The Need for Patient-Subjective Data in the DSM and the ICD

One improvement from the second to the third edition of the Diagnostic and Statistical Manual of Mental Disorders was to replace clinicians' subjective interpretations of mental disorders with objective descriptions of signs and symptoms that could be rated reliably across investigators. Along with clinicians' subjective impressions, however, the subjective experiences of the person with the mental disorder were minimized. This information could be valuable, as people's subjective experiences of disorders may indicate major underlying processes and be different from how characteristics of disorders appear objectively to outside observers. The authors suggest that empirically derived, patient-subjective characteristics of mental disorders be incorporated into future editions of the DSM and the ICD. Not only will these data offer important information that will help to enhance the accuracy of the diagnostic categories of the DSM and ICD, but such data also may serve to enhance clinicians' abilities to conceptualize accurately and empathically treat these disorders in their patients. Examples of patient-subjective criteria and their relationship to current DSM criteria are examined for borderline personality disorder and schizophrenia and suggestions for DSM-V and ICD-11 are offered. Diagnostic criteria that accurately reflect patients' subjective experience could also increase clinicians' ability to empathize with patients, one of the most important variables in treatment alliances.