The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), shortened to DSM-5, is the guide used by clinicians to diagnose mental health conditions. It’s published by a professional body called the American Psychiatric Association (APA) and updated as new research emerges. The fifth edition is the most current iteration and was released in 2013.
The handbook contains descriptions, classifications, and criteria (or symptoms) that must be present for a reliable diagnosis of each mental health condition. It is intended for diagnostic use by trained and experienced mental health professionals.
How many diagnoses are there?
The DSM-5 contains criteria and codes for 20 diagnostic categories. Each category contains a number of diagnoses and subtypes, meaning that the actual total number of diagnoses in the DSM depends on how you count them. The diagnostic categories are:
- Neurodevelopmental Disorders
- Schizophrenia Spectrum and Other Psychotic Disorders
- Bipolar and Related Disorders
- Depressive Disorders
- Anxiety Disorders
- Obsessive-Compulsive and Related Disorders
- Dissociative Disorders
- Somatic Symptom Disorders
- Feeding and Eating Disorders
- Elimination Disorders
- Sleep-Wake Disorders (such as insomnia)
- Sexual Dysfunctions
- Gender Dysphoria
- Disruptive, Impulse-Control, and Conduct Disorders
- Substance-Related and Addictive Disorders
- Neurocognitive Disorders
- Personality Disorders
- Paraphilic Disorders
- Medication-Induced Movement Disorders and Other Adverse Effects of Medication
- Other Conditions That May Be a Focus of Clinical Attention
What is the DSM-5 used for?
The DSM-5 is used for a wide range of treatment, research, and educational purposes.
Therapists use the DSM-5 to:
- Identify and diagnose mental health conditions
- Differentiate between similar diagnoses and ensure that the most appropriate treatment is provided
- Identify the proper diagnosis for submitting claims to health insurance companies so clients can receive coverage for their sessions
The DSM is also a learning tool for students of psychology, counseling, and social work, and provides a standardized framework for researchers to classify, gather data, and talk about mental health conditions.
Do all therapists use the DSM-5?
The DSM-5 is widely used in clinical practice in the US and internationally but is not the only manual in use.
A second diagnostic handbook is called the ICD, or The International Classification of Diseases. The ICD is released by the World Health Organization and is soon to be updated to the eleventh version (ICD-11). Unlike the DSM, which describes mental health conditions only, the ICD captures diagnostic criteria for the breadth of medical conditions. The ICD is the official system used to code medical conditions in the US. However, the DSM and ICD are closely aligned, and the APA suggests that clinicians use them as companion guides.
Some clinicians are opposed to using the DSM altogether out of concern for its limitations, which are discussed below.
Do I need a diagnosis to see a therapist?
No, you don’t need to have a formal diagnosis to see a therapist. That said, having a formal diagnosis is likely to affect the kind of financial assistance you will receive from your health insurance. Check your plan details with your insurance provider, as they are allowed to exclude specific diagnoses.
What are the pros and cons of treatment using a diagnostic model?
The DSM-5, given its wide clinical use, is also closely scrutinized and debated. Using a diagnostic model such as the DSM-5 has both pros and cons:
- Standardized communication: Having a diagnosis means that you and your health professionals share a common language for understanding and communicating about mental illness. This helps enable collaborative treatment, as your doctor, psychiatrist, and any other mental health professionals can work together to help you.
- Treatment selection: Many researchers use the diagnostic categories to define and describe the population of people they are studying, often to see whether a particular treatment will help those experiencing a particular disorder. This helps therapists to know which therapy modalities are best suited to which mental health conditions, so that you receive the best available treatment based on the current evidence.
- Feeling understood: For many people, receiving a diagnosis can be a relief and provide hope. A diagnosis enables a framework for understanding our experience and identifying the next steps.
- Financial: A formal diagnosis is often a necessary requirement for accessing government and health insurance financial support for treatment.
- Labeling and risk of stigma: Having a label attached to you comes with risks. Many people still encounter discrimination, stereotyping, or bullying as a result of having a mental health diagnosis. Labels might also lead to self-fulfilling prophecies, where people behave the way they believe is expected of them.
- Cultural differences: Diagnostic models do not explicitly account for cultural differences in what is considered to be normal or abnormal thinking, beliefs, and behavior. Instead, we rely on our therapists to be culturally competent in their practice; so that they can identify whether a disorder is present or not, and then provide culturally sensitive treatment.
- Categorical: The APA notes that not all mental health conditions fit neatly within the category of one diagnosis in the DSM-5. Categorical diagnosis does not readily allow for individual differences in the experience of mental health challenges.
Sources and references
- American Psychiatric Association, 2013, Diagnostic and Statistical Manual of Mental Disorders, 5th Ed.
- World Health Organization website, “Classification of Diseases”. Accessed online December 2019 at https://www.who.int/classifications/icd/en/
- Jerry Kennard, 2013, “Pros and Cons of a Psychiatric Diagnosis”, Health Central. Accessed online December 2019 at https://www.healthcentral.com/article/the-pros-and-cons-of-a-psychiatric-diagnosis
- Amorette Perkins et al., 2018, “Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings” The Lancet. Cited in Jay Watts, 2018, “Mental health labels can save lives. But they can also destroy them”, The Guardian. Accessed online December 2019 at https://www.theguardian.com/commentisfree/2018/apr/24/mental-health-labels-diagnosis-study-psychiatrists
- American Psychological Association, “Does Your Insurance Cover Mental Health Services?”. PDF accessed online December 2019 at https://www.apa.org/helpcenter/parity-guide.pdf