Major Innovation of DSM-5
- ICD/DSM harmony
- no multiaxial system
- spectrum disorders and dimentional ratings
- greater recognition for age, gender, and culture
- new organization of chapters
DSM-5 Sections
Section I: DSM-5 Basic and Introduction (Use of Manual)
Section II: Diagnostic Criteria and Codes
Section III: Emerging Issues and Models
Appendix
Organization within Chapters
1) Diagnostic Critearia for particular disorder
- subtypes and specifier
- coding and recording procedures
2) Explanatory text information for the disorder
- features
- prevalence
- development and course
- risk and prognosis factors
- culture-related issues
- gender-related issues
- suicide risk
- functional consequences
- differential diagnosis
- comorbidity
Steps in Writing Diagnosis
1) Locate the disorder that meets criteria
2) Write the name of disorder
3) Add any subtypes or specifier
4) Add the code number (one bold, one in parenthesis)
5) Order of Multiple Diagnosis
- focus of treatment or reason for visit listed first (principal diagnosis)
- followed by other diagnoses according to clinical importance
Neurodevelopmental Disorders
Highlights:
- new chapter
- intellectual disability *mental retardation
- communication disorder revised
- intro of ASD
- ADHD criteria changes
1) Intellectual Disability
2) Communication Disorders
3) ASD
4) ADHD
5) Specific Learning Disorder
6) Motor Disorders
7) Other Neurodevelopmental Disorders - other specified vs unspecified options
Schizophrenia Spectrum and Other Psyhotic Disorders
Highlights:
- introduces Schizophrenia Spectrum
- order reflects severity
- Catatonia as separate disorder or specifier
- Schizoaffective Disorder simplified
- Schozphrenia - drop subtypes, revised active phase
- Attenuated Psychosis Syndrome not approved
1) Schizotypical Personality Disorder
2) Delusional Disorder
3) Brief Psychotic Disorder
4) Schizophreniform Disorder
5) Schizophrenia
6) Schizoaffective Disorder
7) Psychotic Disorder Associated with Medical Condition, Substance or Catatonia
8) Other Specified Schizo Spectrum and Other Psyhotic Disorder
9) Unspecified Schizo Spectrum and Other Psyhotic Disorder
Bipolar Disorders and Related Disorders
Higlights:
- separate from Depressive Disorders chapter
- mixed episode removed
- increase activity/energy added as featre of mania and hypomania
- new specifiers: with mixed features, with anxious distress, with peripartum onset
1) Bipolar I Disorder
2) Bipolar II Disorder
3) Cyclothymic Disorder
4) Substance Medication-Induced Bipolar or Related Disorder
5) Bipolar or Related Disorder Associated with Another Medical Condition
6) Other Specified and Unspecified Bipolar or Related Disorder
Depressive Disorders
Higlights:
- chronic depressive spectrum introduced
- changes to Major Depression
- elimination of bereavement, new specifier
- new disorders added
1) Disruptive Mood Dysregulation Disorder
2) Major Depressive Disorder
3) Persistent Depressive Disorder
4) Premenstrual Dysphoric Disorder
5) Substance/Medication Induced Depressive Disorder
6) Depressive Disorder due to Another Medical Condition
7) Other specified and Unspecified Depressive Disorders
Anxiety Disorders
Highlights:
- new organization
- Panic Disorder and Agoraphobia now separated
- Panic Attacks can be applied to any disorder
- Generalized Anxiety Disorder is unchanged
1) Separation Anxiety Disorder
2) Selective Mutism
3) Specific Phobia
4) Social Anxiety Disorder (Social Phobia)
5) Panic Disorder
6) Agoraphobia
7) Generalized Anxiety Disorder
8) Substance/Medication Induced Anxiety Disorder
9) Anxiety Disorder due to Medical Condition
10) Other Specified and Unspecified Anxiety Disorders
Obssessive-Compulsive and Related Disorders
1) OCD
2) Body Dysmorphic Disorder
3) Hoarding Disorder
4) Trichotillomania (hair-pulling)
5) Excoriation Disorder (skin-picking)
6) Substance/Medical Induced OCD
7) Other Specified OCD
Trauma-and Stressor-Related Disorders
Highlights:
- new chapter related to stress
- PTSD modified criteria with new subtypes
- Acute Stress Disorder criteria modified
1) Reactive Attachment Disorder
2) Disinhibited Social Engagement Disorder
3) Posttraumatic Stress Disorder
4) Acute Stress Disorder
5) Adjustment Disorder
6) Other Specified Trauma- and Stressor- Related Disorder
7) Specified and Unspecified Trauma- and Stressor- Related Disorder
Feeding and Eating Disorders
Highlights:
- new title and organization
- avoidan/restrictive food intake disorder added
- modified Anorexia and Bulimia
- Binge-eating disorder added
- changes try to address overuse of NOS
1)Anorexia Nervosa
- low body weight replaces below 85% as expected
- dropped amenorrhea
2) Bulimia Nervosa
- binging behaviors now once a week *twice a week
- dropped purging and non-purging subtypes
3) Pica
4) Rumination Disorder
5) Avoidant/Restrictive Food Intake Disorder
6) Binge-Eating Disorder
7) Other Specifief and Unspecified Feeding or Eating Disorder
Disruptive, Impulse-Control, and Conduct Disorders
Highlights:
- reorganization of externalizing problems
- ODD criteria refined
- new specifier for CD
1) Oppositional Defiant Disorder
2) Intermittent Explosive Disorder
3) Conduct Disorder
4) Antisocial Personality Disorder
5) Pyromania
6) Kleptomania
7) Other Specified and Unspecified Disruptive, Impulse-Control, and Conduct Disorder
Substance-Related and Addictive Disorders
Higlights:
- new chapter title
- types of disorders: substance use, substance induced, non-substance related disorders (gambling)
- dependence and abuse combined into spectrum
- changing face of dependence
1) Alcohol
2) Caffeine
3) Cannabis
4) Hallucinogen
5) Inhalants
6) Opioids
7) Sedative/Hypnotics/Anxiolytics
8) Stimulants
9) Tobacco-Related
10) Other (or unknown) substance
11) Non-Substance-Related Disorders (Gambling)
Personality Disorders
- PD Work Group proposed sweeping changes
- new conceptualization, fewer types of PD, trait rating scales
- changes not approved
- retain DSM-IV-TR disorders
- but updated text
1) Odd/Eccentric Cluster
a. Paranoid Personality Disorder
b. Schizoid Personality Disorder
c. Schizotypal Personality Disorder
2) Emotional/Erratic Cluster
a. Antisocial Personality Disorder
b. Borderline Personality Disorder
c. Histrionic Personality Disorder
d. Narcissistic Personality Disorder
3) Anxious/Fearful Cluster
a. Avoidant Personality Disorder
b. Dependent Personality Disorder
c. Obssessive-Compulsive Personality Disorder
Other Conditions that may be the focus of Clinical Attention (ICD-9 V and ICD-10 Z codes)
- relational problems
- abuse and neglect
- educational or occupational problems
- housing and economic problems
- other social environment problems
- crime or legal system
- psychosocial or environmental circumstances
- health service encounters for counseling and medical advice
- other circumstances of personal history
