The development of humankind has been marked by improvements is several social structures. For instance, education levels has gone up as many are literate and levels of educational attainment have improved. Though developments in the society are marked by improvements in social systems, this is not always easy as they are characterized by new challenges that have to be dealt with before improvements into other areas can be made. The healthcare system is one of the most important social systems as it plays a great role in ensuring the overall well-being of the social human (APA, 2000).
It is quite evident that the field of healthcare and clinical medicine has been developing, on the other hand it is apparent that the challenges that face the provisions of healthcare services are increasing in complexity. DSM-IV-TR diagnosis is a coding system that has been developed to uniquely identify mental problems. This paper seeks to establish the history of DSM diagnosis and determine its clinical manifestation, research development in its study and make recommendations on areas that need to be improved on. The main means used in researching is available literature and research material on DSM-IV-TR.
The research concludes that the operations of APA are within suspicion and so is the validity of DSM-IV-TR diagnosis for mental disorders. Major Features Standardization is a key feature in advancement in any profession. The development of standard DSM that each and every practitioner has to adhere to is key to ensuring uniformity in treatment and ensuring proper management in delivering medical services. The DSM-IV-TR is basically constituted of a number of diagnostic codes that are both clinically relevant and some that bear no relevance to clinical practice (APA, 2000).
Many clinicians and medical practitioners view the three to five digit codes assigned to disorder in the DSM-IV-TR as part of their daily diagnostic approach. Though the codes may appear to be illogical they have considerable practical consequences on the practice of medicine as standards dictate that it is only after the use of the codes will clinicians receive payment for their services and expertise. The manner in which the codes are assigned to conditions has often come under fire as no sense can be made out of the codes.
The American association of Psychologists (APA) which is responsible for the development of the code is blamed for the development of a code that does not make sense. Some have even suggested that APA should develop a simple straightforward approach to the diagnostic codes. On the other hand, APA exonerates itself from blame and attributes the coding to the International classification system (ICD)which is the official coding system used by the US governments and a number of private insurers. The codes classify medical conditions, and cause of injury and death.
In fact in ICD-9-CM mental disorders are included in code 290 to 319 in the coding system that starts from one and ends at 999 (APA, 2000). When the ICD-9-CM system first came into play in the early 1970’s the codes were developed in accordance to some pre-set logical scheme. In the earlier versions of the ICD-9-CM codes, three digit codes were considered to be of the highest order. A number of this high order codes were then divided into ten four digit categories and some even reached the five digit category.
The DSM-IV-TR diagnostic codes are a result of selective perusal of ICD-9-CM system and picking codes that correspond to the DSM-IV-TR category. Therefore, all DSM-IV-TR diagnostic codes are representative of valid ICD-9-CM codes and can therefore be used in cases where ICD-9-CM codes are required. The use of ICD-9-CM is prevalent in handling insurance claims and Medicare requirements. In fact, HIPAA requires that all clinicians use the ICD-9-CM codes for diagnosis of conditions that meet the DSM-IV-TR criteria.
It should be noted that the use of DSM-IV-TR codes is not aimed at complicating the diagnosis of mental conditions rather is useful in standardizing certain data elements and thus ease electronic processing of financial and administrative healthcare transactions. In fact, DSM-IV-TR has no bearing on prescriptions that will be used and is therefore just a system put in place to ensure that the healthcare system is in line with developments in technology.
The development have been made possible by growth in technology and increase in need for better service delivery from patient which can be attributed to developments in information systems that have made the patients more aware of their rights and options. Though DSM-IV-TR and ICD-9-CM codes bear close resemblance, there are cases where different diagnosis under DSM-IV-TR codes have the same code under the ICD-9-CM. This is because the DSM-IV-TR is more specific and more definitive of specific mental conditions. History of Diagnosis Category
The ICD as a body has been in charge of classifications of diseases and disorders. The general system which has been developed with time can be used to uniquely classify a condition by the use of a code than can be of up to six characters long. The APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is an alternative coding system used for psychiatric cases within and without the US. , development of DSM has led to its adoption especially in areas of research outside the US while the use of ICD coding system has remained relevant to almost all clinical cases in and out of the US (Eriksen & Kress, 2005).
The classification of diagnostic categories started in the late 19th century. In fact, the first International list of death was adopted in Chicago in 1893 after a meeting of the International Statistical institute. Recommendations on the use of this list which was then known as the Bertillon classifications was made in 1898 and these recommendations adopted in the entire North America. Over subsequent years a number of revision were made to the list in meetings that were held in France.
