DSM-V Preview

DSMV will be released in May, 2013

Overall Changes to the DSM:The American Psychiatric Association reports two major general changes to the Diagnostic and Statistical Manual of Mental Disorders:

  1. 1.    Removal of the multiaxial system
  2. Changing the chapter order of disorders.

 Organization of DSM-5

DSM-5 will be comprised of three sections:

  • Section 1 will give an introduction to DSM-5 with information on how to use the updated manual;
  • Section 2 will outline the categorical diagnoses according to a revised chapter organization; and
  •  Section 3 will include conditions that require further research before their consideration as formal disorders, as well as cultural formulations, glossary, the names of individuals involved in DSM-5’s development and other information.

Chapter order:

DSM-5’ has 20 chapters which are arranged according to similarities in disorders’ basic vulnerabilities and symptom characteristics.

The  DSM-5 will correlate with the World Health Organization’s (WHO) International Classification of Diseases, eleventh edition (ICD-11) and are expected to facilitate improved communication and common use of diagnoses across disorders within chapters.

 Removal of multiaxial system:

DSM-5 will be nonaxial documentation of diagnosis and combine the former Axes I, II, and III, with separate notations for psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V).

 Section 2 Disorders:

o Autism spectrum disorder

o Binge eating disorder

o Disruptive mood dysregulation disorder

o Excoriation (skin-picking) disorder

o Hoarding disorder

o Pedophilic disorder

o Personality disorders

o Posttraumatic stress disorder

o Removal of bereavement exclusion

o Specific learning disorders

o Substance use disorder

  Section 3 Disorders:

o Attenuated psychosis syndrome

o Internet use gaming disorder

o Non-suicidal self-injury

o Suicidal behavioral disorder

Specific Disorders:

Autistic disorders will undergo changes and renaming.  “Autism criteria will incorporate several diagnoses from DSM-IV including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified) into the diagnosis of autism spectrum disorder for DSM-5 to help more accurately and consistently diagnose children with autism,” according to  the APA.

Binge eating disorder will be moved from DSM-IV’s Appendix B: Criteria Sets and Axes provided for further study to DSM-V Section 2. This change is intended to better represent the symptoms and behaviors of people with this condition. Binge eating disorder will be a recognized mental disorder.

Disruptive mood dysregulation disorder will be included  to diagnose children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year.  The diagnosis is intended to address concerns about potential over-diagnosis and overtreatment ofbipolar disorder in children.

Excoriation (skin-picking) disorder is new to DSM-5 and will be included in the Obsessive Compulsive Disorder and Related Disorders chapter.

Hoarding disorder is new. This disorder will help characterize people with persistent difficulty discarding or parting with possessions, regardless of their actual value. The behavior usually has harmful effects — emotional, physical, social, financial and even legal — for a hoarder and family members.

Pedophilic disorder criteria will remain unchanged, but the name will be revised from pedophilia to pedophilic disorder.

Personality disorders:

DSM-5 will maintain the categorical model and criteria for the 10 personality disorders included in DSM-IV and will include the new trait-specific methodology in a separate area of Section 3 to encourage further study how this could be used to diagnose personality disorders in clinical practice.

Posttraumatic stress disorderwill be included in a new chapter on Trauma- and Stressor-Related Disorders.  DSM-V focuses more on the behavioral symptoms that accompany PTSD and proposes four distinct diagnostic clusters instead of three. PTSD will also be more developmentally sensitive for children and adolescents.

Removal of bereavement exclusion:

The exclusion criterion in DSM-IV applied to people experiencing depressive symptoms lasting less than two months following the death of a loved one has been removed and replaced by several notes within the text delineating the differences between grief and depression.  It recognizes that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one.

Specific learning disorder is extended to reference distinct disorders which interfere with the acquisition and use of one or more of the following skills: oral language, reading, written language, or mathematics.

Substance use disorder combines the categories of substance abuse and substance dependence Previous substance abuse criteria required only one symptom while the DSM-5’s mild substance use disorder requires two to three symptoms.

The following disorders do not appear in the new DSMV:

Anxious depression

Hypersexual disorder

Parental alienation syndrome

Sensory processing disorder

Referenced from the American Psychiatric Association

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