Summary of DSM-5 changes:
The American Psychological Association announced in December 2012 that its board of trustees had approved the Fifth Edition of the DSM, ending more than five years of intense internal and public controversy.
The final text (available this spring) received mixed reviews but many experts say the final version is not radically different from the previous one. Here are some of the changes:
1. Extending the reach of psychiatry: Hoarding, which was previously considered a symptom of obsessive-compulsive disorder, is now a mental disorder. Premenstrual Dysphoric Disorder is also a new disorder (it was previously in the appendix). Binge-Eating Disorder (also formerly in the appendix) is now a full-blown diagnosis.
2. Modifications:
(1) Depression: The committee eliminated the Grief Exclusion from the criteria to diagnose depression but added a note to the text that any significant loss could cause depressive symptoms. This will avoid the perception that bereavement could be assumed to last only 2 months.
(2) Autism: From the outset, the committee intended to tighten the definition of autism, eliminating related labels such as Asperger syndrome and other Pervasive Developmental Disorder. In the face of much opposition, the committee adopted a streamlined definition, but encouraged a look into the person’s diagnostic history. In the current DSM-5 the criteria for autism spectrum disorder (ASD) will incorporate several diagnoses from DSM-IV, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder. A current debate is whether the new diagnostic criteria will result in many patients losing their autism diagnosis and needed services. On the other hand, the new criteria allow for children older than age 3 (as was in the DSM-IV) to meet the criteria for autism.
(3) Bipolar Disorder diagnosis for children: Due to the proliferation of assignment of bipolar disorder diagnosis to children (with the resulting over medications and long-term stigma, the committee settled on an alternative label: Disruptive Mood Dysregulation Disorder (D.M.D.D.) which describes extreme hostility and outbursts beyond normal tantrums. These children would earlier be diagnosed as having ADHD or “Oppositional Defiant Disorder .”
(4) Combining substance abuse and substance dependency into one category called “Substance Use Disorder” requiring 2-3 symptoms (as opposed to only one symptom in the DSM-IV.
(5) Post-traumatic stress disorder will be included in a new chapter in DSM-5 on Trauma and Stressor Related Disorders. There will now be 4 diagnostic clusters instead of 3. The new diagnostic criteria will be more sensitive for children and adolescents to have PTSD.
(6) Communication Disorders now include two diagnoses: Language Disorders and Speech Disorders.
(7) The DSM-5 now includes a Cultural Formulation Interview to help clinicians more effectively assess cultural aspects of psychiatric diagnoses.
(8.) Simple Somatic Symptom Disorder and Complex Symptom Disorder are combined into a single disorder: Somatic Symptom Disorder.
(9) Inclusion of dimensional assessment of depression, anxiety , cognitive impairment and reality distortion across many major mental disorders.
(10) Suicidal Behavioral Disorder is a new disorder.
The total number of diagnoses in DSM-5 is similar to that in DSM-IV. The Committee also approved a commitment to update the book continually. Submitted by Mia Biran, Ph.D.
