DSM IV TR: A Thumbnail Sketch
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Cultural Caveat
When working with clients of different cultural groups, you have to be careful that you do not pathologize behaviors that are normal in their culture. Textbook examples include diagnosing a Native American as psychotic because he is talking to dead relatives. Culturally, this may be accepted in his tribe as a way to process their death and grieve. Alternately, diagnosing an African American mother living in a low-income high-crime neighborhood as having paranoid ideation for thinking everyone around her was dangerous and could hurt her children would be just as irresponsible.

Cultural sensitivity goes a bit further though. Consider three factors:
varying base rates of mental disorders in different ethnic groups
the effects of racism

Varying Base Rates of Mental Disorders
Zhang and Snowden (2000) studied mental disorders in over 18,000 adults collected through an NIH study. They found:
African Americans had lower rates of major depression, obsessive-compulsive disorder, drug and alcohol abuse and dependence, antisocial personality disorder, and anorexia. They had higher rates of phobias and somatization.
Asian Americans had lower rates of schizophreniform disorder, mania and bipolar disorder, panic attacks, somatization, drug and alcohol abuse and dependence, and antisocial personality disorder.
Hispanic Americans had lower rates of schizophrenia, obsessive-compulsive disorder, panic attacks, and drug and alcohol abuse and dependence.

The Effects of Racism
Racial discrimination compared to life stress and demographic variables was also studied in African Americans as it predicted psychiatric disorders. Klonoff, Landrine, and Ullman (2000) found that racial discrimination accounted for 15% of the variance in predicting psychiatric disorders, and contributed a unique portion to the variance even when other factors were forced into the regression equation first. Clearly, this is an additional stressor that could lead to certain disorders more often than others, or require coping with certain skills that might also increase resistance to some disorders but lower resistance to others.

Finally, never underestimate the complexity of acculturation, as well as the stress associated with moving between cultures. Higher acculturation means greater ability to "fit in" to the dominant culture and make parts of it your own. Some studies have shown that as Mexican Americans become more acculturated, they are more likely to show substance abuse. Thus, more acculturation is not always better.

Those simple caveats given, here's a brief, brief, outline of the DSM IV. The Axis is in red, the topic area and text are in normal font, and the actual names of the disorders are in bold.

Axis I - Childhood

Pervasive Developmental Disorders

severe impairments in various areas, including language, behavior, and other developmentally appropriate areas. There are several sub types:

Autistic Disorder

1) impaired social interactions, 2) impaired communication, 3) restrictive or stereotyped behaviors

genetic underpinning, linked to numerous neurological abnormalities

75% are mentally retarded, most cases are diagnosed by age 3

Rett's Disorder (normal until age 5 months), Childhood Disintegrative Disorder (normal until 2 years), Asperger's Disorder (like Autistic without communication deficits), and NOS

Disruptive Behavior Disorders

Attention Deficit-Hyperactivity Disorder

1) developmentally inappropriate pattern of inattention or hyperactivity, 2) onset before the age of 7, 3) signs in at least two settings

genetic and biological underpinnings, maybe labile mood, low self-esteem, low frustration tolerance

Hyperactive, Inattentive, Combined


Conduct Disorder

1) aggressive behavior, 2) destruction of property, 3) significant deceit or theft, 4) serious violation of rules (i.e., truancy, breaking curfews, and running away)

Childhood, Adolescent, Unspecified Onset

Mild, Moderate, Severe

Oppositional Defiant Disorder

many of the same behaviors as a conduct disorder, but with a negativistic defiance

Disruptive Behavior Disorder NOS

Learning Disabilities

achievement that is below expected levels (you may see language delays, motor difficulties, over activity, and low self-esteem)

Reading Disorder, Mathematics Disorder, Disorder of Written Expression, Learning Disorder NOS

Other Developmental Disorders

Developmental Coordination Disorder (a Motor disorder), Expressive Language Disorder, Phonological Disorder, Mixed Receptive-Expressive Language Disorder, Stuttering, NOS (all Communication disorders)

Feeding and Eating Disorders

Pica, Rumination, Feeding Disorder of Infancy or Early Childhood

Tics Disorders

Tourette's, Chronic Motor or Verbal Tic Disorder, Transient Tic Disorder, NOS

Elimination Disorders

Encopresis (With and Without Constipation/Incontinence)

