In terms of structure, DSM-V is divided in three major sections.
The first one is the Introduction, that also contains information about
the appropriate use of the manual. The second one is the categorical
diagnoses, and the third one is an appendix including self-assessment
tools and information about categories requiring additional research.
Moreover, the organization of chapters is designed in order to
demonstrate how disorders are related to one another. Lastly, the most
important structural change is that the multi-axial system, that was
well-known in the previous editions, has now been eliminated, in order
to demonstrate that all disorders are equally valued and regarded.
Except for these structural changes, a lot has changed in the context,
categorization and understanding of the disorders. Nevertheless, the
number of conditions in DSM-IV and DSM-V is almost identical. Some
prominent differences will be discussed per classification category, in
an attempt to summarize the most significant changes in the newest
edition of DSM-V.
Within the broader chapter of Neurodevelopmental Disorders, there are several important changes. The previously-used term Mental Retardation has now been replaced with Intellectual Disability, since the first term has generally been abandoned in the last decades. The sub-category Communication Disorders includes: language disorders; a merged category of the two previously termed expressive and mixed receptive-expressive language disorders, speed sound disorder (which is the new name of Phonological Disorder), and Childhood-onset fluency disorder (previously Stuttering). In the Communication Disorders category a completely new diagnosis, Social Communication Disorder, is now included. Another important change is that, currently, instead of the 4 terms (Autistic, Asperger's, Childhood Disintegrative and Pervasive Developmental) the term Autism Spectrum is used, indicating that the previous diagnoses actually exist within a symptom-severity continuum of a single condition. In this chapter, Attention-Deficit Hyperactivity has been added, because of the brain developmental characteristics of this condition. ADHD was a category of its own in DSM-IV, and its symptoms remain the same, albeit with some contextual changes. Another merged diagnosis is Specific Learning Disorder (Reading, Mathematics, Written Expression and Learning Not Otherwise Specified); though it may be specifically coded, depending on which deficit is more prominent. Also, the terms dyslexia and dyscalculia are now recognized by DSM. Motor Disorders currently include Motor Skill, as well as Tourette's, Developmental Coordination, Stereotypic Movement, Persistent Motor or Vocal Tic, Provisional Tic and Unspecified Tic.
Several changes are also included in the broader category of Schizophrenia Spectrum and Other Psychotic Disorders. Diagnostic Criterion A for Schizophrenia is now different (i.e. 2 criterion A symptoms are required in order for a diagnosis to be made, instead of only one, like in DSM-V), and the 5 schizophrenia subtypes have now been eliminated, as a dimensional approach of symptom severity is introduced. In Schizoaffective Disorder, currently only the occurrence of a major mood episode (i.e. not anymore a mixed episode) during the co-existence of schizophrenic symptoms is necessary for the diagnosis. In Delusional Disorder, delusions are no longer required to be "non-bizarre", and Shared Delusional Disorder is no longer a separate category, unless delusional disorder criteria are not met; in that case, shared delusional disorder is coded as Other Specified Schizophrenia Spectrum and Other Psychotic Disorders. Lastly, Catatonia is diagnosed by the same criteria, regardless of the context (psychotic, bipolar, depressive etc); it may be coded as a specifier for the above-mentioned disorders.
Additionally, there are some contextual changes in Criterion A of Bipolar and Related Disorders. There is no longer a subcategory of a "mixed episode" in Bipolar I Disorder. In Depressive Disorders, some new diangnoses are added: Disruptive Mood Dysregulation and Premenstrual Dysphoric Disorder. Also, bereavement as an exclusion criterion for major depressive episode has been removed.
Some major changes are incorporated within the Anxiety Disorders category. Obsessive-Compulsive, Post-Traumatic Stress and Acute Stress are no longer categorized as anxiety dysfunctions. Also, there are some changes in the diagnostic criteria of Agoraphobia, Specific Phobia and Social Anxiety Disorder. Panic and Agoraphobia are no longer linked; their co-occurrence is now coded as two different diagnoses. Lastly, Separation Anxiety and Selective Mutism are now included in the Anxiety Disorders category.
Among the new chapters that have emerged in DSM-V, are Obsessive Compulsive and Related Disorders and Trauma- and Stressor-Related Disorders. The first one, except for Obsessive-Compulsive Disorder, also includes Hoarding, Excoriation, Trichotillomania, Body Dysmorphic, Substance- / Medication-induced Obsessive-Compulsive and Related, and Obsessive-Compulsive Disorder due to Another Medical Condition. Trauma- and Stressor-Related Disorder includes PTSD, Acute Stress, Adjustment Disorder and Reactive Attachment Dis.
