DSM-S revision. This section is designed to provide a practical guide to using DSM-5, par- ticularly in clinical practice. The primary purpose of DSM-5 is to assist trained clinicians in the diagnosis of their patients’ mental disorders as part of a case formulation assess- ment that leads to a fully informed treatment plan for each individual. The symptoms con- tained in the respective diagnostic criteria sets do not constitute comprehensive definitions of underlying disorders, which encompass cognitive, emotional, behavioral, and physiological processes that are far more complex than can be described in these brief summaries. Rather, they are intended to summarize characteristic syndromes of signs and symptoms that point to an underlying disorder with a characteristic developmental his- tory, biological and environmental risk factors, neuropsychological and physiological cor- relates, and typical clinical course.
Approach to Clinical Case Formulation
The case formulation for any given patient must involve a careful clinical history and con- cise summary of the social, psychological, and biological factors that may have contrib- uted to developing a given mental disorder. Hence, it is not sufficient to simply check off the symptoms in the diagnostic criteria to make a mental disorder diagnosis. Although a systematic check for the presence of these criteria as they apply to each patient will assure a more reliable assessment, the relative severity and valence of individual criteria and their contribution to a diagnosis require clinical judgment. The symptoms in our diagnos- tic criteria are part of the relatively limited repertoire of human emotional responses to in- ternal and external stresses that are generally maintained in a homeostatic balance without a disruption in normal functioning. It requires clinical training to recognize when the com- bination of predisposing, precipitating, perpetuating, and protective factors has resulted ranges. The ultimate goal of a clinical case formulation is to use the available contextual and diagnostic information in developing a comprehensive treatment plan that is in- formed by the individual’s cultural and social context. However, recommendations for the selection and use of the most appropriate evidence-based treatment options for each dis- order are beyond the scope of this manual.
Although decades of scientific effort have gone into developing the diagnostic criteria sets for the disorders included in Section II, it is well recognized that this set of categorical diagnoses does not fully describe the full range of mental disorders that individuals ex- perience and present to clinicians on a daily basis throughout the world. As noted previ- ously in the introduction, the range of genetic/ environmental interactions over the course of human development affecting cognitive, emotional and behavioral function is virtually limitless. As a result, it is impossible to capture the full range of psychopathology in the categorical diagnostic categories that we are now using. Hence, it is also necessary to in- exactly into the diagnostic boundaries of disorders in each chapter. In an emergency de- partment setting, it may be possible to identify only the most prominent symptom ex- pressions associated with a particular chapter—for example, delusions, hallucinations, 20 Use 01 the Manual mania, depression, anxiety, substance intoxication, or neurocognitive symptoms—so that an ”unspecified” disorder in that category is identified until a fuller differential diagnosis is possible.
Definition of 8 Mental Disorder
Each disorder identified in Section II of the manual (excluding those in the chapters enti- tled ”Medication—Induced Movement Disorders and Other Adverse Effects of Medica— tion” and ”Other Conditions That May Be a Focus of Clinical Attention”) must meet the definition of a mental disorder. Although no definition can capture all aspects of all dis- orders in the range contained in DSM-S, the following elements are required:
A mental disorder is a syndrome characterized by clinically significant distur- bance in an individual’s cognition, emotion regulation, or behavior that reﬂects a dysfunction in the psychological, biological, or developmental processes un- derlying mental functioning. Mental disorders are usually associated with signif- icant distress or disability in social, occupational, or other important activities.