Changes in the DSM V

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Changes in the DSM V

As many of you know, the American Psychiatric Association has transitioned from the DSM-IV TR to DSM-V (Diagnostic and Statistical Manual of Mental Disorders) in 2013. Starting in 2014, both the USMLE Step 1 and Comlex Level 1, as well as the behavioral medicine courses taught in both allopathic and osteopathic medical schools, started to incorporate and use the psychiatric criteria from the DSM-V. Below are the high-yield changes that are relevant for medical students. 

  • A less specific terminological change was made regarding the use of “general medical condition.” It is now replaced with “another medical condition” when it’s relevant.
  • As more has become known about neurodevelopmental disorders, the term “mental retardation” has become obsolete. To match this change, the DSM V uses the term “intellectual disability”. Eventually though, the term will probably be changed to “intellectual developmental disorder” as to coincide with US law and the ICD (international center of disease).
  • As far a communication disorders go, the DSM 5 contains childhood-onset fluency disorders (previously stuttering), language disorder, and speech sound disorder (previously phonological disorder). Lastly, the new DSM includes social (pragmatic) communication disorder. This is identified by constant and persistent problems when using verbal or nonverbal communication in social settings.
  • Autism Spectrum Disorder (ASD) was previously known as four different disorders: autism, childhood disintegrative disorder, Asperger’s, and pervasive developmental disorder. After further research, it was found that ‘autism’ is a spectrum rather than a separate disorder. More of a ‘gray’ rather than a ‘black’ or ‘white’ disorder.
  • Attention-Deficit/Hyperactivity Disorder (ADHD) is diagnostically the same in the DSM V, but there are a few smaller changes. There will now be examples to help identify the disorder at many different ages, symptoms are now generalized to “present prior to age 12” (rather than 7), a diagnosis combined with autism spectrum disorder is now allowed, and the threshold for symptoms in adults, and lastly ADHD is now in the neurodevelopment disorders section.
  • Specific learning disorders are defined as what was previously written expression, learning, mathematics, and reading disorders. Often the disorders will occur together. As well as this, this section acknowledges the known specific reading and mathematic disorders (dyslexia etc).
  • The Motor Disorders section includes Tourette’s, persistent motor or vocal tic disorder, unspecified/specified tic disorders, provisional tic disorder, developmental coordination disorder and stereotypic movement disorders. The criteria for tic disorders have been standardized and stereotypic movement disorder is now more clearly defined.
  • Schizophrenia Spectrum Disorders have two major changes. First is the addition of a new requirement that the individual must have at least one of the three symptoms (disorganized speech, hallucinations, delusions). Lastly, the bizarre delusions and auditory hallucinations are no longer required for a diagnosis. The subtypes for schizophrenia (paranoid, catatonic etc.) have been eliminated because of the lack of validity and reliability.
  • For Bipolar Disorders, there is now an emphasis on the change in energy, activity, and mood of the patient. Previously, the patient needed to show this, but major depressive and major manic episodes were needed. It is now more generalized to “mixed features.”
  • Trauma and Stressor-Related Disorders have changed significantly as well.
  • Adjustment disorders are changed from stressful reactions to both traumatic and non-traumatic events rather than just a “leftover” diagnosis when a match was not found in the DSM-IV.
  • PTSD symptom clusters changed from re-experiencing, avoidance, and arousal in DSM IV to intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity in DSM 5.
  • There have been some significant changes to the Depressive Disorders.
    • Coexistence of Major Depressive Disorder (MDD) with at least 3 manic symptoms, but fails to meet hypomanic and manic criteria, can now be given the specifier “with mixed features.”
    • Bereavement Exclusion was removed
    • “With Anxious features” added to both Depressive and Bipolar Disorders as a specifier to help incorporate a possible suicide risk since anxiety and suicide are closely correlated.
  • Obsessive-Compulsive and Related Disorders have been reorganized.

New disorders include hoarding disorder, excoriation (skin-picking) disorder, substance-/medication-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition. Trichotillomania has been moved from impulsive control disorders to this category.

  • The term hypochondriasis is now referred to as “somatic symptom disorder” if no somatic symptoms are present.
  • The anorexia diagnosis no longer requires amenorrhea. Bulimia is no longer limited to binge eating habits at least twice a week, but is now only once a week.
  • With current research and debates on sexual and gender identity disorders, Gender Dysphoria has been added to the DSM V. This is seen in individuals with “gender incongruence” (sex does not match gender).
  • Gambling disorders (addiction) has been added to the Addictive disorders section as well.

These are only some of the more major changes between the DSM IV and DSM V. To read the official document with all of the specific changes, go to this link:http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf

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