Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) / Edition 4

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Overview

The last 6 years has seen many advances in our knowledge of psychiatric illnesses. The DSM-IV-TR™ spans the bridge between DSM- IV™ and DSM-V™ to ensure that the most relevant new information since the DSM- IV™ literature review in 1992 was incorporated and to enhance the educational value. Specifically, new information on associated features, including associated laboratory and physical findings, has been added for many of the disorders.

Sections on prevalence, gender/age/culture, course, and familial pattern have also been revised to reflect recent research findings. More comprehensive differential diagnoses have been incorporated for many of the disorders.

Changes were to the following diagnostic criteria:

  • Personality change Due to a General Medical Condition
  • Paraphilias
  • Tic Disorders

The book contains no figures.

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Product Details

  • ISBN-13: 9780890420249
  • Publisher: American Psychiatric Publishing, Incorporated
  • Publication date: 7/31/2000
  • Series: Diagnostic and Statistical Manual of Menta
  • Edition description: REVISED
  • Edition number: 4
  • Pages: 991
  • Sales rank: 568,998
  • Product dimensions: 7.40 (w) x 10.20 (h) x 2.30 (d)

Read an Excerpt

Multiaxial Assessment

A multiaxial system involves an assessment on several axes, each of which refers to a different domain of information that may help the clinician plan treatment and predict outcome. There are five axes included in the DSM-IV multiaxial classification:
Axis I Clinical Disorders
           Other Conditions That May Be a Focus of Clinical Attention
Axis II Personality Disorders
         Mental Retardation
Axis III General Medical Conditions
Axis IV Psychosocial and Environmental Problems
Axis V Global Assessment of Functioning

The use of the multiaxial system facilitates comprehensive and systematic evaluation with attention to the various mental disorders and general medical conditions, psychosocial and environmental problems, and level of functioning that might be overlooked if the focus were on assessing a single presenting problem. A multiaxial system provides a convenient format for organizing and communicating clinical information, for capturing the complexity of clinical situations, and for describing the heterogeneity of individuals presenting with the same diagnosis. In addition, the multiaxial system promotes the application of the biopsychosocial model in clinical, educational, and research settings.

The rest of this section provides a description of each of the DSM-IV axes. In some settings or situations, clinicians may prefer not to use the multiaxial system. For this reason, guidelines for reporting the results of a DSM-IV assessment without applying the formal multiaxial system areprovided at the end of this section.

Axis I: Clinical Disorders
         Other Conditions That May Be a Focus of Clinical Attention

Axis I is for reporting all the various disorders or conditions in the Classification except for the Personality Disorders and Mental Retardation (which are reported on Axis II). The major groups of disorders to be reported on Axis I are listed in the box below. Also reported on Axis I are Other Conditions That May Be a Focus of Clinical Attention.

When an individual has more than one Axis I disorder, all of these should be reported (for examples, see p. 35). If more than one Axis I disorder is present, the principal diagnosis or the reason for visit (see p. 3) should be indicated by listing it first. When an individual has both an Axis I and an Axis 11 disorder, the principal diagnosis or the reason for visit will be assumed to be on Axis I unless the Axis 11 diagnosis is followed by the qualifying phrase "(Principal Diagnosis)" or "(Reason for Visit)." If no Axis I disorder is present, this should be coded as V71.09. If an Axis I diagnosis is deferred, pending the gathering of additional information, this should be coded as 799.9.

Axis II: Personality Disorders
         Mental Retardation

Axis 11 is for reporting Personality Disorders and Mental Retardation. It may also be used for noting prominent maladaptive personality features and defense mechanisms. The listing of Personality Disorders and Mental Retardation on a separate axis ensures that consideration will be given to the possible presence of Personality Disorders and Mental Retardation that might otherwise be overlooked when attention is directed to the usually more florid Axis I disorders. The coding of Personality Disorders on Axis II should not be taken to imply that their pathogenesis or range of appropriate treatment is fundamentally different from that for the disorders coded on Axis I. The disorders to be reported on Axis II are listed in the box below.

