Psychology

The current DSM has often been criticized due to the several flaws observable from its system of diagnosis. Although it is largely used by clinical and psychiatric professionals, DSM IVTR raises several doubts on its validity reliability, genuineness and ability to provide diagnosis that exist in a real world. It is factual that even after production of the text revision of DSM IV in 2000, there are several changes which ought to be made in it so as to overcome the current criticisms But what are the major criticisms of DSM-IV-TR and what changes should be incorporated in the next DSM to make it more effective and applicable This paper discusses the main criticisms of DSM IVTR alongside relevant changes required on it.

Introduction
The current text revision of the DSM -IV was published in 2000. It is universally abbreviated as DSM-IVTR and it classifies psychiatric diagnosis using five major axes, according to the different aspects of disabilities and disorders. The first level (Axis I) comprises of the clinical disorders which include disorders of learning and major mental disorders. Axis II is a list of personality disorders as well as mental retardation. Physical disorders and acute medical conditions are found in Axis III while Axis IV contains the environmental and psychosocial factors causative of these disorders. The last level, Axis V, contains Childrens Global Assessment Scale (CGAS) for children and teenagers below eighteen years (Beutler, Malik, 2000). In this paper, criticisms of the 2000 text revision (TR) of DSM-IV will be discussed in detail, giving relevant changes that should be incorporated in the next version (DSM V).

Criticisms of the DSM-IVTR
The major criticism of DSM-IVTR is based on the reliability and validity of its diagnosis. Generally, this relates to the doubt whether the disorders and diagnosis it defines are genuine conditions in real life that can be constantly identified through its criteria. Critics argue that DSM-IVTR lacks validity since it does not have any affiliation to an established scientific model of psychological disorders. Therefore, the resolutions taken from its classifications are not scientific (Beutler, Malik, 2000). It lacks reliability partially for the reason that different diagnoses share several criteria and what seem to be actual different criteria are mostly restatements of the same idea. This implies that decision to allocate diagnoses to patients is in some way the result of personal prejudice (Nordmarken, Zur, 2010).

In addition, the DSM-IVTR is criticized due to its lack of definite cut-offs. Despite the text revision that was done on DSM-IV, it is still criticized for lacking a distinctive system of classifying disorders. DSM-IVTR uses arbitrary dividing lines between what is considered abnormal and normal.  Up to date, several efforts aimed at creating boundaries between various related syndromes in DSM have constantly failed.  For instance, DSM-IVTR does not take into consideration the patients context and the extent to which a disorder could be caused by psychological adverse situations. Axis IV fails to outline concrete environmental and psychological factors that contribute to disorders (Blatt, Luyten, 2009). On categorical modeling, critics argue that the structuring method of DSM-IVTR categories represent rising medicalization of human nature, attributed to syndrome mongering by psychiatrists and pharmaceutical companies. For example, amongst the authors of the current DSM, evidence has shown that more than half of them have had some financial affiliations with the pharmaceutical industry. Moreover, all the versions of DSM are intended to be used for administration, research and by mental health professionals. However, to use the diagnostic criteria, one requires clinical training. The terminologies used in DSM-IVTR are only usable among clinical professionals, making its use in research and administration limited (Blatt, Luyten, 2009).

The labeling of the disorders using the current DSM has also been criticized for the reason that it labels some normal behaviors as disorders. For example, normal existential anxieties are labeled as Anxiety Disorder while behaviors such as shyness are labeled as Social Phobia. Further, it labels strong willed-spirited children as victims of Opposition Disorder and lasting grief as Complicated Grief Reaction (Nordmarken, Zur, 2010). This has the effect of making people who exhibit these behaviors conclude that they are abnormal, which is not the condition in most cases. DSM has thus become a social control tool, judging who is normal or not, sane or insane, and who remains free or hospitalized.  The labeling of normal human behaviors as disorders is also used by medical professionals, pharmaceutical companies and insurance companies for financial gains (Nordmarken, Zur, 2010).

Evidence gathered from experienced mental health professionals show that in some cases the symptom pictures described under the current DSM do not exactly match the real symptoms exhibited by the patients. An individual may exhibit symptoms that cut across different DSM disorders and this makes it difficult to determine the real disorder they could be suffering from (Kleinplatz, 2010). This argument is the foundation of the criticism that the symptom pictures in DSM IVTR do not always match with clinical experience. Critics who have thoroughly analyzed the two versions of DSMDSM-IV and DSM-IVTRargue that there is negligible difference between the two and therefore, DSM-IVTR is not important. The only changes that seem evident between the two versions are in the criminal paraphilis (Exhibitionism, Pedophilia, Frotteurism, Voyeurism and Sexual Sadism) and the method of effecting these adjustments is not stated (Kleinplatz, 2010).

Changes in the next DSM
A revision for Reactive Attachment Disorder has been suggested to include a division of two DSM-IV types into two disorders  Disinhibited Social Engagement Disorder and Reactive Disorder of Infancy and Early Childhood. This is because the symptoms of this disorder are a composite of the proposed two conditions. In addition, the Adjustment Disorder which is currently placed under Axis- I, does not fit perfectly under this category and should be included in Trauma and stress related disorders (American psychiatric association, 2010).

More so, a scientific basis of evaluating the validity of DSM disorders should be developed to eliminate doubts on its reliability. Towards this end, the American Psychiatric Association should take the responsibility of identifying a reputable scientific research association that will be assigned the responsibility of conducting research on various DSM disorders so as to verify their genuineness and existence in real life. Consequently, all the disorders that lack scientific justification ought to be removed from the next DSM to circumvent the current adverse effects created by the categorization of normal human behaviors as disorders (for instance shyness.

DSM-IV-TR is more concerned with the symptoms of psychological disorders other than their causes. There is no explanatory basis for the mental disorders using DSM IVTR (Beutler, Malik, 2000). It is crucial that the next DSM addresses this issue by conducting research on the possible etiology of mental disorders to give more credibility to the reliability of its diagnosis.

The arbitrary cut offs should e eliminated from the current DSM. Elimination should be based on the review of the disorder symptoms, classifying all the disorders with almost similar features under the same category, followed by a change on the minimum average number of symptoms required to indicate the presence of a mental disorder in a person. This implies that in the place of the fifty percent minimum symptom which is used by DSM-IVTR, the minimum number of symptoms should be increased to approximately sixty five percent. Such an effort will also eliminate categorical modeling problems.

DSM-IV-TR is produced by the American Psychiatric Association as a requirement under federal legislative mandates. It is used in research, administration and by mental health professionals (American psychiatric association, 2010). However, since its use by people who do not have adequate clinical training results to wrong application, the next version should either limit its use to clinical professionals only or ensure that all laymen intending to use DSM obtain the necessary training and a license. Anyone using DSM must be licensed by both the American Psychiatric Association and the health care industry. Licensing should be done after training (Blatt, Luyten, 2009). To counter the claim by critics that majority of the authors of the current DSM are in one way or another affiliated to the pharmaceutical industry and that their intentions are rather commercial than medical, there should be a complete change in the DSM V planning committee of experts to ensure that they are free of any commercial affiliations. This should be done through a purposive survey of the already existing authors. Subsequently, all the authors who have links with the pharmaceutical companies should be removed from the team and replaced with neutral professionals.

Conclusion
The way forward for the American Psychiatric Association is not to revise the current DSM further, but to come up with a new, scientifically approved version of DSM that not only addresses symptoms, but also the causes of mental disorders. This will eliminate majority of the criticisms of DSM IVTR.