background dsm-iv (Diagnostic and Statistical Manual of mental disorders, fourth edition) has obtained a dominant position within mental health care. The diagnostic system is considered to be a standard in psychiatric diagnostic classification. On the other hand, the dsm-system often is used in a wrong way and users often do not sufficiently realise the advantages and disadvantages. These can be of important consequence for the scientific, the therapeutic and the social domain of psychiatry.
aim To discuss the most important advantages and disadvantages of the dsm-system.
method Literature search using Medline, for the period of 1996-1999, using the keywords dsm, dsm-classification, psychiatric classification and psychiatric diagnosis.
results Besides many advantages, many important disadvantages and even risks of the dsm-system are discussed in literature. These disadvantages concern incorrect and figurative use of the dsm, but also concern the theoretical and scientific foundations of the dsm-system.
conclusion The dsm certainly is of great value for psychiatry, especially toward increasing the reliability of psychiatric diagnostics. However every clinician should be aware of the disadvantages and risks described in this article. These disadvantages can partly be met by adding alternative diagnostic systems or by using standardised measuring instruments. Nonetheless, it is pointed out that diagnostics cannot function without the (subjective) opinion of the clinician. Consequently, it is of great importance in learning psychiatric diagnostic skills to train for a substantial period of time in a broadly based way.