DSM 5 Overview Page 1

DSM-5 Overview WEBINAR: Wednesday, November 19, 2014 PRESENTED BY Dr. Madeleine Byrne, PsyD, LCSW, LSOTP, Director of Treatment IN CONJUNCTION WITH THE Juvenile Justice Training Academy Medical Services ORGANIZATIONAL CHANGES:

• Developmental/lifespan approach recognizing the influence of culture and gender, of genetic and

neurodevelopmental research, and symptoms occurring across multiple disorders

• Neurodevelopmental disorders (diagnosed in childhood) to disorders more applicable to older adults (neurocognitive disorders)

• Multi-axial system to non-axial

- Axis I, II, and III combined - Axis IV (psychosocial and contextual factors) replaced by selected V-codes and ICD codes - Axis V: no more GAF; disability assessment - Aligned with WHO ICD-10 codes

• Disorder reassignments (ie: PTSD to Trauma from Anxiety…)

• “NOS” to Provisional

• Subtypes replaced with specifiers/severity (mild, moderate, severe)

• Age criteria changes in several disorders

• Cultural Formulation Interview

EXPANDED DEFINITION OF MENTAL DISORDER: “A syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behaviors (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.” **The definition of mental disorder in the DSM-5 was developed for clinical, public health, and research purposes

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SOME RELEVANT CHANGES, RENAMED OR NEW DIAGNOSES AND CHAPTERS:

• Mental Retardation: Intellectual Developmental Disorder

(Public Law 111-256, Rosa’s Law: “mental retardation” replaced with intellectual disability)

- Includes both IQ and adaptive functioning but severity is based on adaptive functioning - Global Developmental Delay when clinical severity level cannot be reliably assessed (reserved for

children 5 and under)

• Autism Spectrum Disorder: encompasses previous DSM-IV Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorder

• Disruptive Mood Dysregulation Disorder: severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation

• Dysthymia: Persistent Depressive Disorder

• Anxiety Disorders: Panic Disorder and Agoraphobia no longer linked

• Trauma and Stressor-Related Disorders: includes Adjustment Disorders, Reactive Attachment Disorder and Disinhibited Social Engagement Disorder - PTSD: “subjective reaction” removed, criteria for children under age 6 added, includes learning that the

traumatic event(s) occurred to a close family member or close friend…

• Schizophrenia Spectrum and Other Psychotic Disorders

- Subtypes: paranoid, disorganized, catatonic, etc. gone

• Bipolar and Related Disorders: own chapter; now includes changes in mood and changes in activity or energy

- Anxious Distress specifier

• Hoarding Disorder, Excoriation Disorder • Feeding and Eating Disorders: Anorexia Nervosa and Bulimia Nervosa separated • Gender Dysphoria: in children and in adolescents and adults • Disruptive, Impulse-Control, and Conduct Disorders

- Oppositional Defiant Disorder has 3 types

• Angry/irritable mood • Argumentative/defiant behavior • Vindictiveness

- Conduct Disorder: callous/unemotional interpersonal style specifier - Intermittent Explosive Disorder: verbal aggression and non-destructive or non-injurious physical

aggression included

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• Substance Related and Addictive Disorders

- Substance Use Disorders • “abuse” and “dependence” combined • 4 groups: use, intoxication, withdrawal, induced • Polysubstance Dependence eliminated • Drug-craving added • Recurrent legal problems deleted

- Gambling Disorder added • Personality Disorders

- Can diagnose in children: use cautiously, one year observation mandated - Paranoid, Histrionic and Dependent PD eliminated - Personality functioning based on severity of disturbance in Self (identity and self-direction) and

Interpersonal Functioning (empathy and intimacy) • Physical, Sexual, Psychological Abuse and Neglect: V codes • Suicidal Behavior Disorder and Non-suicidal Self-Injury: conditions for further study

CONTACT INFORMATION:

Dr. Madeleine Byrne Director of Treatment P 254.297.8200 E madeleine.byrne@tjjd.texas.gov

This hand-out is not all-inclusive of the changes from the DSM-IV to DSM 5. Additional information is available at DSM.org.

Case Management TrainingDSM 5 Overview

November 19, 2014

Texas Juvenile Justice DepartmentJuvenile Justice Training Academy 1

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PRESENTEDBY

MadeleineByrne,PsyD,LCSW,LSOTPINCONJUNCTIONWITHTHE

Juvenile Justice Training Academy

DSM 5 OverviewNOVEMBER 19 , 2014

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Section 1

DSM History

DSM History

• First DSM published in 1844

• Purpose of the DSM– Assist trained

clinicians

– Assessment

• DSM Diagnosis

• Diagnostic Criteria

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Case Management TrainingDSM 5 Overview

November 19, 2014

Texas Juvenile Justice DepartmentJuvenile Justice Training Academy 2

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Section 2

Organizational Changes

Organizational Changes

• Developmental Lifespan Approach

• Neurodevelopmental Disorders

• Multi-Axial to Non-Axial

• Disorder Reassignments

• ‘NOS’ to Provisional

• Subtypes –Specifiers

• Age Criteria Changes

• Cultural Formulation

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Section 3

Mental Disorders

Case Management TrainingDSM 5 Overview

November 19, 2014

Texas Juvenile Justice DepartmentJuvenile Justice Training Academy 3

Mental Disorders

“A syndrome characterized by clinically significant disturbance in an individual’s

cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological,

biological, or developmental processes underlying mental functioning.”

EXPANDED DEFINITION: Developed for clinical, public health and research purposes

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Mental Disorders

“Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.”

• Common stressors

• Socially deviant behaviors

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Section 4

Relevant Changes

Case Management TrainingDSM 5 Overview

November 19, 2014

Texas Juvenile Justice DepartmentJuvenile Justice Training Academy 4

Relevant Changes

• Mental Retardation

• Autism Spectrum Disorder

• Disruptive Mood Dysregulation Disorder

• Dysthymia

• Anxiety Disorders

• Trauma and Stressor-related Disorders

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Relevant Changes

• Schizophrenia & Other Psychotic Disorders

• Bipolar and Related Disorders

• Hoarding Disorder, Excoriation Disorder

• Feeding and Eating Disorders

• Gender Dysphoria

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Relevant Changes

• Disruptive, Impulse-Control, Conduct Disorders– Oppositional Defiant

Disorder

– Conduct Disorder

– Intermittent Explosive Disorder

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Case Management TrainingDSM 5 Overview

November 19, 2014

Texas Juvenile Justice DepartmentJuvenile Justice Training Academy 5

Relevant Changes

• Substance Related and Addictive Disorders

• Personality Disorders

• Physical, Sexual, Psychological Abuse and Neglect

• Suicidal Behavior Disorder & Non-suicidal Self-Injury

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Conclusion

Conclusion

Dr. Madeleine ByrneDirector of Treatment

E-mail: madeleine.byrne@tjjd.texas.gov

Phone:(254) 297-8200

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