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on June 2, 2003
Like other reviewers, I agree that if you own DSM-IV (burgundy cover), there is absolutely no reason for you to purchase the DSM-IV-TR (silver cover). Might as well wait for DSM-V (won't that be a treat). If you are not a mental health professional or graduate student, I can't imagine why you would want to own this book. It is essentially a compilation of symptom and behavior checklists that help clinicians make reliable diagnoses of mental disorders.
I would recommend strongly (for both professionals, students, and the lay public), DSM-IV Made Easy by James Morrison. Morrison's book makes the DSM come alive. He illustrates technical points well, and provides interesting case examples that make you think of people when you read the diagnosis, not just symptoms.
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on February 27, 2003
The diagnostic sections remain largely unchanged. Only significant changes were to the text portion, hence the TR designation-- text revised. This is important if you are a student or in a research position. They produced this version in response to the fact that many graduate programs are using the DSM as a text book in their Pathology courses. In this regard, the new version is worthwhile and clearly justified. It also buys them a little more time in development of the DSM V. For clinical purposes, don't bother, it's not worth the money. If you are getting your first copy, or are looking for class, then you want this edition.
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on December 23, 2001
The text-revised version is virtually identical to the 1994 version of the DSM-IV and not worth buying if you have the 1994 version. Along with the DSM-IV, the DSM-IV Text Revised version is, however, an informative book that provides good introductory information, especially in the "Diagnostic Features" section, about a wide variety of mental disorders. A problem of the manual, in my opinion, is its use of a categorical classification system while ignoring the dimensional nature of psychological phenomena.
Lee J. Markowitz, Department of Psychology, University of Waterloo (Ontario, Canada)
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on December 19, 2002
Of course, this is the bible of mental disorder diagnoses, at least in the U.S. The diagnoses are pretty inclusive, but there are several problems with this book as it pertains to the practice of Psychiatry. First, the book offers about 900 pages on symptom diagnosis, and about half a paragraph on the types of psychiatric medications that are effective for the particular diagnosis. 95% of diagnoses have absolutely no recommendations for treatment.
This leads to the second problem: differentiation of primary vs. secondary symptoms. The primary symptoms are the cornerstone of diagnosis. The secondary symptoms take way too much space in this book, and are generally not helpful in making a diagnosis, because the vast majority of secondary symptoms overlap in most mental illnesses. The important use for secondary symptoms is for the type of therapy that should be used (psychotherapy or pharmacotherapy). For example, if two patients are depressed, the diagnosis is made from primary symptoms (tiredness, irritability, difficulty concentrating, psychomotor retardation). However, if patient "A" has no significant secondary symptoms like anxiety or insomnia, they can take a high dose of SSRI or Effexor. But if patient "B" has the secondary symptoms of prominent anxiety and insomnia, Remeron or Serzone may be more helpful, and perhaps a benzodiazepine can be added.
The DSM IV does nothing to further the practicality of psychiatry. And that's a shame, because only a few hundred extra pages of pharmacotherapy recommendations would make the book so much more helpful to psychiatrists, who currently waste a lot of time experienting with every drug for the treatment-resistant patients. Some drugs work better for some people based on secondary symptoms, which cannot be ignored in the choice of drug treatment. A good book that does match secondary symptoms to drug treatment is The Failures of American Medicine.
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on September 19, 2005
The DSM is very clearly written and can be understood by anyone no matter what his or her educational level. It also contains an exceptional psychiatric glossary and an exceptional psychoanalytically oriented section describing the "defense mechanisms." The public is ambivalent about psychiatry but has embraced the DSM because it provides readers with the illusion that if you read this book you can diagnosis yourself and your acquaintances. What most mental health professional know is that this book is a political document as well as a scientific one. It advances the cause of the psychobioligists (over the environmentalists) and the alliance of drug companies, insurance companies and psychopharmacologists. What the sub-committees who wrote each section of the DSM have done is to organize the vast array of life problems that we have long thought of as "neurotic" (and stemming from early family experience) and placed them side by side with clearly biological diseases like schizophrenia and manic-depression. Why? The aim is to create the impression that all of the ordinary habitual problems in love and work that pretty much everyone agrees come from the way you were brought up in your family are in fact biological - and probably inherited - illnesses. Chronic unhappiness, for example, is coded with the "mood disorders" like classic manic depressive illness. Another facet of the DSM that is pernicisous is that each problem the patient has must be coded separately. There is no way to describe the patient in holistic terms. The patient as described by the DSM (and treated by the psychiatrist guided by this document) ends up looking something like a cubist painting by Picasso. What is discouraged is trying to understand the person's various problems as interrelated parts of a comprehensible whole that has developed over a lifetime from a continual ongoing interaction between the person's life experience and their biology. Among the most pernicious effects of the DSM has been its influence on psychiatric education. Psychiatric trainees are encouraged to use the DSM as their first approach to the patient. It is very sad to see these fledglings struggle to make diagnosis rather than to understand their patient. Do they ask whether the patient has a brother or a sister or was born rich or poor. No! Conference after conference is devoted to figuring out which DSM category the patient fits into. No one dares tells the trainee the little secret of the DSM, which is that about half of patients don't fit into any category at all. Some of us, of course, do have OCD or ADD or are narcissistic or suffer from moderate autism (Asperger's Syndrome) but most of us are not so neatly described. Most people have to be squeezed into categories that we don't fit into. The overall chairman of the committee that wrote the DSM IV (Dr. Allen Frances) has, to his credit, acknowledged (in a New Yorker magazine interview) that the DSM IV categories are neither valid nor reliable and don't describe (in his words) "reality." All of this said, the DSM is a crystalline clearly written document that well summarizes contemporary descriptive psychiatry.
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on August 29, 2001
I quote Karl Menninger, on the publication of the DSM-II in 1968:

