A side note on diagnosis

After publishing my post on Oscar Pistorius and his psychiatric evaluation last week, I had a few comments regarding the diagnostic process and how it has changed since the arrival of the DSM-5. The DSM (or Diagnostic and Statistical Manual of Mental Disorders), which is now in its fifth edition, is the “bible” of psychiatry and used throughout the world amongst doctors, psychiatrists and psychologists as the “gold standard” classification system for all mental and psychiatric disorders.

The DSM-5 came out last year. I am not even sure if tertiary hospitals like Weskoppies are using it yet because to get funding in South Africa for textbooks etc. can sometimes take months and even years but I thought I would mention it anyway.

Although I really don’t think it will matter much to the OP psychiatric evaluation, I will just briefly outline how the diagnostic process would work differently if the DSM-5 was used instead of the DSM-IV.

I mentioned the DSM-IV’s multi-axial system, which no longer exists in the DSM-5. The latest edition does not use a multi-axial system but instead lists all disorders (previously Axis I, Axis II, and Axis III) together and has replaced Axis IV with “significant psychosocial and contextual features” while removing Axis V (Global Assessment of Functioning or GAF) altogether.

This means that if OP is diagnosed with GAD and NPD, there will not be a distinction in terms of which Axes each diagnosis belongs to as both fall under the one axis with all the other mental and medical diagnoses.

Essentially, I don’t think using one or another diagnostic system is going to make much of a difference to the outcome of the case. The psychiatric team will still conduct the same procedures and a vaierty of other diagnoses will be on offer in addition to GAD, which is what the defence witness referred to.

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