Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth… (original 1952; edition 2000)

DSM-IV introduced new diagnoses and a better research base than DSM-III-R. ( )

DSM-II replaced the initial DSM with a manual more intended for clinicians than for wardens of large, residential psychiatric facilities. Here we see the germ of subsequent DSMs, though the multiaxial system still has not been introduced and the very brief diagnostic descriptions (not yet really criterion-based) include psychodynamic etiologies. ( )

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RC455.2 .C4 D54 (REF)

Most, I'm sure, wouldn't consider reading the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) for pleasure, and I think that's a shame. Because even though the DSM-IV is used primarily in a clincal setting by highly skilled psychiatric professionals for the differential-diagnosing and treatment of mankind's complex plethora of psychopathologies both common and arcane and every run-of-the-mill disorder inbetween, I opine that the DSM-IV, even though it reads as dry as the Sahara, if not drier, nevertheless can be as wildly entertaining an alternative to playing charades or Pictionary at your next dinner or even office party. I recommend taking turns with your co-workers flipping through the DSM-IVs voluminous pages, so that you can self-diagnose one another's mental maladies.

"I think Susie over in HR has a delusional disorder, erotomanic type, coded 297.1, what do you think?"

Get the idea? Try it out with friends and family too, or on yourself.

However, before one would would ever want to engage in DSM-IV play for fun, one should first have a very clear handle on it's appropriate uses in a professional, and preferably psychiatric setting.

The DSM-IV is organized along its five axes. Each axis corresponds to specific subsets of clinical disorders and their diagnostic (and differential-diagnostic) criteria, etiology, behavorial profile of one afflicted with whatever disorder, treatment options, etc. Also, every specific disorder has its own specific code, just like there's specific police codes for every kind of crime or violation.

So, suppose you suffered from "Neuroleptic-Induced Tardive Dyskinesia," you'd be coded 333.82 on all the paperwork which would then hopefully help convince the insurance companies to pay your mental health practitioner so you could keep on receiving treatment and get better soon.

Axis I of the DSM-IV focuses on "Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention." Simply put, these are the psychopathological (love that word, "psychopathological") biggys: Major Depression, Bipolar Disorder, Schizophrenia, Anxiety Disorder NOS (Not Otherwise Specified), etc.

Axis II is my favorite axis; it covers the Personality Disorders. If people aren't seeking out a therapist for their depression or anxiety, it will undoubtedly be, according to the APA (American Psychiatric Association, which publishes the DSM-IV) for their maladaptive personality types, which can wreak havoc on all levels of their involvement in the social spectrum, most notably, of course, in marriages and in the workplace and at school. There are only eleven Personality Disorders. Let's list each and every one of them, along with their corresponding codes.

1. Paranoid Personality Disorder (301.0). Self explanatory.

2. Schizoid Personality Disorderr (301.20). The loner.

3. Schizotypal Personality Disorder (301.22). People who act bizarre, do bizzare stuff, but don't hear voices and whose symptomatology presents with no clear-cut psychosis. Ergo, they don't make the all out schizophrenia cut.

4. Antisocial Personality Disorder (301.7). Every sociopath who's every lived; every serial killer also, has had this type of PD. It's the primary personality type of most criminals.

5. Borderline Personality Disorder (301.83). These are your stalkers and your "cutters". The teenage girl in White Oleander was on her way to becoming Borderline. Borderlines are miserable, and they're adept at sharing their misery, whether you like sharing it with them or not.

6. Histrionic Personality Disorder (301.50). Think Liza Minelli, Liberace, or any of The Real Housewives of Orange County.

7. Narcissistic Personality Disorder (301.81). I'd argue a lot of actors have this PD. Some doctors or some brain surgeons. It's the God-complex PD of PDs, for those who deem themselves all-powerful, able to control any outcome; they are the center of theirs (and they think, our) universes.

8. Avoidant Personality Disorder (301.82). Closely related to social phobia. Anxiety driven PD. Differentiated from Schizoid PD by concern. Avoidants care about and want to connect with other people, but are shy and inhibited from doing so, while Schizoids, frankly, couldn't give a shit whether they connect with people or not.

9. Dependent Personality Disorder (301.6). If you're 37 and have never left your parent's nest, you probably have Dependent PD. Or the classic spousal abuse scenario in which the person abused refuses to leave her abuser even though she knows down deep she should.

10. Obsessive-Compulsive Personality Disorder (301.4). All too common. Hard to overcome, as they all are. Think Woody Allen.

11. Personality Disorder NOS (301.9).

Axis III covers General Medical Conditions. Perhaps you've got a physical ailment - migraines, say - which negatively affects your mood. Or you suffer from diabetes which can also affect your mood. Any medical conditions that cause psychological problems or contribute to them would be specified on this axis.

Axis IV pertains to Psychosocial and Environmental Problems. Perhaps the most subjective axis for the diagnostician to determine, since they must trust what the patient is telling them; that is, how the patient perceives themselves getting along in the world: in their marriage, relationships, job, education, etc. Are there any outside factors like a flood, say, or a fire resulting in the loss of their home, negatively contributing to their psychological profile?

Axis V: Global Assessment of Functioning. This is where a good clinician can wrap up all the diagnostic criteria and observations and tie a pretty (or not so pretty) bow on the patients overrall psychology, good or bad. There's a GAF scale the clinician uses, as well, to track a patient's progress and provide a numeric figure for a pretty nebulous construct: how well is the patient operating in all the psychologically and behaviorally pertinent areas of their life under inspection?

So that's the DSM-IV (soon to be the DSM-V) in a nutshell. ( )