Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision)

Psychiatrists will have you believe that some skill is required to use DSM, most laypeople with a brain, however will start to realise that the validity of this book can be somewhat questionable and really is best used as a party game.


Great for Psychologists, disappointing for Psychiatrists   December 19, 2002
 30 out of 37 found this review helpful

Of course, this is the bible of mental disorder diagnoses, at least in the U.S. The diagnoses are pretty inclusive, but there are several problems with this book as it pertains to the practice of Psychiatry. First, the book offers about 900 pages on symptom diagnosis, and about half a paragraph on the types of psychiatric medications that are effective for the particular diagnosis. 95% of diagnoses have absolutely no recommendations for treatment.

This leads to the second problem: differentiation of primary vs. secondary symptoms. The primary symptoms are the cornerstone of diagnosis. The secondary symptoms take way too much space in this book, and are generally not helpful in making a diagnosis, because the vast majority of secondary symptoms overlap in most mental illnesses. The important use for secondary symptoms is for the type of therapy that should be used (psychotherapy or pharmacotherapy). For example, if two patients are depressed, the diagnosis is made from primary symptoms (tiredness, irritability, difficulty concentrating, psychomotor retardation). However, if patient "A" has no significant secondary symptoms like anxiety or insomnia, they can take a high dose of SSRI or Effexor. But if patient "B" has the secondary symptoms of prominent anxiety and insomnia, Remeron or Serzone may be more helpful, and perhaps a benzodiazepine can be added.

The DSM IV does nothing to further the practicality of psychiatry. And that's a shame, because only a few hundred extra pages of pharmacotherapy recommendations would make the book so much more helpful to psychiatrists, who currently waste a lot of time experienting with every drug for the treatment-resistant patients. Some drugs work better for some people based on secondary symptoms, which cannot be ignored in the choice of drug treatment. A good book that does match secondary symptoms to drug treatment is The Failures of American Medicine.


It's the Mainstay   January 21, 2004
 24 out of 33 found this review helpful

I am a psychologist and I have been practicing for about 30 years. I remember the little DSM II. It was the size of the companion small book that can be purchased. The DSM has a history. There was actually a time when psychologists and psychiatrists were considering 2 different texts. Reading the reviewers was interesting as this is my tool to differentiate what my clients present. It is continually being improved and that is the focus of TR. There are subtle differences and clarifications. This book is the basis of identifying the specifics of what we are working with. The DSM IV was a collaborative effort to acurately represent international, cultural, and biological differences. My clients don't care but some don't know that an adjustment disorder of mood is different than dysthymia or depression which is again different from Bi Polar disorder. I probably wouldn't read it if I didn't do this kind of work. Yet it may be important to people with diagnosed illness. It can assist the capable reader in being an informed consumer.


Not the simple, useful nosology you're looking for.   August 30, 2001
 22 out of 30 found this review helpful

I quote Karl Menninger, on the publication of the DSM-II in 1968:
"This year [1968] the APA took a great step backward when it abandoned the principles used in the simple useful nosology [DSM-I]. In the interest of uniformity, in the interest of having some kind of international code of designation for different kinds of human troubles, in the interest of statistics and computers, the American medical scientists were asked to repudiate some of the advances they had made in conceptualization and in the designation of mental illness."
Since then, it's gotten worse, not better, with thousands of symptom checklists and numbered diagnoses, conveniently correlated to the ICD-9 standard diagnosis codes for easier billing.
But people, medical students and physicians included, will insist on treating DSM-IV as a textbook in psychiatry. It's nothing of the sort - it never touches on the essential topics of etiology, prognosis, and treatment. People memorize the checklists and think they understand psychiatry, when in fact they have entirely failed to grasp the noble and great endeavor: riddling out the first causes and mechanisms of our humanity, and how those mechanisms go awry.
Well, then, you say, what about diagnosis? Isn't this a diagnostic manual?
In my opinion, for that purpose DSM-IV is worse than useless to a lay person. Consider the previous reviewer who thought the book made a good party game, diagnosing his healthy friends with all sorts of 'disorders'. It wouldn't take much experience in a psychiatric emergency room to realize that psychiatric illness is no party game - but it would take some. Without the context provided by direct, caring relationships with the mentally ill, the jargon and symptoms discussed in this book are meaningless. This book will not teach you to be a psychiatric diagnostician! Only experience can do that. It's intended as a quick reference guide for people with that experience, and a reference concerned with very practical matters not relevant to the patient-physician relationship (such as the standardized conduct and reporting of clinical trials, or how to justify billled services).
I'd disagree strongly with the prior reviewer who felt psychiatric patients should read their DSM-IV. If you're a psychiatric patient "on the same page" as your health care practictioner, get off the page and get on top of your life! You have more pressing concerns than making yourself into an expert psychiatric diagnostician and quibbling over the learned APA's compilation of symptom checklists - you need to heal.
In short, I can't imagine recommending this tome to anyone for any purpose - people who need it don't need me to tell them so.
If you're interested, however, in psychiatry, I urge you to read the classics - Freud for the grounding of psychodynamics, Skinner on behaviorism, Menninger's superb "Man Against Himself" on suicide and depression, Erich Fromm's "Escape From Freedom" and "Man For Himself" for academic psychophilosophy, Kraepelin on dementia praecox (what we now call 'schizophrenia' - I prefer his original term), Wundt on introspective self-analysis, Kraft-Ebbing's "Psychopathia Sexualis" for a laugh and for a serious understanding of the social construction of sexual "disorder" - if you're really interested in these topics, you'll find these authors far more stimulating, I guarantee!


specific value only   February 27, 2003
 20 out of 21 found this review helpful

The diagnostic sections remain largely unchanged. Only significant changes were to the text portion, hence the TR designation-- text revised. This is important if you are a student or in a research position. They produced this version in response to the fact that many graduate programs are using the DSM as a text book in their Pathology courses. In this regard, the new version is worthwhile and clearly justified. It also buys them a little more time in development of the DSM V. For clinical purposes, don't bother, it's not worth the money. If you are getting your first copy, or are looking for class, then you want this edition.