"This year [1968] the APA took a great step backward when it abandoned the principles used in the simple useful nosology [DSM-I]. In the interest of uniformity, in the interest of having some kind of international code of designation for different kinds of human troubles, in the interest of statistics and computers, the American medical scientists were asked to repudiate some of the advances they had made in conceptualization and in the designation of mental illness."

Since then, it's gotten worse, not better, with thousands of symptom checklists and numbered diagnoses, conveniently correlated to the ICD-9 standard diagnosis codes for easier billing. But people, medical students and physicians included, will insist on treating DSM-IV as a textbook in psychiatry. It's nothing of the sort - it never touches on the essential topics of etiology, prognosis, and treatment. People memorize the checklists and think they understand psychiatry, when in fact they have entirely failed to grasp the noble and great endeavor: riddling out the first causes and mechanisms of our humanity, and how those mechanisms go awry.

Well, then, you say, what about diagnosis? Isn't this a diagnostic manual?

In my opinion, for that purpose DSM-IV is worse than useless to a lay person. Consider the previous reviewer who thought the book made a good party game, diagnosing his healthy friends with all sorts of 'disorders'. It wouldn't take much experience in a psychiatric emergency room to realize that psychiatric illness is no party game - but it would take some. Without the context provided by direct, caring relationships with the mentally ill, the jargon and symptoms discussed in this book are meaningless. This book will not teach you to be a psychiatric diagnostician! Only experience can do that. It's intended as a quick reference guide for people with that experience, and a reference concerned with very practical matters not relevant to the patient-physician relationship (such as the standardized conduct and reporting of clinical trials, or how to justify billled services).

I'd disagree strongly with the prior reviewer who felt psychiatric patients should read their DSM-IV. If you're a psychiatric patient "on the same page" as your health care practictioner, get off the page and get on top of your life! You have more pressing concerns than making yourself into an expert psychiatric diagnostician and quibbling over the learned APA's compilation of symptom checklists - you need to heal.

In short, I can't imagine recommending this tome to anyone for any purpose - people who need it don't need me to tell them so. If you're interested, however, in psychiatry, I urge you to read the classics - Freud for the grounding of psychodynamics, Skinner on behaviorism, Menninger's superb "Man Against Himself" on suicide and depression, Erich Fromm's "Escape From Freedom" and "Man For Himself" for academic psychophilosophy, Kraepelin on dementia praecox (what we now call 'schizophrenia' - I prefer his original term), Wundt on introspective self-analysis, Kraft-Ebbing's "Psychopathia Sexualis" for a laugh and for a serious understanding of the social construction of sexual "disorder" - if you're really interested in these topics, you'll find these authors far more stimulating, I guarantee!
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on November 24, 2011
Do not buy this book. Even AFTER I read all the reviews of people saying that their book was fake and photocopied, I still bought it. Big mistake. It was CLEARLY not the REAL DSM. All the pages are dull and photocopied. The words slant and are copied crooked (you think if you were copying it, you would at least photocopy them straight!). The binding is horrible. The pages are stuck together with this thick chalk-looking glue. The glue is so thick that I can't open the book and set it down on the table with out it closing shut by its self. I bought it for my master's class, and everyone next to me can open their book and theirs is nice bright white, and mine can't even open and is dull photocopied white. The only good thing (so far), is that I haven't found any content discrepancies from the original DSM.
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on December 18, 2009
Buyer Beware-- This book is found to contain many diagnostic coding errors. I recently took an abnormal psychology class at the master's level and found that the book that I purchased through Amazon was incorrectly published with coding errors for some of the disorders. When I contacted Amazon customer service they said that it had been past my 30 day return and they could not help me, I am in the process of contacting the publisher as I write this review; because I paid over $70 for a book that is incorrect and will not help me professionally when I need it later in my courses. So be very careful to screen the books as soon as you get them, I did not know until I had already gone through the course that the book was incorrect and now am out the money I spent and will have to spend another $70 for a new edition in order to complete my class work.

Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision)
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on August 11, 2000
The study of mental disorders is an ever evolving process. It is good to see a revision of the old DSM IV which has been in use for the past five years. The book is printed in a easy to read print size and the layout has been updated. There will be other revisions so this is the first of many, until DSM V.
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on June 2, 2012
The book was intact. However, the printing was poor.
The pages were dull in color because of the ink.
Likewise, there were ink stains in several pages.
I will not recommend it.
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