The fifth and new version of the DSM generated many expectations, but it was not until last Saturday, December 1, that the board of directors of the renowned American Psychiatric Association (APA) approved the compendium of updates, revisions and changes regarding this manual.
These are the general changes to the DSM
Chapter order: The order of the DSM-IV chapters was always a mystery to many clinicians, since they did not relate to each other. As a modification, the DSM-V consists of 20 chapters, which were restructured based on the disorders and how they are related, according to their vulnerability and the characteristics of the symptoms. These changes allow the DSM-V to be interconnected with the ICD-11 (International Classification of Diseases of the World Health Organization), which will facilitate communication and common use of diagnoses.
Elimination of the multiaxial system: Most clinicians only paid attention to axes I and II, which explains why this system never enjoyed much acceptance. The DSM-5 will move to documentation without diagnostic axis, combining the former axes I, II, and III with separate annotations for psychosocial and contextual factors (Axis IV) and disability (Axis V).
Specific disorders
Autistic Disorder: will be renamed and reorganized. The autism criterion will incorporate several DSM-IV diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder into a single autism spectrum diagnosis. According to the APA, this will help more accurately and consistently diagnose children with autism.
Mood Dysregulation Disorder: This disorder will be included in the DSM-5 to diagnose children who exhibit persistent irritability and frequent episodes of lack of control on 3 or more occasions per week in a year. This diagnosis attempts to address concerns of overdiagnosis and overtreatment of bipolar disorder in children.
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Binge eating disorder: Binge eating disorder will be moved from DSM-IV Appendix B: Proposed Criteria and Axes for Further Studies to DSM-5 Section 2. The change is intended to better represent the symptoms and behaviors of people with this condition. This means that binge eating disorder is now a recognized disorder.
Excoriation Disorder: It is new in the DSM-V and will be included in the chapter related to obsessive-compulsive disorders.
It is added to the DSM-V with the support of extensive scientific research on this disorder and is characterized by the persistent inability to discard possessions, regardless of their real value. This behavior has emotional, physical, social, financial and even legal repercussions for patients and their families.
Pedophilic Disorder: Diagnostic criteria will remain unchanged, but the name will be revised from pedophilia to pedophilic disorder
Personality disorders: The DSM-5 will maintain the categorical model and criteria of the 10 personality disorders included in the DSM-IV, and will include the new trait-specific methodology in a separate area of Section 3 to promote further study of how this could be used for the diagnosis of personality disorders in clinical practice.
Post-Traumatic Stress Disorder: It will be included in a new chapter of the DSM-5 referring to trauma and related disorders depending on the stressor. The DSM-5 pays much more attention to behavioral symptoms and proposes four different diagnoses instead of three. Post-traumatic stress disorder will also be more sensitive to changes in children and adolescents.
Elimination of Dueling Exclusion: Bereavement exclusion is a criterion used in the DSM-IV that applies to people who experience depressive symptoms that last at least 2 months after the death of a loved one. This is a recognition that grief is a psychosocial stressor that can precipitate a major depressive episode following the death of a loved one.
Specific Learning Disorder: Expands the DSM-IV criteria to represent different disorders that interfere with the acquisition and use of one or more academic skills such as: oral language, reading, writing or mathematics.
Substance Use Disorder: This combined the DSM-IV categories of substance abuse and substance dependence into a single disorder, not only combining the diagnostic criteria but also strengthening them. The previous substance abuse criteria only required one symptom, while the DSM-5 requires two to three symptoms.
Section 3
There will also be new definitions of clinical conditions, but they will be found in Section 3, a new category for disorders that will not be covered by insurance companies, as they need further research, these include:
- Attenuated psychosis syndrome
- Online gaming disorder
- Non-suicidal self-harm
- Suicidal behavior.
Excluded Proposals
The APA board also rejected the proposal to include the following conditions, due to a lack of research on these topics.
These are the inclusions and modifications of the new DSM. We await your opinion!
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