In the common situation in which an individual has more than one Axis 11 diagnosis, all should be reported (for examples, see p. 35). When an individual has both an Axis I and an Axis II diagnosis and the Axis II diagnosis is the principal diagnosis or the reason for visit, this should be indicated by adding the qualifying phrase 'Principal Diagnosis)" or "(Reason for Visit)" after the Axis II diagnosis. If no Axis II disorder is present, this should be coded as V71.09. If an Axis II diagnosis is deferred, pending the gathering of additional information, this should be coded as 799.9.

Axis lI may also be used to indicate prominent maladaptive personality features that do not meet the threshold for a Personality Disorder (in such instances, no code number should be used-see Example 3 on p. 37). The habitual use of maladaptive defense mechanisms may also be indicated on Axis II (see Appendix B, p. 811, for definitions and Example 1 on p. 37).

Axis III: General Medical Conditions

Axis III is for reporting current general medical conditions that are potentially relevant to the understanding or management of the individual's mental disorder. These conditions are classified outside the "Mental Disorders" chapter of ICD-9-CM (and outside Chapter V of ICD-10). A listing of the broad categories of general medical conditions is given in the box below. (For a more detailed listing including the specific ICD-9-CM codes, refer to Appendix G.)

As discussed in the "Introduction," the multiaxial distinction among Axis I, Axis Il, and Axis III disorders does not imply that there are fundamental differences in their conceptualization, that mental disorders are unrelated to physical or biological factors or processes, or that general medical conditions are unrelated to behavioral or psychosocial factors or processes. The purpose of distinguishing general medical conditions is to encourage thoroughness in evaluation and to enhance communication among health care providers.

General medical conditions can be related to mental disorders in a variety of ways. In some cases it is clear that the general medical condition is directly etiological to the development or worsening of mental symptoms and that the mechanism for this effect is physiological. When a mental disorder is judged to be a direct physiological consequence of the general medical condition, a Mental Disorder Due to a General Medical Condition should be diagnosed on Axis I and the general medical condition should be recorded on both Axis I and Axis III. For example, when hypothyroidism is a direct cause of depressive symptoms, the designation on Axis I is 293.83 Mood Disorder Due to Hypothyroidism, With Depressive Features, and the hypothyroidism is listed again and coded on Axis III as 244.9 (see Example 3, p. 37).

In those instances in which the etiological relationship between the general medical condition and the mental symptoms is insufficiently clear to warrant an Axis I diagnosis of Mental Disorder Due to a General Medical Condition, the appropriate mental disorder (e.g., Major Depressive Disorder) should be listed and coded on Axis I; the general medical condition should only be coded on Axis III.

There are other situations in which general medical conditions are recorded on Axis III because of their importance to the overall understanding or treatment of the individual with the mental disorder. An Axis I disorder may be a psychological reaction to an Axis III general medical condition (e.g., the development of 309.0 Adjustment Disorder With Depressed Mood as a reaction to the diagnosis of carcinoma of the breast). Some general medical conditions may not be directly related to the mental disorder but nonetheless have important prognostic or treatment implications (e.g., when the diagnosis on Axis I is 296.30 Major Depressive Disorder, Recurrent, and on Axis III is 427.9 arrhythmia, the choice of pharmacotherapy is influenced by the general medical condition; or when a person with diabetes mellitus is admitted to the hospital for an exacerbation of Schizophrenia and insulin management must be monitored).

When an individual has more than one clinically relevant Axis III diagnosis, all should be reported. For examples, see p. 35. If no Axis III disorder is present, this should be indicated by the notation "Axis III: None." If an Axis III diagnosis is deferred, pending the gathering of additional information, this should be indicated by the notation "Axis III: Deferred." ...