In 1922, a mixed commission was formed to deal with the list and it is this commission that is responsible for the fourth and fifth which was also the last editions of Bertillon classifications (Eriksen & Kress, 2005). In 1938, the need for parallel classification of diseases that were fatal came into light. A number of subdivision of the original list were made over the next decade but the efforts failed to gain general acceptance. The ICD-6 was endorsed in 1948 when the World Heath Organization first met (Eriksen & Kress, 2005).
The ICD-6 was a revision of the reports on publications of statistic on classification of deaths and injuries. A number of revisions followed which led to increase in the scope of ICD which included the integration of disabilities and procedure medicines. It soon became clear that the ICD could not cover all informations required for proper diagnosis and in the tenth revision meeting a recommendation was made on a new concept whose basis would be health related classification that places emphasis on family of diseases.
This led to the development of the ICD-9 in the 1970’s which was later revised to include development in healthcare to produce the current code which is the ICD-10 (Eriksen ; Kress, 2005). The APA’s DSM which was first published in 1952 and revised in subsequent years was derived from ICD-6 which was a major revision of the ICD-5 to include specific cases of psychiatric disorders (Eriksen & Kress, 2005). Changes in DSM The DSM was first published by the APA in 1952 an has over the years gained acceptance and usage in the US and in other areas around the globe (Eriksen & Kress, 2005).
The DSM coding system just like any other social idea has attracted both criticism and praise in all four versions that have been developed up to now. The DSM evolved out of a system of collecting information and statistics on psychiatric disorder which was developed by the US army. Development of DSM are continuous and have over the year kept in touch with improvement in medical and psychiatric field. The development of the DSM can be traced back to 1917 when APA developed a statistical manual for the insane (Eriksen & Kress, 2005).
This manual was developed through consultations with other psychiatric and medical bodies that led to a number of revisions. The medical 203 scheme was developed as a result of increased participations of the US soldiers in analysis and assessment of US soldiers (Eriksen & Kress, 2005). DSM-I is basically a revision of medical 203 that abandoned the basic outline and tried to express what resembles the present day perception of mental disturbance. DSM-I was a 130 page documents which contained 106 mental disturbances.
The second version of the DSM, DSM-II was published in 1968 in a 134 page document that included 182 disorders. A notable difference with DSM-I is the drop of the term reaction though neurosis was maintained. Both versions reflected psycho-dynamics of mental disorders though they also used Kraepelin classification system where symptoms were not detailed for specific disorders. Revisions of DSM-II that led to the development of the DSM-III were aimed at improving uniformity in diagnosis of mental disorders after DSM-II came under heavy criticism.
The Rosenhan experiment led to controversy and realization on the need for standardizing diagnosis. Formulation of DSM-III was a controversial affair especially the deletion of neurosis and inclusion of the term disorder which led to criticism from even political circles. In 1980, DSM-III was released in a 494 page document which listed 265 diagnostic categories. This version of DSM was revised in 1989 by reorganization and change in criteria (Eriksen & Kress, 2005). Some categories were deleted while others added, for instance the controversial premenstrual dysphoric disorder was discarded.
The resultant was entitled DSM-III-R which was contained in a 567 page document that had 292 diagnoses (Eriksen & Kress, 2005). DSM-IV was brought out in 1994 in a 886 page document that contained 297 disorders. One of the notable development made by DSM-IV is the inclusion of clinical significance criteria in half of categories which were in need of symptomatic cause (Eriksen & Kress, 2005). DSM-IV-TR is the most recent coding system and is basically a revision of DSM-IV. This coding system was published in 2000 and had no major changes on specific criteria for diagnosis.
Text sections were added to give extra information and some codes updated to ensure consistency with the ICD coding system. Disorders Psychiatric disorders often manifest themselves in individual behavior and therefore one has to compare the expected behavior to the behavior being displayed to determine if there are any discrepancies that may warrant medical attentions. Before the development of DSM-III that recognized conduct disorder as a psychiatric disorder individuals displaying high levels of hyperactivity and poor behavior were considered to be rude and anti-social (Eriksen & Kress, 2005).
