The Intelligent Clinician's Guide to the DSM-5®

by Joel Paris

The Intelligent Clinician's Guide to the DSM-5® explores all revisions to the latest version of the Diagnostic and Statistics Manual, and shows clinicians how they can best apply the strong points and shortcomings of psychiatry's most contentious resource. Written by a celebrated professor of psychiatry, this reader-friendly book uses evidence-based critiques and new research to point out where DSM-5 is right, where it is wrong, and where the jury's still out. Along the way, The Intelligent Clinician's Guide to the DSM-5® sifts through the many public controversies and clinical debates surrounding the drafting of the manual and shows how they inform a modern understanding of psychiatric illness, diagnosis and treatment. This book is necessary reading for all mental health professionals as they grapple with the first major revision of the DSM to appear in over 30 years.

Genres: Counselling, Nonfiction, Psychology, Psychiatry, Mental Health

272 pages, Paperback

First published January 1, 2013

About the author

Dr Paris is Professor, Department of Psychiatry, McGill University, and Research Associate, Department of Psychiatry, Jewish General Hospital. He obtained his psychiatric training at McGill. His research interests include: developmental factors in personality disorders (especially borderline personality), culture and personality.
Current projects: risk factors for borderline personality disorder in children the biological correlates of borderline personality disorder.

Reviews

[Lisa Gray · Rating 5 out of 5]

Obviously this book isn't of interest to everyone, but I'm trying to read 100 books this year, so I'm darn well counting it! This book is probably more useful than the actual DSM itself -- and if you are interested in mental health, it's actually a pretty interesting look at our system of diagnosing and the wacky factors that influence what becomes a diagnosis and what doesn't (hint: follow the money).

[Victor Oanca · Rating 4 out of 5]

A nicely written critique of the DSM 5 system of classification. Was expecting more a more scientific and arguments approach but it's a nice introduction on the subject. Well written and lively.

[Brandt · Rating 4 out of 5]

For as long as there has been a Diagnostic and Statistical Manual of Mental Disorders (DSM), it has been treated as if it contained scientific truths. Yet, is that what the DSM really is? Or, is it really only a rough draft of diagnoses based on the supposed consensus of experts? This seems to be the question that drives the explanation and critique forwarded by Dr.Joel Paris in The Intelligent Clinician's Guide to the DSM-5.

A good place to start is to envision a mental disorder as similar to that of a medical diagnosis; viz., that both require scientific classification. However, the differences arise in that mental disorders lack the more fundamental understanding of disease processes. Mental disorders are based more on signs and symptoms which lack the requisite biological markers to obtain validity in science. Therefore, a psychiatric diagnosis should not be considered real in the same way as described for a medical disease. The consequence of labeling people with a normal spectrum of thoughts, behaviors, and emotions as mentally ill, could lead to stigmatizing and unnecessary treatment. Curiously, what is normal, and who decides that criteria?!

Dr. Paris begins by taking the reader on a brief journey through the history of psychiatric diagnoses and then delves into explaining why DSMs are made. It is in this section of the book that the reader can recognize the intricate, and somewhat disturbing, patterns that led up to the current edition, Diagnostic and Statistical Manual of Mental Disorders ( The Guide of the Perplexed). The point is that the whole system of diagnosing and treating mental disorders is perplexing, and as in the case of the DSM-V®, “psychiatry should not and cannot make radical revisions until it learns more about the etiology if mental illness” (p. 183).
I will end with one of the more penetrating paragraphs of the book,

“We are told, without solid evidence, that millions of people with mental symptoms are tragically undertreated. Again, the subtext is drugs. Although it is true that some patients with severe disorders are not getting the help they need, mild or subclinical symptoms may not need the same treatment or any treatment at all. The thrust of these arguments, usually based on epidemiological data, is that drugs should be prescribed to an even larger percentage of the population than is already the case. The pharmaceutical industry can only rejoice at such conclusions. The rest of us are left to weep” (p. 185).

And, weep we shall…

Happy Reading!

[Fulvia · Rating 4 out of 5]

Written in a lively, reader-friendly fashion, the book provides an evidence-based critique of DSM-5 and outlines issues that Dr. Joel Paris argues should be addressed in future diagnostic classifications. The book has chapters on all the major diagnoses in psychiatry, in which the main problems of diagnosis are addressed, and in which all changes in DSM-5 are described.

