The Diagnostic and Statistical Manual of Mental Disorders (DSM) contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It is recognized and referred to by all mental health professionals worldwide however it is not used widely because of some pitfalls that I will describe below.
The American Psychiatry Association (APA) is in charge of the collection, review, release and revision of the DSM and the current version is the 5th one (DSM-5 was initially published in May 2013). On January 2022 the APA announced that a text revision will be released in March and it may contain some substantial changes (like the introduction of a new disorder: prolonged grief disorder, the addition of new codes for suicidal behaviour without the requirement of any other diagnosis and also considerations of the impact of racism and discrimination on mental disorders).
Besides the significant diagnosis tool, the DSM provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders and related scientific publications. And this is the primarily reason why it is important to be trained on it and to be kept updated on the revisions even though in daily clinical practice we can consider diagnosis as a limiting factor for psychotherapy.
DSM is classifying mental illness and symptoms in categories, and it is mainly used by health systems for coding mental illnesses and disorders, and it serves to define the most appropriate drug treatment (gold standard). However, in some different approaches to psychotherapy like the Brief Strategic Therapy (BST), we prefer to focus on how the then said diagnosed disorder is impacting the patient and his/her relationship with himself/herself, his/her relatives, and the world in general. We describe in a pragmatic manner what is the problem and its consequence for the patient. We also pay attention to avoid that the diagnosis become a self-fulfilling prophecy.
A self-fulfilling prophecy is the psychological phenomenon of someone "predicting" or expecting something, and this "prediction" or expectation is coming true simply because the person believes or anticipates it will and the person's resulting behaviours align to fulfil the belief. For example, a patient who has a confirmed diagnosis of bipolar disorder, he/she can act upon some expected bipolar behaviours and as a matter of fact the confirmed diagnosis will alleviate his/her guiltiness and his/her belief of being bipolar will be reinforced. Therefore, in order to limit the risk of this self-fulfilling prophecy, the patient should consider psychotherapy. In BST we are mainly investigating and putting the emphasis on the interpersonal difficulties the patient is currently facing through a circular loop and how he/she feels accountable and/or responsible for some of the rigid interactions.
In conclusion, the DSM is complementary to other operational manuals developed in psychotherapy to support the development and application of customized interventions, however in order to provide a multi-pronged approach to the mental health issues it is important to be able to communicate with other mental health professionals with the same ‘language’ and provide the best mental care for the patient.
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