Enuresis (Nocturnal, Diurnal, Nocturnal and Diurnal)


Separation Anxiety

1) significant difficulty separating from a parent that is not age appropriate, 2) lasting for at least 4 weeks

Selective Mutism - failure to speak in specific settings despite speaking on other settings

RAD - pathogenic care and over/under attachment by 5 years, Inhibited or Disinhibited

Stereotypic Movement DisorderWith Self-Injurious Behavior

Disorder of Infancy, Childhood, or Adolescence NOS

Axis I - Adulthood


1) disturbed consciousness due to changes in cognition or the development of perceptual abnormalities, 2) rapid onset, 3) fluctuating symptoms, 4) it may last hours to weeks

Medical Condition, Substance Intoxication, Substance Withdrawal, Multiple Etiologies, NOS


1) multiple deficits, 2) memory impairment, 3) progressive and irreversible

Alzheimer's Disease

With Early or Late Onset

With Delirium, Delusions, Depressed Mood, Uncomplicated

With Behavioral Disturbance

Vascular Dementia

memory impairment, neurological damage

With Delirium, Delusions, Depressed Mood, Uncomplicated, Behavioral Disturbance

Dementia Due to other General Medical Conditions

Due to HIV, Head Trauma, Parkinson's, Huntington's, Picks, Creutzfeldt-Jakob, Other

Substance Induced Persisting Dementia

Multiple Etiologies


Amnestic Disorders

disturbed memory, but not consciousness, usually from C.V.A., stroke, or head trauma, sometimes psychological consequences

Amnestic Disorder due to General Medical Condition Transient or Chronic

Substance Induced


Mental Disorders Due to a General Medical Condition

Something Due to Medical Condition

due to medical problems and cannot be explained by psychological means; include mood, personality change, cognitive/consciousness changes, psychosis, anxiety, sexual and sleep disorders

Substance Abuse Disorders

With and Without Physiological Dependence

Early Full Remission (1-11 months no Dependence or Abuse), Early Partial Remission (1-11 months no Dependence, but Abuse), Sustained Full Remission (12 months with no Dependence or Abuse), Sustained Partial Remission (12 months with no Dependence, but Abuse)

On Agonist Therapy, In A Controlled Environment

Dependence, Abuse, Intoxication, Withdrawal

With Dementia, Amnesia, Psychotic With Delusions, Psychotic With Hallucinations, With Mood, With Anxiety, With Sex, and With Sleep

Alcohol, Amphetamine, Caffeine, Cannabis, Cocaine, Hallucinogen, Inhalant, Nicotine, Opioid, Phencyclidine, Sedative/Hypnotic/Anxiolytic, Polysubstance, Other or Unknown

Schizophrenia Disorders

1) symptoms persist for six months, 2) one month of at least two symptoms from the following; delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms (impoverished affect, thought, or speech)

Paranoid, Disorganized, Catatonic, Undifferentiated, Residual Type

Episodic With/Without Residual/Negative Symptoms, Continuous, Single Episode In Partial/Full Remission, Other or Unspecified

Schizophrenia Like Disorders

Schizophrenaform Disorder - symptoms of schizophrenia lasting less than six months

Schizoaffective Disorder

symptoms of schizophrenia with a concurrent mood disorder, but a period exists without the mood disorder while schizophrenic symptoms are present

Bipolar, Depressed Type

Delusional Disorder

nonbizarre delusions

Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed, Unspecified

Brief Psychotic Disorder

Shared Psychotic Disorder

Psychotic Disorder Due to Medical Condition


Mood Disorders

Major Depressive, Manic, Mixed, and Hypomanic Episodes

Chronic, With Catatonic Features, Melancholic Features, Atypical Features, Postpartum Onset

With/Without Interepisode Recovery, With Seasonal Pattern, With Rapid Cycling

Onset During Intoxication, Onset During Withdrawal

Mild, Moderate, Severe With/Without Psychotic Features which are Mood Congruent/Incongruent, Partial/Full Remission, Unspecified

Major Depressive Episode - 5 symptoms over 2 weeks

Major Depressive Disorder - numerous Major Depressive Episodes over a six month period

Dysthymic Disorder - depressive symptoms lasting 2 years, and longest remission is less than 2 months

