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DSM-5 officially released at APA Conference

Some facts

• Names
  Much of the DSM-5 changes simply involve disorders moving to a new or differently named Diagnostic Classification. For example, ADHD moved from the “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence” Classification to "Neurodevelopmental Disorders” Classification 
• Numbers
  Numbered Categorization changed to alpha numerical (e.g. 300.4 changed into F42)
• Timeframe
  APA is giving 2 years to transition from DSM-IV to DSM-5
• Update DSM-5
  After 2 years, the DSM-5 will be the DSM-5.1
  
  

General changes

• Axes I – V
  Discarded Multi-Axial System (Axes I – V)
• Level of Severity and Insight
  Now Specifiers for Level of Severity and Insight in order to diagnose: example severity:
  0 = No Impairment (71-100 GAF) 
  1 = Mild Impairment (61-7- GAF)
  2 = Moderate Impairment (31-60 GAF)
  3 = Severe Impairment (1-30 GAF) 
• 799.9: Diagnosis or condition deferred on Axis I 
  Instead Diagnosis or condition deferred on Axis I, now CNEC (Conditions Not Elsewhere Classified) 

Neurodevelopmental Disorders

• Autism
  Autism Spectrum Disorder will now be a single condition with different severity levels which will encompass Autism, Asperger’s DO, and Persistent Developmental DO NOS 
• ADHD 
  Will be under Neurodevelopmental Disorders, not much change

Depressive Disorders

• Mood Disorders 
  Depressive Disorders moved from the Mood Disorders Classification to its own Depressive Disorders Classification, along with Dysthymic DO and Premenstrual Dysphoric DO 
• MDD criteria
  No major changes to MDD criteria
• Added Disruptive Mood Dysregulation Disorder (Formally from DSM-IV’s Pediatric Bipolar DO) 
  •Temper outbursts that are out of proportion to situation in at least two separate settings
  •Visibly angry or irritable 3 or more times a week
  •Presence for at least 12 months or longer in duration
  •Onset before age 10

Bipolar and Related Disorders

• Bipolar Disorders
  no longer under Mood DOs Classification
• Bipolar I or II
  No major changes to diagnosing

Anxiety Disorders

• Separation Anxiety DO
  moved to Anxiety Disorders  Classification and not in Childhood Disorders Classification
• Panic DO
  can no longer be diagnosed With or Without Agoraphobia; Agoraphobia is its own disorder
• Specific Phobia
  symptoms duration from 6 months now 3 months

Trauma and Stressor Related Disorders 

• PTSD
  - moved from Anxiety Disorders to Trauma and Stressor Related Disorders
  - new criteria will be patient engages in reckless or self-destructive bxs.
  -  Two clinical subtypes will be added:
      * Dissociative subtype (with additional depersonalization and derealization symptoms)
      * Preschool subtype for children 6 years and younger 
• Adjustment DO 
  no  longer in own Classification, moved to Trauma and Stress Related Disorders 

Obsessive-Compulsive Related Disorders

• OCD
  
  • No longer in the Anxiety Disorders Classification
  • Specifiers will include Level of Insight and Impairment

• Body Dysmorphic DO
  No longer in the Anxiety Disorders Classification

• Hoarding (New)
• Hair Pulling DO (discarded Trichotillomania)
  No longer in the Impulse-Control  DOs NOS Classification
• Skin Picking DO (New)

Schizophrenia Spectrum and Other Psychotic DOs

• Schizotypal Personality DO 
  Schizotypal Personality DO moved from the Personality DO Classification to Schizophrenia Spectrum and Other Psychotic DOs Classification
• Schizophrenia
  
  • Discarded Disorganized, Paranoid, etc. Subtypes in order to “destigmatize Schizophrenia”.
  • No changes to sx criteria
    
    
    

Neurocognitive Disorders

• Delirium
• Mild Neurocognitive Disorder (New)
  Cognitive change is not substantial insofar as minimal interference in daily life functioning 
• Major Neurocognitive Disorder (New)
  