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Table of Contents

Task Force on DSM-IV ... xi
Work Groups forthe DSM-IV-TR Text Revision ... xv
Acknowledgments for DSM-IV-TR ... xix
Acknowledgments forDSM-IV Text Revision ... xxi
Introduction ... xxiii
Cautionary Statement ... xxxvii Use of the Manual ... 1
DSM-IV-TR Classification ... 13
Multiaxial Assessment ... 27
Disorders Usually First Diagnosed inInfancy, Childhood, or Adolescence ... 39
Delirium, Dementia, and Amnestic andOther Cognitive Disorders ... 135
Mental Disorders Due to a General Medical Condition ... 181
Substance-Related Disorders ... 191
Schizophrenia andOther Psychotic Disorders ... 297
Mood Disorders ... 345
Anxiety Disorders ... 429
Somatoform Disorders ... 485
Factitious Disorders ... 513
Dissociative Disorders ... 519
Sexual and Gender Identity Disorders ... 5A
Eating Disorders ... 583
Sleep Disorders ... 597
Impulse-Control Disorders Not Elsewhere Classified ... 663
Adjustment Disorders ... 679
Personality Disorders ... 685
Other Conditions That May Be aFocus of Clinical Attention ... 731
Additional Codes ... 743
Appendix A:Decision Trees for Differential Diagnosis ... 745
Appendix B:Criteria Sets and Axes Provided for Further Study ... 759
Appendix C:Glossary of Technical Terms ... 819
Appendix D:Highlights of Changes inDSM-IV Text Revision ... 829
Appendix E:Alphabetical Listing ofDSM-IV-TR Diagnoses and Codes ... 845
Appendix F:Numerical Listing ofDSM-IV-TR Diagnoses and Codes ... 857
Appendix G:ICD-9-CM Codes for Selected General MedicalConditions and Medication-Induced Disorders ... 867
Appendix H: DSM-IV Classification (With ICD-10 Codes) ... 883
Appendix I:Outline for Cultural Formulation andGlossary of Culture-Bound Syndromes ... 897
Appendix J:DSM-IV Contributors ... 905
Appendix K:DSM-IV Text Revision Advisers ... 929
Index ... 933
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Customer Reviews

Average Rating 4
( 40 )
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See All Sort by: Showing 1 – 20 of 40 Customer Reviews
  • Posted January 16, 2010

    This is the reference book that explains it all.

    This is a very helpful book. It describes psychiatric disorders and how to code them for insurance purposes. Ths DSM V is a year or two away, so this is the book to have for now.

    1 out of 2 people found this review helpful.

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  • Posted September 3, 2009

    more from this reviewer

    APA Sets The Standard By Which All Others Are Judged, The DSM-IV Is Essential

    This is such an essential reference for all students of psychology, including the PhDs, PsyDs, college students, and even high-school students, that it is required reading for most upper-division Abnormal Psychology courses in every college throughout the nation. The key elements behind any diagnosis of pathology, especially psychopathalogy, is the understanding of all of the disparate manifestations that such disorders can take. The DSM-IV TR, serves all students well to that end, and conveys very effectively the most pertinent aspects of mental diagnoses. With psychology being such an incredibly broad and interdisciplinary profession and course of study accordingly, there is a great need for a reference such as this. Phobias, paraphilias, mood disorders, sleep disorders, and many other problems of the human mind, are explored and articulated in such a way as to be accessible by everyone, and to remind us all, PhDs or not, that we are all human and thus are all susceptible to the same mental dysfunctions that so predominate and also punctuate the course of human existence. Plus, it looks good on a coffee table, office, or in a university.

    Michael Wade

    1 out of 3 people found this review helpful.

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  • Anonymous

    Posted June 13, 2009

    Get Familiar With It

    I was told by my instructor to get this book if at all possible, used or new. It took me time to go through it to understand the format of the entire book. This was something necessary to get familiar with the process of using it, but also, it was extremely helpful in understanding why it is so highly recommended. Now that I have done this, everytime I pick it up, my time is not wasted in researching what I need to. It is definately worth the purchase and is now very valuable to me.

    1 out of 2 people found this review helpful.