Cyclothymic Disorder - subclinical depression for 2 years, and longest remission is less than 2 months

Depressive Disorder NOS

Bipolar I - Single Manic, Most Recent Episode Hypomanic, Most Recent Episode Manic, Most Recent Episode Mixed, Most Recent Episode Depressed, Most Recent Episode Unspecified

Bipolar II - recurrent depression and interspersed hypomanic episodes


Anxiety Disorders

Panic Disorder With/Without Agoraphobia

Agoraphobia Without Panic Disorder

Specific Phobia

Social Phobia

Obsessive/Compulsive Disorder

Generalized Anxiety Disorder


PTSD - traumatic experience that is re-experienced and produces intense arousal and anxiety, as well as efforts to avoid this, for at least one month

Acute Stress Disorder - PTSD for less than one month

Somataform Disorders

1) physical symptoms that are not explained by medical issues, 2) that cause distress, 3) and that are not intentionally produced

Somatization - specific symptoms

Undifferentiated Somatoform - nonspecific

Conversion - neurological symptoms - Motor, Sensory, Seizure or Convulsion, Mixed

Pain Disorder - Acute, Chronic


Body Dismorphic


Factitious Disorder - voluntarily produced

With Predominantly Psychological/Physical/Psychological and Physical Symptoms

Malingering Disorder - feigned symptoms (V65.2)


Dissociative Disorders

Dissociative Amnesia Disorder

Dissociative Fugue Disorder

Dissociative Identity Disorder

Depersonalization Disorder


Sexual and Gender Disorder

• Sexual Desire Disorders (2)

• Sexual Arousal Disorders (2)

• Orgasmic Disorders (3)

• Sexual Pain Disorders (2)

• Paraphilias (9)

Gender Identity

in Children/Adolescents or Adults

Sexually Attracted to Males, Females, Both, Neither

Gender Identity NOS

Sexual Disorder NOS

Eating Disorders

Anorexia Nervosa

1) refuses to maintain normal weight, 2) intense fear of increase in weight, 3) disturbed perceptions of the body shape and size, 4) amenorrhea (90 % of patients are female)

Restricting, Binging/Purging

Bulimia Nervosa

1) binge eating with no control, 2) purging, 3) undue importance given to body shape and weight


Sleep Disorders

• Dyssomnias - problems sleeping (6)

• Parasomnias - Nightmare, Sleepwalking, Terror, NOS

• Others (3)


Intermittent Explosive Disorder



Pathological Gambling



Adjustment Disorders

With Anxiety, With Depressed Mood, Mixed Mood, Conduct, Mixed Emotions and Conduct, Unspecified

Axis II

Disorders Diagnosed in Adulthood - Personality Disorders

Cluster A - odd or eccentric behaviors




Cluster B - emotional/erratic behavior





Cluster C - anxious and fearful




Disorders Diagnosed in Childhood

Mental Retardation

1) IQ <70, 2) concurrent deficits in adaptive functioning, 3) onset before age 18, mild, moderate, severe, profound

causes can be heredity (PKU), embryonic development (Down's Syndrome, anoxia, toxins), medical problems (lead poisoning), psychological problems (severe deprivation)

Mild, Moderate, Severe, Profound, Unspecified

Axis III
General Medical Conditions

Axis IV
Psychosocial Stressors
problems with primary support group (death, abuse, separation),
social environment (death or loss, discrimination, living alone), educational problems (illiteracy),
occupational problems (unemployed), housing problems (homeless, unsafe), economic problems (poverty),
problems with access to health care (inadequate care), problems in interaction with legal services (arrest, victimization),

Axis V
Global Assessment of Functioning
0-10 persistent danger of hurting self; can't maintain standard of self-care
11-20 some danger of hurting self; occasionally unable to maintain standard of self-care; impairment in communication
21-30 delusions, hallucinations; impairment in communication and judgment; major impairment in most areas (stays in bed, no friends)
31-40 some impairment in reality testing; major impairment in select areas
41-50 serious symptoms (suicidal ideation but low risk, for example); serious impairment in one area
51-60 moderate symptoms
61-70 mild symptoms; able to function with some problems in relationships and work
71-80 slight impairment; transient symptoms
81-90 good functioning
91-100 happy, healthy, content