Part I: Diagnostic Principles
Chapter 1-Introduction
Chapter 2-The history of diagnosis in psychiatry
Chapter 3-How diagnostic manuals are made
Chapter 4-What is and is not a mental disorder
Chapter 5-Diagnostic validity
Chapter 6-Dimensionality
Chapter 7-Clinical utility
Part II: Specific Diagnoses
Chapter 8-Schizophrenia spectrum and other psychoses
Chapter 9-Bipolar and related disorders
Chapter 10-Depressive disorders
Chapter 11-Anxiety disorders, trauma, and the OCD spectrum
Chapter 12— Substance abuse, eating, and sexual disorders
Chapter 13-Neurodevelopmental and disruptive behavioral disorders
Chapter 14-Personality disorders
Chapter 15—Other diagnostic groups
Part III—Overview
Chapter 16-Responses to DSM-5
Chapter 17-DSM-5 in practice
Chapter 18-A guide for the perplexed

[Lee · Rating 2 out of 5]

As stated by another reviewer, this is labeled as a "guide" but it really isn't a guide at all except to say: "take the DSM diagnostics with a grain of salt."

That being said, I would say it's a decent overview of skepticism about contemporary psychiatry. Although I believe the author is extremely biased (his work focuses on BPD) and at times writes as if he is the authority on all things psychiatry even though he clearly hasn't had experience in the area. For example, claiming that DID (dissociative identity disorder) doesn't exist, and is solely a manipulation by hypnosis. He clearly doesn't understand what certain syndromes/diagnoses are about.

Anyway, still I recommend to any practitioner or any person needing to self-dx.

[Bianca Strete · Rating 4 out of 5]

Not exactly a guide in my opinion, but the author does argue that the diagnostic system is arbitrary and insufficiently backed up by science, and also provides some first-hand insight into how diagnostics are given in a clinical setting and how this process contributes to the high rate of misdiagnosis. Would have liked to hear more about the author's ideas on how this can be improved.

Like Richard Bentall, Johann Hari and other authors, he describes an increased tendency to offer medication for mild symptoms of a particular illness in the early stages.

I particularly enjoyed Chapter 13 on Personality Disorders (that one being the main area of expertise of the author).

The main conclusion is summed up in one sentence at the very end of the book.

[Kim · Rating 3 out of 5]

Although Dr. Paris provides some valid points, he is overly repetitive about them. Dr. Paris glosses over the fact that some of the flaws he drones on about are a result of the way the healthcare system (at least in the US) is set up. Dr. Paris also seems to write the book strictly to psychiatrists. At times, I wondered if Dr. Paris sees any type of treatment other than medication as valid for mental health issues. Although he acknowledges that professionals other than psychiatrists use the DSM, most of his critiques don't seem to take this fact into account. However, the book provided some insightful information and food for thought.

[Taryn Sawyer · Rating 3 out of 5]

The DSM-5 is looked at through the lens of a set-in-his-ways man who has personal beef with the APA's DSM committee. He seems to hold firm the belief that neurodivergence such as ADHD is simply the result of pill-happy psychiatrists trying to help parents calm their difficult children. While there's wisdom to be had in this text, do remember that the source material is a man who wants the DSM to go back to DSM-IV - which had more flaws than the 5.

[Brent · Rating 4 out of 5]

A very detailed critique of the DSM-5. I wonder if the authors fears have come to fruition.

[Ainsley Hartman · Rating 3 out of 5]

This book was just okay. Nothing revolutionary, not that I wholeheartedly disagreed with (but I did skim a good chunk of it so maybe I missed something?).

[Kerry · Rating 4 out of 5]

The word 'guide' in the title is a bit misleading — if you're looking for a straight cheat sheet to what's changed from the DSM-IV, you might be disappointed. Instead, this is a thoughtful, easy-to-read critique of the major changes and weaknesses of the DSM-5 — and the entire field of modern psychiatry, as reflected in its pages. If you're a mental health practitioner with concerns about trends in over-diagnosis and the influence of big pharma on treatment, it's worth a read. I found the discussions of pediatric bipolar disorder and personality disorders to be especially useful.

[Henry · Rating 2 out of 5]

Disapointed. This very well written book is more for academics than for clinicians.

Most of the arguments while well thought out, are of no importance to me. I was looking for a fast was to understand how to use the new DSM this does it, but not as its principal function

[Ryan Holst · Rating 4 out of 5]

The author is a psychiatrist with a lot of practice experience which is quite helpful. The book does get a bit dry as it is a bit of a clinical read. Overall very good though. Highlights the limitations of the dsm and looks at the history of it as well

[Joan · Rating 4 out of 5]

Succinct review of changes and issues with the new DSM. A little heavy onthe cynical side but an important read for any clinician

[Wendy C · Rating 5 out of 5]

excellent explanation of current DSm 5 and bridge from past to present editions. excellent source of differential diagnosed

[Faith]

Worthy of further research and study!