DSM 5 - Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

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The Diagnostic and Statistical Manual of Mental Disorders – often referred to as the DSM – is the diagnostic bible for mental health professionals.

A publication of the American Psychiatric Association, the first version of the DSM was released over 60 years ago in 1952. Since that time it has undergone several revisions, with the most recent edition, the DSM-IV, published in 1994. Minor updates were made to the 4th edition, in the DSM-IV-TR, which was released in 2000. The newest edition - the DSM-5 – is scheduled to be released in May of this year (2013).

The DSM contains information regarding every official psychiatric disorder. Each diagnostic listing contains detailed information regarding the specific criteria required for a diagnosis, as well as a thorough overview of that particular disorder.

The overview discusses diagnostic features, subtypes (when indicated, e.g. paranoid schizophrenia"), specifiers (e.g. "early onset", "chronic", etc.), associated features and disorders, features related to culture, age, and / or gender, information regarding the prevalence of the disorder, the course the disorder typically takes, family patterns, and differential diagnoses (i.e. how to distinguish the disorder from other disorders with overlapping or similar symptoms).

With each revision of the DSM, changes are made that impact the way disorders are classified and diagnosed. These changes are made based on a variety of factors, including new research-based finding as well as the input of experts from a variety of professions including psychiatry, psychology, neurology, pediatrics, social work, and several others. Since 1952, it’s no surprise that the cumulative changes to the DSM have been substantial.

Diagnostic criteria for listings in this newest edition of the DSM were finalized and approved on December 1, 2012, by the APA’s board of trustees.

The DSM-5 will have 3 sections

  • Section 1 includes an introduction and instructions on how to use the new version;
  • Section 2 covers the diagnostic categories;
  • Section 3 includes conditions that need additional research, a glossary of terms, and other important information.

Following are some of the most salient changes to the new DSM:

No More Multiaxial Assessment System

In prior versions of the DSM, a system that included 5 "axes" or dimensions was used for diagnostic and treatment purposes. The axes were:

This system will be replaced with a more simplified, nonaxial documentation approach in the DSM-5. Essentially, the former first three Axes (I, II, and III) will be combined, with separate notations for the other two former Axes, covering psychosocial and environmental factors (IV), as well as disability (V).

Restructured Order of Chapters

The order of chapters (20 in all) in the DSM-5 will be different from past editions, with related disorders / chapters grouped together. For example, one of the new chapters is Trauma- and Stressor-Related Disorders", which will include Posttraumatic Stress Disorder.

New Diagnoses

Disruptive Mood Dysregulation Disorder – The addition of this diagnosis will hopefully reduce the number of children misdiagnosed with Bipolar Disorder, who are subsequently prescribed heavy duty drugs as part of their treatment. Prominent symptoms of DMDD include a persistent, irritable mood and frequent, major anger outbursts or tantrums. Some healthcare providers are concerned about this diagnosis, arguing that the symptoms aren’t necessarily abnormal and shouldn’t warrant a mental health diagnosis. Opponents to this new addition also argue that these symptoms may also be caused by several other psychiatric disorders.

Hoarding Disorder – Serious hoarding behavior affects a significant percentage of the population. Previously regarded as a symptom or subtype of Obsessive-Compulsive Disorder (also a symptom of Obsessive-Compulsive Personality Disorder), it will now be listed as a separate, distinct disorder. The primary symptom is the inability (or persistent difficulty) to discard or give up possessions, regardless of their actual value. Historically, compulsive hoarding has been a difficult behavior to treat successfully.

Binge Eating Disorder – Symptoms include regularly eating unusually large amounts of food in a discrete period of time. Individuals with this disorder feel unable to control their binge eating. It is often done privately and accompanied by negative feelings (e.g. guilt, self-loathing, disgust, etc.). Their binge eating is not followed by an inappropriate attempt to compensate (e.g. exercising excessively or purging) as is commonly seen in Bulimia Nervosa or Anorexia Nervosa. Prior to the DSM-5, individuals with this binge eating pattern have been diagnosed with Eating Disorder NOS (not otherwise specified).

Excoriation Disorder – Individuals who compulsively pick their skin for no apparent reason, such as the presence of an underlying medical condition, may be given this new diagnosis. This disorder, sometimes called dermatillomania, will be included in the Obsessive-Compulsive and Related Disorders" chapter in DSM-5.

Revised Diagnoses

Autism Spectrum Disorder – This is likely one of the most significant (and controversial) diagnostic changes in the DSM-5. It includes the disorders formerly known as Autistic Disorder, Asperger’s Syndrome, Pervasive Developmental Disorder, and Childhood Disintegrative Disorder.

Posttraumatic Stress Disorder – PTSD will now include 4 (instead of just 3) distinct diagnostic clusters. Behavioral symptoms will receive more focus, as will the unique developmental aspects with regards to children and teens with PTSD.

Pedophilic Disorder – This will be the new name for the disorder formerly known as Pedophilia. The diagnostic criteria will remain the same.

Substance Use Disorder – This new disorder will combine what was formerly two disorders – Substance Abuse and Substance Dependence.

Specific Learning Disorder – This will replace Learning Disorders and will include learning problems in mathematics, oral language, written language, and reading. A specifier will be used to denote the specific area of learning difficulties.

Removal of Bereavement Exclusion – This change acknowledges the fact that bereavement and Major Depression are not always entirely separate. Grief following a loss is a significant psychological stressor and may trigger a major depressive episode in some individuals.

Disorders Requiring Further Research

The DSM-5 includes Attenuated Psychosis Syndrome (a precursor to schizophrenia), Internet Use Gaming Disorder, Non-Suicidal Self-Injury, and Suicidal Behavioral Disorder in this section. It is important to note that treatment for disorders in this category will likely not be covered by health insurance, as they still need more research.

Rejected Proposed Disorders

Disorders that were considered for the DSM-5, but later rejected include Anxious Depression, Hypersexual Disorder, Parental Alienation Syndrome, and Sensory Processing Disorder. These disorders, although legitimate per some mental health professionals, are not included with the disorders requiring further research. They were deemed as having insufficient research to warrant inclusion.


American Psychiatric Association, Dec. 1, 2012 press release, www.psych.org


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