• Subject Name : Nursing

Clinical Research on Psychiatric Diagnosis

Introduction to The Diagnostic and Statistical Manual of Mental Disorders

 Diagnostic and Statistical Manual of Mental Disorders (DSM) is the classification method that is utilized for the diagnosis of the psychotic disorder. It is used by the clinics for identifying the disorder by considering the symptoms associated with the mentally ill patient (Regier et al., 2013). There has been a different controversy that has been raised concerning the accuracy of the DSM classification and it has been one of the major issues with psychiatric disorder treatment process. The controversy has raised the point concerning the effectiveness of the classification system (Vahia, 2013). The report is going to discuss the different controversies that are associated with the DSM and consumer experience concerning the diagnosis of mental disorders by utilizing the DSM system.

Controversy with DSM

Different controversies have been associated with DSM and it has increased the negative attitude toward the classification system. One of the controversies that have become one of the heated arguments is the lack of boundaries between the normal and abnormal state. The lack of boundary between both states leads to confusion between the diseased and health state which lead to the poor diagnosis followed by the wrong treatment which has a negative impact over the individual. This controversy is important as due to this grief is considered to be depression and forgetfulness is understood as a neurocognitive disorder. The minor fluctuation of the thought process or behaviour is normal in population but declaring it a mental disorder is the issue with the diagnosis system (Ghaemi, 2018). Another controversy that has been raised in the DSM is the direct influence of the pharmaceutical companies in the reframing of the guidelines. The huge section health care hold in the GDP indicates that is a big business that has been contributing to the nation’s economy. The mental disorder is one of the most expensive treatments that utilize the different pharmaceutical products to improve the mental wellbeing of the patient. This controversy arises due to the linking minor symptoms or fluctuation in the normal state as a mental disorder state to increase the diagnostic of the population with the mental disorder. This controversy has raised the issue for the team involved in the revising the DSM system as new disorder and symptoms of different disorders are revised in the latest DSM classification (Nemeroff et al., 2013).

The association of the DSM is also considered to be with medicalising patterns of behaviour and mood that has also negatively impacted the population. The medicalising process leads to the normative behavioural and mood changes to be extreme and associated with a mental disorder. The controversy was raised as due to the medicalising patterns of behaviour and mood lead to the mental disorder to be ubiquitous which increase the issue for the patient and wrong treatment has a negative effect over the patient health outcome. The false-positive diagnosis is evident due to the medicalising patterns which lead to the unnecessary treatment process which lead to increase financial burden over the patient (Kriegler & Bester, 2014). 

These findings reveal that the controversy that has been associated with the DMS has increased the vulnerability of the individual to acquire the mental disorder which leads to an increased the prevalence of the mental disorder patient across the globe. It has established a slope in which all the normal behavioural aspect can be considered to be a sign or symptoms of the mental disorder. The symptomatic diagnosis pattern is also one of the controversy points as sometimes two disorder having close symptoms lead to the chances of misdiagnosed which lead to the wrong diagnosis. The classification system is based on the symptomatic criteria which lead to the presence of disorder based on the sing and symptoms presented by the patient. The lack of information concerning different disorder leads to considering wrong symptoms or excluding from the list which harms the psychiatric health care sector (Wakefield, 2013). 

Consumers' Qualitative Experience

The issue with the DSM has directly affected the wellbeing of the patient due to the wrong diagnosis or overemphasizing over the grief or stress as a sign of a mental issue. The patients have experienced the poor diagnosis of the mental disorder due to the unclear boundary of the DSM which led to the establishment of the treatment that is not required. This leads to the chances of the overdose of the medication which lead to the poor health status of the patient which sometimes suppress the normal functioning of the brain. The patients have experienced that some time due to the wrong diagnosis they also experienced the physical health deterioration which directly decreases the overall wellbeing of the individual. The patients mentioned that sometimes just the counselling can help them to improve their stress or grief but due to the issue with the DSM clinics declare it as a medical disorder that needs right intervention to improve the mental state of the patient (Dowrick & Frances, 2013). 

