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6. What is the DSM-IV-TR?

The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text-Revised) is considered the standard diagnostic manual for establishing the diagnosis of various mental disorders. In its introduction a few caveats are outlined. Mental disorder implies a distinction of disorders of the mind from those of the body, an assumption no longer considered valid.

The term “mental disorder” lacks a consistent operational definition that covers all situations. Categorizing specific disorders has its limitations because there are no absolute boundaries dividing one disorder from another.

The criteria listed for each disorder are guidelines only and should not be applied in either a “cookbook fashion” or in an “excessively flexible” manner. Finally, the purpose is primarily to enhance agreement among clinicians and investigators and is not to imply that any “condition meets legal or other non-medical criteria for what constitutes mental disease, mental disorder, or mental disability”.

Keep these caveats in mind, as it is easy to get caught up in a physician’s diagnosis, believing it is set in stone, which it is not. As new information is acquired in treatment the diagnosis and treatment plan may change. Additionally, it is not uncommon for clinicians to disagree on the diagnosis because of the previous caveats. When reading the various symptoms individually it is easy to identify with many of them and jump to the conclusion that one has the described condition.

Only time and the guidance of a skilled clinician who is probing and comprehensive in his or her questioning will help establish a diagnosis that leads to an effective treatment plan. The ability to establish a diagnosis is important in developing a treatment plan that restores one’s health, and if the treatment plan fails the first order of business is to reconsider the diagnosis.


Treatment plan - the plan agreed upon by patient and clinician that will be implemented to treat a mental illness. It incorporates all modalities (therapy and medication). 



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