In March 2022, the American Psychiatric Association (APA) published a revised text (TR) of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, to clarify certain mental health conditions and criteria and codes. diagnosis
Highlights of the recent update include the addition of prolonged grief disorder as a condition, as well as symptom codes for suicidal behavior and non-suicidal self-harm.
The APA also consulted with cultural and equity professionals to recognize the historical role of racial discrimination in clinical diagnoses. DSM-5-TR language was updated to promote inclusion of people of color and marginalized groups.
DSM-5-TR Updates
The DSM-5-TR has refined some of its diagnostic criteria and codes, which can better inform how mental health professionals work with their clients and how they submit claims to insurance companies.
Although the revised text cannot fully address each individual’s unique experiences and situations, improved diagnostic criteria can help clinicians identify their clients’ disorders or conditions more accurately.
If you value articles like this, consider supporting us by becoming a Pro subscriber. Subscribers enjoy access to members-only articles, materials, and webinars.
Prolonged grief disorder
One of the new features is the inclusion of as a condition, mentioning the associated symptoms in its list of diagnostic criteria. Doctors can now make a formal diagnosis for those who have faced difficulty coping with the loss for an extended period of time.
Still, everyone’s grieving process is different, and there is some controversy among doctors when it comes to linking a person’s experiences of loss with a mental health disorder. Studies have shown that 1 in 10 adults may experience prolonged grief, especially now, with this pandemic that has killed so many people suddenly (Prigerson et al., 2021), so this is a really important addition.
Diagnostic criteria
According to the DSM-5-TR, diagnostic criteria for prolonged grief include:
- A persistent grief response for more than 12 months (6 months for a child)
- Symptoms that significantly disrupt a person’s daily functioning
- Experiences that cannot be attributed to another condition, such as major depressive disorder (MDD) or post-traumatic stress disorder (PTSD).
Unspecified mood disorder
The DSM-5 removed “mood disorder not otherwise specified” as a diagnosis in its 2013 update, which meant that doctors had to diagnose their clients with a specific mood disorder.
The DSM-5-TR has returned to the “unspecified” diagnosis to include a range of possible mood disorders, which can help doctors avoid potential misdiagnoses. The idea of its reinstatement is to provide a diagnosis to someone whose symptoms do not fit neatly into bipolar or depressive disorders. This is important because distinguishing between bipolar disorder and depressive disorders takes time. Often, the symptoms co-occurring with bipolar disorder are not always noticeable at first. If misdiagnosed with depression and an SSRI is prescribed to a person who does not actually have depression, this medication could lead to a manic episode.
Including mood disorder not otherwise specified again allows professionals more time to observe their patient’s symptoms and provide a more accurate diagnosis and subsequent prescription.
Non-suicidal self-harm
The DSM-5-TR has added self-harm without the presence of suicidal tendencies to its list of diagnoses.
Because not all people who have self-harmed have done so with the intention of ending their life, grouping them into suicidal tendencies could blur the assessments made by treating professionals.
Additionally, diagnostic codes for suicidal behavior without the presence of other mental health disorders have been included in the new updates.
Focus on gender inclusive language
The revised text of the DSM-5 includes changes to its language about gender and gender identity to help reduce stigma by clarifying that these aspects of a person are not selected by choice.
This includes the most precise and inclusive changes to:
- “Desired gender” to “experienced gender”
- “Cross-sex medical procedure” to “gender-affirming medical procedure”
- “Born male/born female” to “individual assigned male/female at birth”
Focus on race and discrimination
According to the authors of the review, the review was conducted through an equity and inclusion lens and making appropriate changes was a priority for the review committees.
Future iterations of the DSM-5 are likely to incorporate additional changes, specifically around how the causes of social, sociocultural, and genetic disorders intersect, all with the goal of allowing patients to be viewed within a more holistic framework.
Race and discrimination have historically affected mental health care. Having this recognized in the DSM-5-TR is a step forward in creating safer and more inclusive environments for people of color and marginalized groups.
But there are still barriers to quality mental health care, such as cost factors, health insurance, and sufficient access to culturally competent therapists.
Bibliographic reference: Prigerson, H.G., Kakarala, S., Gang, J., & Maciejewski, P.K. (2021). History and Status of Prolonged Grief Disorder as a Psychiatric Diagnosis. Annual Review of Clinical Psychology, 17, 109-126. https://doi.org/
Fountain: