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The Diagnostic Manual for the Mentally Ill and Intellectually Disabled

It’s called the “other” dual diagnosis. While most professionals and laypeople understand dual diagnosis to mean those who suffer from both mental illness and substance abuse, the term is also used for those with the double challenge of mental illness and mental retardation.

The intellectually disabled long have been deprived of needed treatment and even compassion because their mental illness has been seen through the lens of their disability. It was thought that people with cognitive disabilities could not possibly have mental illness, perhaps could not even have the same feelings, as the typical population. This “diagnostic overshadowing” — the tendency to let the mental retardation diagnosis block recognition of mental illness — still lingers. When a person with ID acts in uncharacteristic or even dangerous ways, it is still all too often understood as misbehavior, not as possible symptoms of an undiagnosed medical or mental illness.

The National Association for the Dually Diagnosed has published the Diagnostic Manual-Intellectual Disability (DM-ID): A Textbook of Diagnosis of Mental Disorders in Persons with Intellectual Disability. NADD is doing much to gain recognition of dual diagnosis and to ensure that people with intellectual disabilities who present psychiatric symptoms are accurately diagnosed. Now clinicians new to the population have an authoritative resource to guide them in the assessment and treatment of the “other dual diagnosis.” For experienced clinicians, the book provides a standardized set of diagnostic criteria that will facilitate communication and inform treatment.

Developed through a cooperative effort of NADD and the American Psychiatric Association (APA), the volume was 10 years in the making. Using the DSM-IV-TR categories of mental illness, panels of experts worked to describe how symptoms are expressed by those who often can’t adequately report their experience. Each chapter was developed through consensus, using an evidence-based approach. The book was then edited by Robert J. Fletcher, D.S.W., A.C.S.W., Chief Editor, Earl Loschen, MD, Chrissoula Stavrakaki, M.D., Ph.D. and Michael First, M.D. (Dr. First also edited the DSM-IV-TR.)

Each chapter reviews the diagnostic criteria for a diagnosis as defined by the DSM-IV-TR, describes issues that are specific to how the diagnosis is expressed by people with intellectual disabilities, provides a review of relevant literature and discusses the etiology and pathogenesis of the disorder. Symptoms for the diagnosis are then arranged in three columns: Column 1 sets out the diagnostic criteria as stated in the DSM-IV-TR. Column 2 lists adapted criteria for those with mild to moderate retardation and Column 3 lists adapted criteria for those with severe to profound retardation. Often Columns 1 and 2 are much the same. Sometimes Columns 2 and 3 are collapsed. When no adaptation is needed or appropriate, it is simply stated.

The Diagnostic Manual for the Mentally Ill and Intellectually Disabled

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Marie Hartwell-Walker, Ed.D.

Marie Hartwell-WalkerDr. Marie Hartwell-Walker is licensed as both a psychologist and marriage and family counselor. She specializes in couples and family therapy and parent education. She writes regularly for Psych Central as well as Psych Central's Ask the Therapist feature. She is author of the insightful parenting e-book, Tending the Family Heart.

Check out her book, Unlocking the Secrets of Self-Esteem.

APA Reference
Hartwell-Walker, M. (2016). The Diagnostic Manual for the Mentally Ill and Intellectually Disabled. Psych Central. Retrieved on October 23, 2020, from
Scientifically Reviewed
Last updated: 17 May 2016
Last reviewed: By a member of our scientific advisory board on 17 May 2016
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