Thick and Thin: Perspectives on DSM-5

A recent post by Dr. George Dawson, Real Psychiatry: Observations from Amazon on DSM-5 sales about the Diagnostic and Statistical Manual (DSM-5) got me thinking about how our department is adjusting to the new classification manual. It also reminded me of something I heard Dr. Paul McHugh, co-author with Dr. Phillip Slavney of “The Perspectives of Psychiatry” say at a conference about the DSM several years ago: “We used to be thin; now we’re thick!”DSM from thin to thick

As Dr. Dawson says, a lot of people criticized the DSM-5 and predicted bad things would come from its publication. But you know, it’s just a classification manual. It has its uses. It’s a guide, not a god (and I think McHugh might have said that, too). There are those who criticize the critics, but I still agree with Dr. Allen Frances’ dozen general tips about psychiatric diagnosis, The Dirty Dozen on Dr. Allen Frances’ General Tips for Psychiatric Diagnosis – The Practical Psychosomaticist.

And I thought I’d share a few slides briefly covering what we’re learning on how to use the DSM-5.

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Mchugh, P. R., MD, and P. R. Slavney, MD (1998). The Perspectives of Psychiatry, The Johns Hopkins University Press.

Chisolm, M. S., MD, and C. G. Lyketsos, MD, MHS (2012). Systematic Psychiatric Evaluation: A Step-by-Step Guide to Applying the Perspectives of Psychiatry, The Johns Hopkins University Press.

Frances, A., MD (2013). Essentials of Psychiatric Diagnosis, Revised, The Guilford Press.



  1. Jim, I like your slide show. From my current field of addiction you might want to consider one additional bullet point. Cravings have been added and “recurrent substance-related legal problems” has been eliminated. This is a very interesting development because there is a large and controversial literature on craving that I am trying to summarize in a single drawing. My understanding is that the legal criteria was eliminated because by the time it happens the other criteria for dependence are positive. For the addiction category there are also the mild, moderate and severe modifiers based on the number of positive criteria.


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