"The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition" (DSM IV) is considered a "necessary evil" among many clinicians. Although its existence sometimes results in the labelling of individuals in a way that may stigmatise or even dehumanize them, it is essential to understanding symptoms, disorders and delivering the kind of counselling that many people need to reach mental health.
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The DSM IV has amassed a gargantuan amount of research that can be of great use while working with different disorders. Without the separate categories that the DSM IV has distinguished, it would have been impossible to conduct this research and gather these data. For example, it can be useful to know that 20 to 30 per cent of individuals with Obsessive-Compulsive Disorder have reported a past or current tic, or that 8 to 10 per cent of individuals with Borderline Personality Disorder die by committing suicide.
While it is a heavy enough task to categorise an individual with a pathology, the possibility of misdiagnosing him is an even scarier thought. The DSM IV is very thorough in the way that it covers differential diagnoses. Every disorder has a lengthy section where it details other possibilities and how to distinguish these disorders from each other. There are also charts called "decision trees" in the back of the book that can help clinicians narrow down diagnoses through a series of key questions.
Many critics of the DSM IV have pointed to the fact that several of the diagnostic criteria for various disorders have a cultural bias. The manual has a definite orientation toward Anglo-American culture and does not sufficiently consider what the norm is within other cultures within America. For example, many traits associated with Dependent Personality Disorder may not be considered pathological at all among cultures that are collectivistic and place a greater emphasis on family cohesion over the individual's desires.
Labelling individuals with pathologies that can be looked up in a book as though the person were a dictionary entry has been considered dehumanizing and demoralising by many critics of the DSM IV. These critics insist that focusing on the diagnostic criteria and symptoms to the extent that many clinicians do can result in losing sight of the client as a unique individual with a unique personality and set of problems.
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