What is the DSM 5

Diagnostic and Statistical Manual of Mental Disorders DSM-5

The German version of the fifth edition of the diagnostic-statistical manual of mental disorders (DSM-5) of the American Psychiatric Society is a weighty book. It weighs 2.3 pounds. When you reach for it, it falls out of your hand easily. You need both hands to hold it. You have to sit at the desk to open it. In short, it is not reading for the wing chair.

In terms of content, however, it is not. The layout is much more eye-friendly than that of the original edition. In my opinion, the translation was successful. Unusual words like "disruptive affect regulation disorder" are to be blamed on the creators of the DSM-5, not the translators.

Just a few pointers

It makes no sense to discuss a diagnostic and classification catalog with a length of 1,300 pages in detail. So just a few tips: If you want to familiarize yourself with the German version of the DSM-5, first turn your attention to the table of contents, the 35-page name and coding of the diagnoses that precede the book, the foreword of the German-language version (seven pages) and of the American edition (five pages) and - most importantly - the appendix, which summarizes the main changes in the DSM-5 compared to the DSM-IV (eleven pages).

When you have done all of this, it can no longer be a matter of reading, but of looking up. If you do that, the tome becomes a real treasure trove. It is noticeable that the German publishers have completely dispensed with the classic coding of the American original edition. They only use the coding of the advanced version of the WHO ICD, which is enclosed in brackets in the original. So you have to go back to the original if you need the American coding.

Conglomerate of diagnoses

The harsh preliminary criticism in the German media in 2013 made it quite clear that not everyone will like what they find there. Certainly not all criticism was justified. This is especially true for the nonsensical claim that the manual shortens the time of "normal" mourning to two weeks! However, one wonders with some right what sense such a conglomerate of hundreds of diagnoses makes and how these should be manageable in everyday life.

The central problem of the diagnostic approach, however, is that the previous versions from 1980 had already made the radical change from dimensional to categorical diagnostics. Since then, the symptoms that the diagnostician perceives are no longer sighted, weighted and put together to form an overall picture, rather they are listed and checked off equally in a catalog of criteria. For example, the presence of five out of ten symptoms listed may mean that "the criteria for the presence of a disorder are met".

This leaves little room for maneuver for the clinician, who, however, should also have the last word, according to the makers of the DSM-5. That is probably more of a pious wish - as well as the warning that the manual must not be used like a cookbook and that it does not belong in the hands of beginners.

Three notes

At this point just three remarks: The psychotic disorders that interest me in particular are summarized under the umbrella term of schizophrenia spectrum disorders. The schizophrenia appears in this way under "also ran".

The term dementia is no longer used: it has been replaced by the term "neurocognitive disorder". From the point of view of stigmatization, this certainly makes sense.

Also noteworthy is the extensive catalog of the additionally coded so-called "other clinically relevant problems". These include interpersonal problems, abuse, mistreatment and neglect, psychological and physical abuse, sexual violence by partners, problems related to education and work, problems related to housing or economic conditions and many others (pp. 985-1003).

Anyone who needs the DSM-5 for their work should not shy away from the investment - even in addition to the American original edition - despite the high price. If you just want to leaf through it - browsing would be the wrong expression - go to a specialist library or contact a good friend.

PS: The reviewer attaches importance to the fact that he selected, bought and paid for the book under discussion himself.

Asmus Finzen in Psychosocial Review