The Diagnostic and Statistical
Manual of Mental Disorders (DSM) is the manual utilized by most mental
health professionals to diagnose clients.  The most recent edition is the
fourth edition, text revised (DSM-IV-TR).  The DSM-IV-TR in Action by
S. F. Dziegielewski was "…designed to support the practitioner with the
current application principles relating psychopathology to clinical mental
health practice" (p. xvii).  Dziegielewski is successful in her goal, as
this is a fabulously useful resource for the practicing clinician.  It provides
countless helpful hints in assessment, diagnosis, record-keeping, ethics,
confidentiality, and issues of cultural competency.   It is written for mental
health professionals, with a writing style that is technical but simple enough
that even an inexperienced clinician could understand. 

The author provides a thorough
history of the DSM (Chapter 1), including its current uses and controversies. 
She continually keeps the clients’ best interests in mind, making it clear that
clinicians must be sensitive and remember "…that categorizing an
individual with a mental health disorder can result in a psychiatric label that
is difficult to remove" (p. 9).  The author describes how assessment and
diagnosis are continual processes and that any given diagnosis must be related
to the client’s needs. 

In Chapter 2, the author cautions
against careless labeling of clients that may occur with diagnosis:  "Consideration
should always be used to ensure that terms are not used incorrectly and that
individuals who suffer from a mental disorder are not referred to or treated in
a careless or derogatory manner. It is important to guard against this type of
labeling and to remind others of this as well" (p. 24).  She makes the
relevant and important point of discussing how both mental health professionals
and their clients have their own cultural background that influences them.

Chapters 3 and 4 are useful
resources for mental health professionals.  Chapter 3 clearly explains the
current multiaxial system and how to diagnose on each axis.  Dziegielewski also
discusses how to code culturally-related behaviors and symptoms, defense
mechanisms, and clinical presentations suggestive of a medical diagnosis.  All
these are incredibly relevant to the practicing clinician and the author makes
them very clear and easy to understand.

Chapter 4 deals with the topic of
record-keeping, giving good examples of formats, including information on
confidentiality issues when storing records on computer.  The rest of the book
(Chapters 5 through 12) describes specific clinical disorders and how to best
assess and treat them.  The disorders covered include Reactive Attachment
Disorder, Conduct Disorder, Alcoholism, Anorexia Nervosa, the Psychotic
Disorders, Obsessive-Compulsive Disorder, Bipolar Disorder, and Borderline
Personality Disorder.  Each chapter contains information unique to that
disorder, with sample treatment plans and interventions.  These chapters are
incredibly useful to mental health professionals, as the disorders listed often
pose both diagnostic as well as treatment challenges.

Although the author includes
various aspects of clinical practice that are relevant with regard to
assessment and diagnosis, she skims over topics that certainly deserve greater
attention.  These topics include treatment approaches and theoretical
orientations. For example, Dziegielewski focuses on time-limited approaches
with an apparent bias against long-term treatment approaches.  Although many
clinicians utilize short-term approaches, especially in the modern world of
managed care, long-term approaches continue to be practiced by many mental
health professionals.  Furthermore, she seems to focus more on assessment than
treatment.  This becomes an area of concern if the reader considers only her
limited information for treatment references. One wonders if it is advantageous
to include such topics at all and hopes that the reader understands further
study is required in order to fully grasp their depth.  Despite these few
shortcomings, the author provides a handy reference tool for mental health
clinicians.  Her focus maintains respect for the population served and includes
the relevant issues facing professionals today. DSM-IV-TR in Action is a
resource integral to every practicing clinician’s collection.

© 2003 Geneva S. Reynaga

Geneva S. Reynaga, M.A. is
currently a pre-doctoral intern at the Department of Mental Health located at
the Correctional Medical Facility in Vacaville, CA.  She is a doctoral
candidate at Pepperdine University in West Los Angeles, CA.  Interests include
neuropsychological assessment, psychoanalysis, and ethnic minority issues.  She
is nearing the completion of her theoretical dissertation entitled, “Toward a
Culturally Relevant Model for the Assessment of Psychopathology in
Mexican-Americans.”

Categories: MentalHealth