic Settings
When the DSM-IV categories, criteria, and textual descriptions are employed for ­forensic purposes, there are significant risks that diagnostic information will be misused or misunderstood.
In most situations, the clinical diagnosis of a DSM-IV mental disorder is not sufficient to establish the existence for legal purposes of a "mental disorder,""mental disability,""mental disease," or "mental defect." In determining whether an individual meets a specified legal standard (e.g., for competence, criminal responsibility, or disability), additional information is usually required beyond that contained in the DSM-IV diagnosis.
Nonclinical decision makers should also be cautioned that a diagnosis does not carry any necessary implications regarding the causes of the individual's mental disorder or its associated impairments.
Limitations: Ethnic and Cultural Considerations
Special efforts have been made in the preparation of DSM-IV to incorporate an awareness that the manual is used in culturally diverse populations in the United States and internationally. Clinicians are called on to evaluate individuals from numerous different ethnic groups and cultural backgrounds (including many who are recent immigrants).
Diagnostic assessment can be especially challenging when a clinician from one ethnic or cultural group uses the DSM-IV Classification to evaluate an individual from a different ethnic or cultural group.
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