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  • Anonymous

    Posted August 28, 2008

    good but let's not over-rate it

    just responding to comment that the dsm-4 is based entirely on empirical evidence - that is simply not true - it is a very good book and very necessary but that comment is in no way accurate - in large part, the manual was designed to assist in future research - there are many areas where assumptions are made based upon consensus or opinion and therefore not based upon empirical evidence - if for no other reason, this often occurs because the condition described has not yet been thoroughly studied - so great book but it needs to stand on what it is and not be overestimated for what it isn't - just to give one quick example - in DSM3, the diagnosis of major depression required six months of symptoms and more recent editions require only two weeks to make the definition - both decisions were subjective

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted April 24, 2006

    For crying out loud, it's a reference book!

    The DSM-IV is a reference book, a diagnostic tool and a useful resource. It is not the final word on an individual's condition nor does it appear to be part of a conspiracy theory as some reviewers have intimated. If it is used in the way the authors intended then it is very handy. Keep a copy in your counselling office - you never know when you might need it!!

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted November 3, 2010

    Totally Pissed

    Purchased new, however the book literally fell apart on the first day of use.

    0 out of 1 people found this review helpful.

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  • Anonymous

    Posted April 21, 2010

    The DSM-IV

    The Diagnostic and Statistical Manual of Mental Disorders is one of the most comprehensive tools used in psychology today. It is the tool that is most widely recognized and most widely used. While it takes some time to get used to the format, it does provide some great information. Prior to purchasing this book I considered some of the supplemental guides that are available. However, nothing was as thorough as the Diagnostic and Statistical Manual of Mental Disorders (version 4). Plus, if someone is planning on working in the field of psychology or social work it is important to have all the necessary tools. This book, without question, is one of the most important tools.

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  • Posted February 6, 2010

    Great tool

    A+++

    0 out of 2 people found this review helpful.

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  • Anonymous

    Posted April 20, 2009

    Helpful

    This resource is helpful in providing insight to diagnosis planning. It was a little complicated to get around as the diagnosis groups may not be where they are expected to be.

    0 out of 1 people found this review helpful.

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  • Posted October 10, 2008

    more from this reviewer

    What's In a Name?

    I know there are those who would ban this book for assigning damning labels to that swarming mass that is humanity. And those using it for professional purposes should undoubtedly proceed with real caution. But for the rest of us -- those simply trying to make sense of the nuttiness that our friends and family members, and most especially our ex-lovers exhibit -- the DSM-IV is probably the best guide there is: the bible of mental disorders. Would-be writers will find it a fantastic research tool as well. Looking to put a little meat on the bones of a character? Check out the Diagnostic and Statistical Manual of Mental Disorders. Can't fall asleep? Dip in anywhere; even if you can't sleep, at least you won't just be tossing and turning.

    0 out of 1 people found this review helpful.

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  • Anonymous

    Posted July 13, 2008

    A Textbook as important as the Physicians 'PDR'

    When I was in school this book was my bible. There is a wealth of information in it. I have had the opportunity to preview parts of DSM V TR that will be out in 2010. This book makes diagnosing so much easier when a disorder presents as possibly two. That is where the Difirential diagnosis comes in to play to avoid mistakes. To make such an allegation such as Richard S made is no more than uneducated arrogance. The DSM IV and all the way back to the first DSM is absolutely based on pure empirical scientific evidence. The APA takes decades or more to produce a newer version. That should tell you how much research and case studies go into these books. The DSM IV was 1st copywritten in 1994 and the DSM V is not due to be released until late 2010. I have had a glimpse to the new DSM V TR and because of 9/11 their will be much more helpful information that we have at our disposal to treat those in need. As for commentor Richard S. all I can say is that arrogance is fear. I have said for many years that this book should not be made available to the general public, they do not know how to use it, they cannot understand half of the language or terminology. I feel it should only be sold to Physicians, Psychiatrists, Psychologists Licensed Social workers, Licensed Mental Health Counselors, Psychiatric Nurses and students in a Graduate related program. Apparently, Richard is not in the profession or he would not stand in judgement.

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  • Anonymous

    Posted August 22, 2007

    a necessary book

    A very much needed book for social workers. Its fairly easy to use and has all the up to date information that in necessary for the field.

