DSM Structure
100 — What is a categorical diagnostic system?
A categorical diagnostic system classifies mental disorders as discrete conditions with defined criteria thresholds, meaning a person either meets criteria for a diagnosis or does not.
100 — Define diagnostic reliability.
Reliability refers to the consistency of a diagnosis across clinicians, settings, and time.
100 — What is diagnostic uncertainty?
Diagnostic uncertainty is the recognition that diagnoses may evolve over time due to overlapping symptoms, development, or incomplete information.
100 — What major change did DSM-5 make to the multiaxial system?
DSM-5 eliminated the five-axis system and adopted a non-axial, integrated diagnostic format.
100 — What is the purpose of the Cultural Formulation Interview?
To assess how culture shapes symptom expression, meaning, coping, and help-seeking.
100 — When unsure diagnostically, what is a comps-safe response?
State what additional information you would assess before finalizing the diagnosis.
200 — What does it mean that DSM diagnoses are polythetic?
Polythetic means that no single symptom is necessary or sufficient for diagnosis; instead, a subset of symptoms from a larger list can meet criteria.
200 — Define diagnostic validity.
Validity refers to how accurately a diagnosis represents a true, distinct clinical entity.
200 — Why is comorbidity common in DSM diagnoses?
Because many disorders share symptoms and risk factors, leading to multiple diagnoses within the same individual.
200 — What replaced Axis IV considerations in DSM-5?
Psychosocial and environmental factors are now documented using ICD Z-codes.
200 — What is meant by cultural identity in diagnosis?
The individual’s self-identified cultural background, values, language, and social context.
200 — Why is differential diagnosis always important on comps?
It demonstrates clinical reasoning beyond checklist diagnosis.
300 — Why does polythetic diagnosis increase heterogeneity?
Because individuals can meet criteria through different symptom combinations, resulting in wide variability within the same diagnosis.
300 — Why does DSM prioritize reliability over validity?
Because reliability is necessary for shared language and research, even though validity remains an ongoing challenge.
300 — How does symptom overlap affect diagnosis?
Overlap can blur diagnostic boundaries and increase the risk of misclassification or overdiagnosis.
300 — How are psychosocial stressors documented now?
Through narrative clinical formulation and Z-codes rather than a separate axis.
300 — What are cultural idioms of distress?
Culturally specific ways of expressing psychological distress that may not map directly onto DSM symptoms.
300 — How do you justify a diagnosis without overconfidence?
By linking symptoms to criteria while acknowledging uncertainty and alternatives.
400 — What are the strengths of categorical diagnosis?
It improves diagnostic reliability, standardization, communication among clinicians, research consistency, and insurance reimbursement.
400 — How can a diagnosis be reliable but not valid?
Clinicians may consistently agree on a diagnosis that does not reflect a single underlying disorder or mechanism.
400 — How should clinicians manage diagnostic uncertainty?
By using provisional diagnoses, longitudinal assessment, differential diagnosis, and ongoing clinical judgment.
400 — Why was the multiaxial system removed?
It was seen as artificial, inconsistently applied, and redundant with modern integrated care models.
400 — How can culture affect symptom presentation?
Culture influences how distress is experienced, labeled, communicated, and interpreted.
400 — What role does clinical judgment play beyond DSM criteria?
It integrates context, development, culture, risk, and longitudinal patterns.
500 — What are the major limitations of categorical diagnosis?
It inflates comorbidity, obscures dimensional symptom severity, and may poorly map onto underlying biological or psychological mechanisms.
500 — Give a comps-level critique of DSM validity.
DSM categories often reflect symptom clusters rather than etiologically distinct disorders, limiting construct validity despite acceptable reliability.
500 — Why is diagnostic humility important in clinical work?
It prevents overconfidence, promotes reassessment, and supports ethical, patient-centered care.
500 — What are the clinical implications of a non-axial system?
Clinicians must intentionally integrate medical, psychological, and social factors without relying on structural prompts.
500 — How does cultural formulation prevent misdiagnosis?
By distinguishing culturally normative behavior from psychopathology and reducing clinician bias.
500 — How would you verbally critique DSM use in oral comps?
By describing DSM as a useful framework that must be applied flexibly and supplemented by clinical judgment.