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Mental health: What's normal, what's not
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Signs and symptoms that mark specific mental illnesses are spelled out in detail in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This 2-inch-thick book classifies and describes more than 300 types of mental disorders. Published by the American Psychiatric Association, it's used by mental health providers to diagnose everything from anorexia to voyeurism.
Why does a specific diagnosis even matter if the line between mental health and mental illness is sometimes blurry? One reason is that the health insurance companies use the diagnoses spelled out in the DSM to determine coverage and benefits, to reimburse mental health providers. But more important is that in order to provide appropriate treatment, your health care professional must know what condition to treat — and whether it needs to be treated.
Despite these criteria and efforts to back up diagnoses with sound science, a precise definition of normal mental health remains elusive. The Diagnostic and Statistical Manual defines mental disorders as "behavioral or psychological syndromes or patterns that cause distress, disability in functioning, or a significantly increased risk of death, pain or disability. And that syndrome or pattern can't just be an expected and culturally accepted response to a particular event, such as grieving the death of a loved one."
What's considered mental illness can change over time
New medical information can lead to changes in the classification of mental disorders. New disorders will be added, while existing ones will be removed, or the associated signs and symptoms will be modified as new opinions develop over time. For example, experts are considering whether premenstrual signs and symptoms may be added to the DSM as a diagnosable condition called premenstrual dysphoric disorder.
Revisions may also reflect evolving social and cultural attitudes. Homosexuality, for instance, used to be classified as a mental disorder, but it was removed from the Diagnostic and Statistical Manual in 1973.
Seeking evaluation and treatment
Even if you do have a diagnosable mental disorder, it may not pose a problem in your daily life to such an extent that it requires treatment. On the other hand, there's no question that certain mental health conditions can have a serious impact on your life and the lives of the people you care about.
Many people with debilitating mental health issues, such as depression, avoid treatment or just consider their signs and symptoms a normal part of life. If you have something going on that's disruptive or that is making you unhappy, don't hesitate to seek advice. A good place to start is by talking with your family doctor about what's bothering you. Another option is to set up an appointment with a counselor or psychologist to discuss your concerns. If you do have a mental health condition that causes problems, treatment such as medications or counseling can probably help.
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- Introduction. In: PDM Task Force. Psychodynamic Diagnostic Manual (PDM). Silver Spring, Md.: Alliance of Psychoanalytic Organizations; 2006:1.
- Introduction. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Feb. 2, 2009.
- Appendix B: Criteria sets and axes provided for further study. Proposed disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Feb, 2, 2009.