In fact, the effects of the environment and nature of parenting were some of the factors attributed to development of behavior problem and it was seldom considered a medical condition. The inclusion of conduct problems as disorders raised eyebrows as the society had learned to accept and consider poor societal conduct as a consequence of individual personality rather than mental disorder. Over the years, definition of disorders have been expanded as seen in increase in number of disorder and increase in number of pages of DSM documents. Review of Empirical Studies
Credibility of DSM-IV diagnosis has come under fire from different circles. One of the major question raised centers around a possible conflict of interest in the members of the panel that was central in formulation of DSM-IV as they are alleged to have had financial ties to pharmaceutical companies. According to research findings, over 56% of the panel that developed DSM-IV had financial associations with major pharmaceutical companies. Such claims against a body that developed a framework for diagnosis of medical disorders presents a serious threat on the integrity and objectivity of their findings.
The finding further claim that the relationship between the people charged with the development of diagnostic criteria for mental disorders and the for-profit pharmaceutical industry is particularly strong in areas where drugs are first line interventions in management of mental disorders. The article states that pharmaceutical companies contribute immensely to research, journals and conventions of which DSM formulating members are included. The research further claims that in 2004 APA had over 54 symposiums that were funded by pharmaceutical companies.
Moreover, the amount of revenue gained by APA as a result of advertisement of pharmaceutical products and services increased by a whooping 24% in just one year. Some state that APA failed to acknowledge social constructivism and therefore their findings bear close resemblance of medicalisation of all forms of adverse human experiences. The increased relationship between psychiatric diagnosis and marketing of pharmaceutical products is blamed on high levels of globalization, but ethical considerations should be placed above economic principles of globalization that the human person has control over.
Reliability It is generally accepted within medical circles that diseases and conditions whose etiology and pathogenesis is now well understood presents a major challenge in nosology. Moreover, mental disorders have been a major headache that the medical fraternity has for a number of years tried to understand and develop proper management approaches. The causes of mental disorders are not fully understood and management of conditions is an area of study that is yet to be fully understood.
It is therefore clear that classifications of medical conditions is a task that is almost impossible under medical principles. However, APA has been piling categories of mental diseases with ease that defies the principle of nosology. This bring about a question on their objectivity and levels with which they conform to medical practice in formulating DSM diagnosis. Thus the article may have some considerable degree of truth value and cannot be discounted on medical grounds. Furthermore, the data it presents is credible and so are the sources cited in the article.
If the article were to be analyzed on the viability of its information then credible would be the only answer. Moreover, if there is one thing that the American public has learned from events that led to the 2008 financial crisis is that what they see is not what is really happening. Value of DSM Analysis The APA is a professional body charged with ensuring the psychological well being of the American society. Heath is an important aspect of the human person and therefore the bodies that develop policies and frameworks that determine the nature of healthcare practice should be above suspicion.
The evidence brought against APA on the manner in which it developed DSM-IV diagnosis which is basically is an earlier version of DSM-IV-TR diagnosis warrants suspicion on their operations. Furthermore, considerations on medical principle of nosology clearly shows that the classification of medical disorders is not as easy as APA has made it look. In fact, classification of medical disorders is nearly impossible and therefore classifications made by APA warrants suspicion and have no medical basis.
A body charged with the management of the heath of members of the society should be beyond suspicion and the article presents a clearly laid out argument and evidence of possible malpractice. Therefore, DSM-IV-TR diagnosis is within suspicion especially on the validity of their findings. Questions on the validity of DSM-IV-TR diagnosis bring all sorts of questions on its relevance and usefulness. It is therefore clear that the use of DSM-IV-TR diagnosis is questionable. Conclusion The wide adoption of DSM-IV-TR diagnosis by professionals and research bodies may be an indication of its relevance to medical conditions.
Though developed by professionals, DSM-IV-TR diagnosis is a theoretical framework that may be difficult to implement. Changes in the number of pages and medical disorders in subsequent revisions of DSM standards is may be an indication that it lacks in some key areas hence the need to improve, this is proved by APA’s announcement that it schedules to release a better DSM-V diagnosis in 2009. To put DMS into perspective, the development on DMS-IV diagnosis was basically an inclusion of clinical significance criteria in half of categories which were in need of symptomatic cause thus, what there areas are they yet to address?
Thus the manner and the relevance of DSM-IV-TR diagnosis has to be analyzed by independent professional to ascertain the viability of the code and proper measures put in place to ensure APA’s conduct is above suspicion. Reference List APA (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington DC: American Psychiatric Association. Eriksen, K. & Kress, V. E. (2005). Beyond the DSM Story: Ethical Quandaries, Challenges, and Best Practices. Thousands Oaks: SAGE Publications.