Another category that includes changes as compared with DSM-V is Somatic Symptom and Related Disorders (previously named "Somatoform Disorders"). There are now fewer categories in this category, in order to avoid diagnostic overlap. Among those is Somatic Symptom Disorder, which merges previously separate categories of Somatization Disorder, Hypochondriasis and Pain Disorder (now coded as Somatic Symptom Disorder with predominant pain). The same applies to the chapter Feeding and Eating Disorders, which incorporates several DSM-IV disorders previously in "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence"- a category that has now been completely. These disorders are Pica and Rumination Disorder, Avoidant/ Restrictive Food Intake Disorder and Elimination Disorders. Lastly, Binge Eating Disorder is a new diagnosis added in this category. Additionally, previous Sleeping Disorders is now termed Sleep-Wake Disorders, and various changes have been formulated in this chapter as well.
In Sexual Dysfunctions (previously named "Sexual Disorders and Gender Identity Disorders") there are some different conceptualizations as well. Gender-specific sexual dysfunctions have been added, and currently all dysfunctions must persist for at least 6 months for a diagnosis to be made. Genito-pelvic Pain/Penetration Disorder is completely new in DSM-V, while Paraphilias and Gender Dysphoria are no longer considered as Sexual Disorders as in DSM-IV, but they comprise separate chapters in DSM-V. One more new chapter is Disruptive, Impulse Control and Conduct Disorders, combining diagnosis from "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence": Oppositional Defiant Disorder, Conduct Disorder, Disruptive Behaviour Disorder; and the Impulse-Control Disorders Not Otherwise Specified, that includes diagnoses such as Intermittent Explosive Disorder, Kleptomania and Pyromania.
Some additional changes are established in the chapter Substance-related and Addictive Disorders (previously Substance-related Disorders), that has been updated with Gambling Dis., and in Neurocognitive Dis., where Mild and Major Neurocognitive Dis., combining Dementia and Amnesic, have been added.
In conclusion, quite a lot has changed in DSM-V. Some would argue that an attempt has been made for DSM-V to be more "user-friendly", simplified, better organized and structured and more in line with current research advances. In specific, there is a tendency to simplify terms and categories of disorders. Moreover, multiple diagnoses on many occasions are incorporated or merged in one term, while new categorical chapters, even diagnoses, have been created, or previous terms have now been renamed, sometimes sounding more "politically correct". On the downside, the newest DSM-V edition has also been severely criticized. The most worrying aspect of this criticism is that the diagnostic thresholds have been lowered, thus making it easier for an individual to be diagnosed with a mental disorder. An increasing tendency of patterns of behavior to be medicalized has been observed, and this may have quite adverse results in the long run.
Aspira Continuing Education is an online CEU provider for MFTs, Social Workers and Professional Counselors. Aspira has several courses to choose from with an easy to navigate/user-friendly website. Visit http://www.aspirace.com to obtain online CEUs for MFT continuing education and Social Worker continuing education.
Within the broader chapter of Neurodevelopmental Disorders, there are several important changes. The previously-used term Mental Retardation has now been replaced with Intellectual Disability, since the first term has generally been abandoned in the last decades. The sub-category Communication Disorders includes: language disorders; a merged category of the two previously termed expressive and mixed receptive-expressive language disorders, speed sound disorder (which is the new name of Phonological Disorder), and Childhood-onset fluency disorder (previously Stuttering). In the Communication Disorders category a completely new diagnosis, Social Communication Disorder, is now included. Another important change is that, currently, instead of the 4 terms (Autistic, Asperger's, Childhood Disintegrative and Pervasive Developmental) the term Autism Spectrum is used, indicating that the previous diagnoses actually exist within a symptom-severity continuum of a single condition. In this chapter, Attention-Deficit Hyperactivity has been added, because of the brain developmental characteristics of this condition. ADHD was a category of its own in DSM-IV, and its symptoms remain the same, albeit with some contextual changes. Another merged diagnosis is Specific Learning Disorder (Reading, Mathematics, Written Expression and Learning Not Otherwise Specified); though it may be specifically coded, depending on which deficit is more prominent. Also, the terms dyslexia and dyscalculia are now recognized by DSM. Motor Disorders currently include Motor Skill, as well as Tourette's, Developmental Coordination, Stereotypic Movement, Persistent Motor or Vocal Tic, Provisional Tic and Unspecified Tic.
Several changes are also included in the broader category of Schizophrenia Spectrum and Other Psychotic Disorders. Diagnostic Criterion A for Schizophrenia is now different (i.e. 2 criterion A symptoms are required in order for a diagnosis to be made, instead of only one, like in DSM-V), and the 5 schizophrenia subtypes have now been eliminated, as a dimensional approach of symptom severity is introduced. In Schizoaffective Disorder, currently only the occurrence of a major mood episode (i.e. not anymore a mixed episode) during the co-existence of schizophrenic symptoms is necessary for the diagnosis. In Delusional Disorder, delusions are no longer required to be "non-bizarre", and Shared Delusional Disorder is no longer a separate category, unless delusional disorder criteria are not met; in that case, shared delusional disorder is coded as Other Specified Schizophrenia Spectrum and Other Psychotic Disorders. Lastly, Catatonia is diagnosed by the same criteria, regardless of the context (psychotic, bipolar, depressive etc); it may be coded as a specifier for the above-mentioned disorders.
