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New Changes in the DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) will be released later this month and includes new disorders relating to grief, childhood temper tantrums, binge eating, PMS, and painful sex, among others. It has also changed how existing conditions—including oft-polarizing ADHD and autism—are diagnosed.

The chart below features some of the major changes* to the DSM-5.

 New Condition

  Description

Childhood-Onset Fluency Disorder

  • A disorder with a new name for stuttering
Social (Pragmatic) Communication Disorder (SCD)
  • Symptoms of this condition "include difficulty in the acquisition and use of spoken and written language as well as problems with inappropriate responses in conversation." 
  • Individuals with this disorder may struggle with "effective communication, social relationships, academic achievement, or occupational performance."
  • The addition of this disorder is meant to provide a more accurate diagnosis to people with certain communication problems than earlier DSM editions.

Disruptive Mood Dysregulation Disorder (DMDD)

  • Children between the ages of 6 and 18 who "exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year."
  • This diagnosis was introduced in the hope of reducing the number of children diagnosed with bipolar disorder; however, some experts worry a child's normal temper tantrums may be confused as a mental disorder.

Premenstrual Dysphoric Disorder (PMDD)

Hoarding Disorder

  • Symptoms include having "persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them."

Excorciation

  • Skin-picking disorder

Somatic Symptom Disorder (SSD)

  • This new disorder combines 4 previously recognized disorders—somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder.
  • Diagnosis for SSD requires that a person have "somatic symptoms," meaning bodily symptoms, "that are either very distressing or resulting in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviors regarding those symptoms," for at least 6 months.
  • Although this change is intended, in part, to remove the stigma of being labeled a “hypochondriac," some psychiatrists worry that people living with chronic pain may be mislabeled as mentally ill.
Binge Eating Disorder
  • Originally in an appendix of the DSM-IV, this condition now appears with other eating and feeding disorders in the DSM-5, based on research supporting the "clinical utility and validity" of the disorder
  • To be diagnosed, a person must binge at least once weekly on average over the past 3 months.

Gender Dysphoria

  • This new condition replaces "gender identity disorder," in an effort to remove the stigma of mental illness for transgendered people.
  • Diagnosis requires that there is "a marked difference between the individual's expressed/experienced gender and the gender others would assign him or her."
  • Symptoms must last for at least six months, and be accompanied by "significant distress or impairment in social, occupational, or other important areas of functioning."

Gambling Disorder

  • For the first time, gambling disorder will appear as the sole condition in a new category on behavioral addictions, based on research showing that gambling activates the brain reward system with effects similar to those of drugs.

 

 

Existing Condition

Description of Changes

Autism

  • Four previously separate disorders –autistic disorder, Asperger’s Syndrome, childhood disintegrative disorder and pervasive developmental disorder—are now combined into autism spectrum disorder.
  • In the DSM-IV, there were 2027 different ways to be diagnosed with autism; in the DSM-5, there are just 11. Some psychiatrists believe past criteria were “too loose.” Several studies concluded that the new criteria were too strict, and might exclude some high functioning patients.

ADHD

  • The same 18 symptoms are used for diagnosis, but several changes have been made, including lowering the age of onset from 7 years to 12 years; allowing people to be diagnosed with both ADHD and autism spectrum disorder; decreasing the number of symptoms needed for an adult diagnosis of ADHD; and removing the three subtypes of ADHD, "predominantly hyperactive/impulsive, predominantly inattentive, and combined inattentive and hyperactive."

Schizophrenia

  • A change in the assessment of "bizarre delusions" means that some people previously diagnosed with schizophrenia will be re-diagnosed as having delusional disorder (treatment is similar, but patients with delusional disorder usually have better outcomes).
  • The requirement for the presence of psychotic symptoms—such as delusions, hallucinations, or disorganized thinking—has been strengthened.
  • The 5 schizophrenia subtypes (paranoid, disorganized, catatonic, undifferentiated, and residual) have been eliminated.
  • An assessment tool has been added for the core symptoms of schizophrenia, including delusions, negative symptoms, cognitive symptoms, motor symptoms, disorganization, and mood symptoms.

Bipolar Disorders

  • Assessment of manic and hypomanic episodes now emphasizes changes in activity and energy, which is expected to enhance accuracy of diagnosis.
  • There has been a change to the assessment of "mixed episodes", in which a person has overlapping symptoms of both mania and depression.

Major Depressive Disorder

  • The bereavement exclusion, which had excluded depressive symptoms lasting less than 2 months following the death of a loved one, has been eliminated.
  • The exclusion was removed, in part, because bereavement is a "severe psychosocial stressor" that can cause depression in a vulnerable person.
  • A footnote has been added to help clinicians distinguish between the symptoms of bereavement and the symptoms of "a major depressive episode."

Agoraphobia, Specific Phobia, and Social Anxiety Disorder (Social Phobia)

  • The requirement that people over the age of 18 recognize that their anxiety is "excessive or unreasonable," has been eliminated because many people with these disorders "overestimate the level of danger" in situations where they feel fearful.
  • For example, a person suffering from Agoraphobia—an anxiety disorder in which a person avoids situations where they might panic—might overestimate the actual danger of being in a crowded public space.

Body Dysmorphic Disorder

  • Diagnosis now requires that patients have "repetitive behaviors or mental acts in response to preoccupations with perceived defects or flaws in physical appearance."

Post-Traumatic Stress Disorder

  • Assessment now includes "new or reconceptualized" symptoms, such as "persistent negative emotional states" and "irritable or aggressive behavior and reckless or self-destructive behavior."
  • The threshold for diagnosis have been lowered for children and adolescents, and separate criteria now exist for children 6-years-old and younger. 

Substance-Related and Addictive Disorders

  • There are no longer separate diagnoses for substance abuse and dependence; instead the DSM-5 has created "substance use disorders" for people having trouble with alcohol, narcotics, or other substances.
  • The "recurrent legal problems" criterion for substance abuse has been removed, and the new criterion "craving or a strong desire or urge to use a substance" added. 
  • Tobacco use disorder has been also been added, and it has the same criteria as other substance use disorders. 

*This chart is not a comprehensive summary of all DSM-5 changes.

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