  • Neurocognitive Disorder Due to Alzheimer’s Disease
  • Vascular Neurocognitive Disorder
  • Frontemporal Neurocognitive Disorder
  • Neurocognitive Disorder Due to Traumatic Brain Injury

Substance Use and Addictive Disorders

• Substance Use Disorders wil be Substance Use and Addictive Disorders
• No longer separating Abuse and Dependence
• 4 Groups
  
  • Substance Use DOs
  • Substance Induced DOs
  • Intoxication
  • Withdrawal 
• Severity Levels (similar to PANSS) 
  
  • 0-1 = No Impairment
  • 2-3 = Mild
  • 4-5 = Moderate
  • 6-7 = Severe
• Discarded Polysubstance Dependence, assess which substance the pt was their favorite.

Personality Disorder Dimensional Paradigm

• Alternative DSM Model for Personality Disorders Slated to take affect during DSM-5.1
• Four Personality Functioning Impairments:
  
  • Impairment in Self-Functioning (choose a or b)
    a.Identity: how one views oneself; where one looks for self-identity, power, and pleasure
    b.Self-direction: what norms/ethical behavior are followed and how they are followed. 
    AND
  • Impairment in Interpersonal Functioning (choose a or b)
    a.Empathy: how one cares or does not care about others
    b.Intimacy: how one engages in relationships.
• Will need to rank on various Domains:
  
  • Introversion
  • Antagonism
  • Disinhibition
  • Compulsivity
  • Detachment

V Codes

• Non-Suicidal Self Injury Self-Harm Syndrome
  
  • 5 or more occasions engaged in intentional self-inflicted or damage in the last one year
  • Must have met 2 or more of the following during the past one year:
    a.Interpersonal difficulties or negative feelings occurring immediately prior to the self-injurious act.
    b.Presence of urge or preoccupation directed toward self-injurious act.
    c.Activity is engaged in with the expectation of relief
• Suicidal Behavior Disorder
  •Person has engaged in behavior that is intended to lead to death within 24 hours but has survived
  •Cannot have committed behavior in a confused state (e.g., being intoxicated)
  •Can include aborted or interrupted attempt 
  
  
  

Dissociative Disorders

• Depersonalization-Derealization Disorder 
  Previously Depersonalization DO
• Dissociative Amnesia 
  Previously Dissociative Fugue
• Dissociative Identify Disorder
  
  • At least 2 separate personalities present with one personality being the protector and the other being the primary personality
  • Validity of this DO is still under question

 Feeding and Eating Disorders

• Anorexia Nervosa
  No longer under the Eating Disorders Classification
• Bulimia Nervosa
• Rumination Disorder
• Pica
  No loner under the Childhood DOs Classification
• Binge Eating Disorder (New)
  
  • Eating in a discrete period of time more food than a person would normally eat
  • A sense of lack of control when eating 1 time a week for 3 month duration.
  • 3 or more of the following
    a.Eating rapidly
    b.Eating until one is uncomfortably full
    c. Eating large amounts of food when not feeling physically hungry
    d. Eating alone because of feeling embarrassed given the amount of food consumed.
• Avoidant/Restrictive Food Intake Disorder (New)
  
  • Used to be a DO if childhood but now recognized as a lifespan DO
  • A lack of interest in food because of how the food tastes, feels, etc.

Disruptive Impulse Control and Conduct Disorders

• Oppositional Defiant Disorder
• Conduct Disorder
• Intermittent Explosive Disorder
• Dyssocial Personality Disorder (DPD)
  Previously Antisocial Personality Disorder
• Pyromania and Kleptomania Discarded

Somatic Symptom Disorders (Previously Somatoform Disorders)

• Conversion Disorder
• Factitious Disorder
• Somatic Symptom Disorder (was Somatization Disorder)
• Illness Anxiety Disorder (New)
  
  1. Care-Seeking: seeks care from medical personnel.
  2. Care-Avoidant: does not seek medical advice because fears test result

Sources

• American Psychiatric Association. (2013), DSM-5

Retrieved from http://www.psychiatry.org/practice/dsm/dsm5