Additionally, there are some contextual changes in Criterion A of Bipolar and Related Disorders. There is no longer a subcategory of a "mixed episode" in Bipolar I Disorder. In Depressive Disorders, some new diangnoses are added: Disruptive Mood Dysregulation and Premenstrual Dysphoric Disorder. Also, bereavement as an exclusion criterion for major depressive episode has been removed.
Some major changes are incorporated within the Anxiety Disorders category. Obsessive-Compulsive, Post-Traumatic Stress and Acute Stress are no longer categorized as anxiety dysfunctions. Also, there are some changes in the diagnostic criteria of Agoraphobia, Specific Phobia and Social Anxiety Disorder. Panic and Agoraphobia are no longer linked; their co-occurrence is now coded as two different diagnoses. Lastly, Separation Anxiety and Selective Mutism are now included in the Anxiety Disorders category.
Among the new chapters that have emerged in DSM-V, are Obsessive Compulsive and Related Disorders and Trauma- and Stressor-Related Disorders. The first one, except for Obsessive-Compulsive Disorder, also includes Hoarding, Excoriation, Trichotillomania, Body Dysmorphic, Substance- / Medication-induced Obsessive-Compulsive and Related, and Obsessive-Compulsive Disorder due to Another Medical Condition. Trauma- and Stressor-Related Disorder includes PTSD, Acute Stress, Adjustment Disorder and Reactive Attachment Dis.
Another category that includes changes as compared with DSM-V is Somatic Symptom and Related Disorders (previously named "Somatoform Disorders"). There are now fewer categories in this category, in order to avoid diagnostic overlap. Among those is Somatic Symptom Disorder, which merges previously separate categories of Somatization Disorder, Hypochondriasis and Pain Disorder (now coded as Somatic Symptom Disorder with predominant pain). The same applies to the chapter Feeding and Eating Disorders, which incorporates several DSM-IV disorders previously in "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence"- a category that has now been completely. These disorders are Pica and Rumination Disorder, Avoidant/ Restrictive Food Intake Disorder and Elimination Disorders. Lastly, Binge Eating Disorder is a new diagnosis added in this category. Additionally, previous Sleeping Disorders is now termed Sleep-Wake Disorders, and various changes have been formulated in this chapter as well.
In Sexual Dysfunctions (previously named "Sexual Disorders and Gender Identity Disorders") there are some different conceptualizations as well. Gender-specific sexual dysfunctions have been added, and currently all dysfunctions must persist for at least 6 months for a diagnosis to be made. Genito-pelvic Pain/Penetration Disorder is completely new in DSM-V, while Paraphilias and Gender Dysphoria are no longer considered as Sexual Disorders as in DSM-IV, but they comprise separate chapters in DSM-V. One more new chapter is Disruptive, Impulse Control and Conduct Disorders, combining diagnosis from "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence": Oppositional Defiant Disorder, Conduct Disorder, Disruptive Behaviour Disorder; and the Impulse-Control Disorders Not Otherwise Specified, that includes diagnoses such as Intermittent Explosive Disorder, Kleptomania and Pyromania.
Some additional changes are established in the chapter Substance-related and Addictive Disorders (previously Substance-related Disorders), that has been updated with Gambling Dis., and in Neurocognitive Dis., where Mild and Major Neurocognitive Dis., combining Dementia and Amnesic, have been added.
In conclusion, quite a lot has changed in DSM-V. Some would argue that an attempt has been made for DSM-V to be more "user-friendly", simplified, better organized and structured and more in line with current research advances. In specific, there is a tendency to simplify terms and categories of disorders. Moreover, multiple diagnoses on many occasions are incorporated or merged in one term, while new categorical chapters, even diagnoses, have been created, or previous terms have now been renamed, sometimes sounding more "politically correct". On the downside, the newest DSM-V edition has also been severely criticized. The most worrying aspect of this criticism is that the diagnostic thresholds have been lowered, thus making it easier for an individual to be diagnosed with a mental disorder. An increasing tendency of patterns of behavior to be medicalized has been observed, and this may have quite adverse results in the long run.
Aspira Continuing Education is an online CEU provider for MFTs, Social Workers and Professional Counselors. Aspira has several courses to choose from with an easy to navigate/user-friendly website. Visit http://www.aspirace.com to obtain online CEUs for MFT continuing education and Social Worker continuing education.
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