Changes in DSM-5: An OverviewSheila L. Videbeck, PhD, RN

• The focus of this overview is major changes between DSM-IV-TR (2000) and DSM-5 (2013).

• Both organizational and conceptual changes in diagnoses are included.

• Further, inclusive and detailed changes and explanations for changes are available at www.DSM5.org/HighlightsofChanges

Overview

• Elimination of the only age-based section: Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence. Diagnoses from this section have been distributed to other sections based on disorder categories.

• Creation of new sections: Neurodevelopmental Disorders; Obsessive-Compulsive and Related Disorders; Trauma- and Stressor-Related Disorders.

Major DSM-5 Changes

• Sections renamed to better reflect disorders in the section

• Change in the name of diagnoses (with minimal change in individual diagnosis)

• Change in conceptual approach to a set of diagnoses, specifically Autism Spectrum Disorder

• Changes in definition, criteria for diagnoses, and/or specifiers of the disorder

Major DSM-5 Changes (continued)

• The term “General medical condition” has been replaced throughout DSM-5 with “Another medical condition”

• Diagnoses are no longer placed on the multi-axial system of Axes I-V

• The Global Assessment of Functioning Scale (GAF) has been eliminated

Major DSM-5 Changes (continued)

• This category has been eliminated • Disorders formerly in the section have been

distributed in other sections • Neurodevelopmental Disorders is a new section

that contains many of the diagnoses from this old section

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

• Mental Retardation diagnosis has been replaced with Intellectual Disability

• Both cognitive capacity (IQ) and adaptive functioning are assessed with severity based on adaptive functioning rather than IQ

Intellectual Disability

1. Language Disorder (combines Expressive and Mixed Receptive-Expressive Disorder)

2. Speech Sound Disorder (replaces Phonological Disorder)

3. Childhood Onset Fluency Disorder (formerly Stuttering)

4. Social Pragmatic Disorder (New)

Communication Disorders is a category in Neurodevelopmental Disorders that includes:

• A conceptual change defines Autism Spectrum Disorder as a single condition with different levels of symptom severity – 2 symptom categories are: social communication & interaction; and repetitive, behavior, interests, & activities

• Encompasses previous diagnoses of Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder NOS

Autism Spectrum Disorder

• Attention Deficit/Hyperactivity Disorder• Specific Learning Disorder (includes former

reading, math, written expression, and NOS diagnoses)

• Motor Disorders (includes Developmental Coordination Disorder, Stereotypic Movement Disorder, Tourette’s Disorder, and other vocal and motor tics, & unspecified disorders)

Additional Neurodevelopmental Disorder Diagnoses

• Elimination of paranoid, undifferentiated, disorganized, and residual subtypes

• Delusional Disorder – can now include bizarre delusion(s)

• Schizoaffective Disorder – major mood episode must be present for a majority of the total duration of disorder

Schizophrenia Spectrum and other Psychotic Disorders

• Criteria for mania and hypomania now include changes in activity and energy as well as mood changes

• Changes in diagnosis of Bipolar Disorder in children on slide #13

Bipolar and Related Disorders

• Disruptive Mood Dysregulation Disorder – for children under age 18 who have persistent irritability and frequent extreme out of control behavior (to address concerns about potential overdiagnosis of Bipolar Disorder)

• Persistent Depressive Disorder (replaces Dysthymic Disorder)

• Bereavement no longer excluded from depression diagnosis

Depressive Disorders

• PTSD moved to new section called Trauma and Stressor Related Disorders

• OCD moved to new section called Obsessive-Compulsive and Related Disorders

• Social Anxiety Disorder (replaces Social Phobia)• Panic Disorder with Agoraphobia – now 2

diagnoses, no longer one diagnosis• Separation Anxiety Disorder – moved from the

old First Diagnosed in Infancy…section

Anxiety Disorders

• Obsessive-Compulsive Disorder – moved from Anxiety Disorder section

• New Diagnosis: Hoarding Disorder• Body Dysmorphic Disorder – moved from old

Somatoform Disorder section• Trichotillomania• Skin-picking Disorder• Substance-induced OCD and OCD due to

another medical condition

Obsessive-Compulsive and Related Disorders

• Reactive Attachment Disorder – moved from the old First Diagnosed in Infancy…section

• Disinhibited Social Engagement Disorder• PTSD – moved from Anxiety Disorders section• Acute Stress Disorder – moved from Anxiety

Disorder Section• Adjustment Disorders – old section of

Adjustment Disorders eliminated

Trauma and Stressor-Related Disorders

• Depersonalization/Derealization Disorder – concepts of depersonalization and derealization combined to replace former Depersonalization Disorder

• Dissociative Fugue – now a specifier under Dissociative Amnesia instead of a stand-alone diagnosis

Dissociative Disorders

• Formerly called Somatoform Disorders• Somatic Symptom Disorder (replaces

Somatization Disorder)• Illness Anxiety Disorder (replaces

Hypochondirasis)• Conversion Disorder – also called Functional

Neurological Symptom Disorder• Factitious Disorder: Imposed on self or Imposed

on other colloquially known as Munchausen’s Syndrome and Munchausen’s by proxy)

Somatic Symptom and Related Disorders

• Adult diagnoses of Anorexia Nervosa and Bulimia Nervosa are essentially unchanged

• New Diagnosis: Binge Eating Disorder• New Diagnosis: Avoidant/Restrictive Food

Intake Disorder• Pica and Rumination Disorder - moved from

former First Diagnosed in Infancy…section

Feeding and Eating Disorders

• Conduct Disorder and Oppositional Defiant Disorder – moved from former First Diagnosed in Infancy…section

• Intermittent Explosive Disorder, Kleptomania, & Pyromania – moved from former Impulse-Control Disorder section

Disruptive, Impulse-Control, and Conduct Disorders

• Gambling – moved from former Impulse-Control Disorder section

• No longer a separation of substance abuse and dependence

• Categories reduced by combining amphetamine and cocaine into stimulants; phencyclidine included in hallucinogens; and nicotine expanded to tobacco

Substance-Related and Addictive Disorders

• Formerly Delirium, Dementia, and Amnestic and other Cognitive Disorders section

• Delirium remains in section• Amnestic Disorder and Dementia are now in a

new category called Mild or Major Neurocognitive Disorder specified according to etiology (vascular, HIV Infection, Traumatic Brain Injury, Alzheimer’s Parkinson’s Huntington’s, Prion, other medical condition, multiple etiologies), location (Frontotemporal), or characteristics (with Lewy Bodies)

Neurocognitive Disorders

• Personality Disorder diagnoses remain unchanged in Section II

• Another alternative approach is proposed in Section III to be used for further study; it contains changes proposed in drafts of DSM-5 which were not ultimately accepted

• The alternate section has 6 rather than 10 diagnoses with criteria focusing on personality traits and personality functioning

Personality Disorders

• For changes in criteria, definitions, or specifiers that are routinely used by clinicians making diagnoses, see the website www.DSM5/HighlightsofChanges

Additional Changes