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted July 20, 2007

    A MUST HAVE

    If you are a psychology student or obviously in the psychology field, you need the DSM-IV-TR. It is an excellent resource for learning the criteria for mental disorders. I have learned a lot from this book and will continue to rely on it for the most up-to-date diagnostic criteria. To the other 'reviewers'... I think there is some personal opinion being abused here, and very likely this book has not even been read by these 'reviewers'.

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  • Anonymous

    Posted June 5, 2006

    Not research based?

    The DSM-IV may not be empirically based, however, if you have read any of the myriad research literature, it is clear that the diagnostic criteria of the disorders in the DSM-IV are not arbitrary...nothings perfect, but I wouldn't go as far as to call the Manual driven by drug companies...read more Journal articles and evaluate this issue for yourself.

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  • Anonymous

    Posted May 26, 2005

    A great book to promote diseases !

    The DSM IV-TR is a great book to promote diseases that fit the armaments of medications that the pharmaceutical companies would like physicians to use. The problem with the whole DSM serie is that it is mostly subjective and based on speculation. The DSM is not based on hard empirical evidence but on a consensual system by few well-connected psychiatrists on the payroll of the pharmaceutical companies. These same psychiatrists also happen to belong to the American Psychiatric Association and/or work as hired guns/consultants for the APA, which also happens to receive yearly funding or gifts from the pharmaceutical companies $500,000 worth. The whole process is deceitful and shameful!!!

    0 out of 1 people found this review helpful.

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted June 3, 2005

    A great book to promote diseases !

    The DSM IV-TR is a great book to promote diseases that fit the armaments of medications that the pharmaceutical companies would like physicians to use. The problem with the whole DSM serie is that it is mostly subjective and based on speculation. The DSM is not based on hard empirical evidence but on a consensual system by few well-connected psychiatrists on the payroll of the pharmaceutical companies. These same psychiatrists also happen to belong to the American Psychiatric Association and/or work as hired guns/consultants for the APA, which also happens to receive yearly funding or gifts from the pharmaceutical companies $500,000 worth. The whole process is deceitful and shameful!!!

    0 out of 1 people found this review helpful.

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted January 12, 2004

    Sad misunderstanding of people

    This book is useful for catagorizing symptoms, but completly misunderstands how people can really be cured. It misses completly the roots of peoples sufferings. People are not machines, and drugs supress symptoms, they dont cure anything.

    0 out of 1 people found this review helpful.

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  • Anonymous

    Posted October 2, 2003

    The definitive source..

    The DSM, is the definitive guide for a categorical classificaton of disorders. The authors represent an inter-generational effort of scholarship. It is neither a text to be interpreted by laypeople, nor a definitive measure of human potential. It is an employed utility of the profession, to convey a 'deepened understanding' of a human state, with a standarization of language.

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  • Anonymous

    Posted June 8, 2003

    The human psyche captured

    The DSM is - unjustly - much decried and much derided by critics, both laymen and mental health practitioners. Its shortcomings notwithstanding, it is a noble and largely successful attempt to capture the dysfunctions of the human psyche in the confines of a single tome. Is mental illness a mere figment of our cultural and social milieu? Are the distinctions between mental disorders - the differential diagnoses - too ambiguous? Is the DSM too formal and bureaucratic? You bet. Has anyone come up with anything remotely better? No, Sir! The DSM is not only a system of classification - but also an insightful distillation of decades of clinical experience. A must. Sam Vaknin, author of 'Malignant Self Love - Narcissism Revisited'.

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  • Anonymous

    Posted March 13, 2003

    A monumental effort with less than monumental results

    Any criticism of the 'DSM-IV-TR' is really a criticism of psychiatry in general. The 'DSM-IV-TR' represents a massive undertaking by a massive number of people, which is perhaps the reason that the results are somewhat generic and nebulous. Where's the neuroscience? Nowhere. That's my main criticism. Until psychiatry begins to truly dissect the biochemical aspects of mental illness, all there'll be is a caricature of what is truly awry in mental illness, and hence the 'DSM-IV-TR'.

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