 The DSM diagnosis medicalises the behavioural and mood that leads to the sign of SIC tag over the patient that is easily accepted by society. The patient discussed that tag lead to decrease socializing of the patient which increase different behavioural episode in the individual and ultimately leading to the behavioural issue of a lifetime. The DSM has increased the perspective of the mental disorder as per the patient understanding and as per the classification, normal low mood or anger is also considered to be the sign of the mental illness that needs to be urgently addressed (Brunoni, 2017). The patient has also added that the DSM use should be abolished as the classification is not able to link the symptoms with the physical test or biological marker that decreases the reliability. The lack of discriminative symptoms between the different psychiatric condition lead to the decreasing reliability of the DSM and patient think it can lead to the increasing prevalence of the mental disorder. There is need to broader the perspective of the diagnosis pattern of the psychiatric issue so that all the external and internal factor can be considered before declaring the presence of any disorder (Timimi, 2014). The patient's experiences have indicated that there are less satisfaction and poor experience with the DSM which increase the need to reframe the diagnosis criteria to improve the patient views for the diagnostic system.

Conclusion on The Diagnostic and Statistical Manual of Mental Disorders

The report can be concluded by adding that DSM was proposed to improve the diagnostic pattern in the psychiatric disorder but there has been may lop holes that presented as controversy. Different points have been raised against the DSM like lack of boundary, link to pharmaceutical, medicalising patterns of behaviour and mood and symptomatic diagnosis. These have negatively impacted the patient health outcome and satisfaction that was evident from the patient discussed in the report. The patient experience reveals that due to the loopholes of the DSM they have to face an issue like deteriorated mental or physical health, decrease social presence or behavioural issue. The issue has increased their reluctance behaviour toward the use of DSM for the diagnosis of the mental disorder due to lack of physical test or biological marker it is less reliable. 

References for The Diagnostic and Statistical Manual of Mental Disorders

Brunoni, A. R. (2017). Beyond the DSM: Trends in psychiatry diagnoses. Archives of Clinical Psychiatry (São Paulo), 44(6), 154–158. https://doi.org/10.1590/0101-60830000000142 

Dowrick, C. & Frances, A. (2013). Medicalising unhappiness: New classification of depression risks more patients being put on drug treatment from which they will not benefit. BMJ, 347(dec09 7), f7140–f7144. https://doi.org/10.1136/bmj.f7140 

Ghaemi S. N. (2018). After the failure of DSM: Clinical research on psychiatric diagnosis. World Psychiatry: Official Journal of the World Psychiatric Association (WPA)17(3), 301–302. https://doi.org/10.1002/wps.20563

Kriegler, S. & Bester, S. E. (2014). A critical engagement with the DSM-5 and psychiatric diagnosis. Journal of Psychology in Africa, 24(4), 393–401. https://doi.org/10.1080/14330237.2014.980629 

Nemeroff, C.B., Weinberger, D. & Rutter, M. (2013). DSM-5: A collection of psychiatrist views on the changes, controversies, and future directions. BMC Med 11, 202. https://doi.org/10.1186/1741-7015-11-202

Regier, D. A., Kuhl, E. A. & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World Psychiatry: Official Journal of the World Psychiatric Association (WPA)12(2), 92–98. https://doi.org/10.1002/wps.20050

Timimi, S. (2014). No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished. International Journal of Clinical and Health Psychology, 14(3), 208–215. https://doi.org/1016/j.ijchp.2014.03.004 

Vahia V. N. (2013). Diagnostic and statistical manual of mental disorders 5: A quick glance. Indian Journal of Psychiatry55(3), 220–223. https://doi.org/10.4103/0019-5545.117131

Wakefield, J. C. (2013). DSM-5: An overview of changes and controversies. Clinical Social Work Journal, 41(2), 139–154. https://doi.org/10.1007/s10615-013-0445-2

Wakefield, J. C. (2016). Diagnostic issues and controversies in DSM-5: Return of the false positives problem. Annual Review of Clinical Psychology, 12(1), 105–132. https://doi.org/10.1146/annurev-clinpsy-032814-112800

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