How do clinicians actually use the Diagnostic and Statistical Manual of Mental Disorders in clinical practice and why we need to know more.
The clinical use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is explicitly stated as a goal for both the DSM Fourth Edition and DSM Fifth Edition (DSM-5) revisions. Many uses assume a relatively faithful application of the DSM diagnostic definitions. However, studies demonstrate significant discrepancies between clinical psychiatric diagnoses with those made using structured interviews suggesting that clinicians do not systematically apply the diagnostic criteria. The limited information regarding how clinicians actually use the DSM raises important questions: a) How can the clinical use be improved without first having a baseline assessment? b) How can potentially significant shifts in practice patterns based on wording changes be assessed without knowing the extent to which the criteria are used as written? Given the American Psychiatric Association's plans for interim revisions to the DSM-5, the value of a detailed exploration of its actual use in clinical practice remains a significant ongoing concern and deserves further study including a number of survey and in vivo studies.
*Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute; †Department of Psychiatry, McGill University, Montreal, Quebec, Canada; ‡Department of Psychiatry, Tufts Medical Center, Tufts University School of Medicine, Boston, MA; §Behavioral Health, Blue Cross Blue Shield of Michigan, Detroit; ∥Department of Psychiatry, University of California, San Diego; ¶Department of Psychiatry, Mount Sinai School of Medicine, New York, NY; #Department of Psychiatry, Philadelphia VA Medical Center, University of Pennsylvania; and **The Zucker Hillside Hospital, Glen Oaks, NY.
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D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis*; D010818:Practice Patterns, Physicians' / Q000592:standards*