DSM-IV vs. DSM-5

By: Janet Greider

Principles of the DSM-5

The two primary goals behind restructuring the DSM-5 are to make the Manual more clinician-friendly, and reflect the more modern and comprehensive understanding of the existing psychiatric disorders.

New Structure in DSM-5

In order to accomplish these goals, the Task Force and Work Groups of the DSM-5 have decided to restructure the layout of the DSM-5. Instead of categorizing diagnoses by symptoms and axises, as in the DSM-IV, the DSM-5 will follow a sequential ‘lifespan’ order. The new ordering of disorders will allow editors to locate related disorders spatially near one another in the new chapters (Herrod & Conners, 2011).

How the New Structure will Facilitate Goals

The ‘lifespan’ organization will be more clinician-accessible.  In the DSM-5, disorders that are usually identified in childhood and infancy (such as Neurodevelopmental Disorders) will appear before disorders usually identified in adulthood (such as Sleep-Wake disorders and Sexual Dysfunctions).  Except for certain unique circumstances, clinicians will be able to use the age of the client to narrow down the field of possible disorders the client may be experiencing (American Psychiatric Association, 2011).

This focus on sequential lifespan development will also be applied within each category of disorders, where the ones seen earliest in childhood will be towards the front, while disorders identified later in life will be found later in the DSM-5 (American Psychiatric Association, 2011; Herrod & Conners, 2011).

The Work Groups also recognize that some of the disorders present in the DSM-5 are underused, esoteric, out of context culturally or easily combined or confused with other diagnoses.  In 2009, the DSM Task Force members have suggested that the DSM-5 will reflect an altered and reduced list of diagnoses.

Current Category List for Proposed DSM-5

Criterion and Disorder-specific Changes

In addition to the new structural organization of the DSM-5, there have been changes to the diagnostic critera. Certain disorders have been re-categorized, while other disorders have remained in the same category but had specific criteria changes, such as refined scales. Other disorders have been added, and still others have been removed.  Throughout this process, the Task Force of the DSM-5 has strongly pushed for accounting for multicultural, racial, and gender influences diagnoses, as well as including ‘dimensional assessment measures’. These measures would allow clinicians to evaluate not just the symptom, but its severity and any potentially crosscutting syndromes that would overlap with other diagnoses.
Example of a document discussing a new measure for suicide-ideation and behavior, and suggestin further research before inclusion in the DSM-5

Examples of Proposed Removals, Re-categorizations, Specifications, and Additions to the DSM-5:

Some of the primary revisions to categorization include the ongoing Asperger’s Syndrome vs. Autism Spectrum Disorder Debate. More on Asperger’s Syndrome

The new category of Autism Spectrum Disorders will actually encompass several presently differentiated disorders, including Asperger’s Syndrome, childhood Disintegrative Disorder and Pervasive Developmental Disorder (not otherwise specified). In specific terminology, the DSM-5 will replace ‘mental retardation’ with ‘intellectual disability’, which will follow the terminology used in other disciplines and the ICD-10. (APA, 2011)

Examples of Newly Added Categories and Changes to Current Categories

A new category that will potentially be included in the DSM-5 is ‘behavioral addictions’, which will include ‘gambling addiction’, re-categorized from its current location under Impulse-Control Disorders (Proposed Revisions, 2011)

The current categories of ‘Substance Abuse’ and ‘Substance Dependence’ will be replaced with a new category ‘Addiction and Related disorders’ (Proposed Revisions, 2011)

Under the category of “Mood Disorders”, the DSM-5 Task Force may incorporate a new diagnostic disorder of temper dysregulation with dysphoria (TDD). The rationale for including TDD as a new disorder is that it provides a category of symptoms that differentiate between children with bipolar disorder and oppositional defiant disorder (Proposed Revisions, 2011).

Finally, the category of ‘binge-eating’ has been added as a separate disorder to “Eating Disorders”, in lieu of its current categorization of Eating Disorders Not otherwise Specified. In addition to separating out ‘binge-eating’, the Work Group for Eating Disorders has refined the criteria of bulimia nervosa and anorexia nervosa, while altering some of the definitions to recognize that eating disorders can begin in childhood and also affect older adults and narrowing the criteria for anorexia nervosa and bulimia nervosa (Proposed Revisions, 2011).

References:

American Psychiatric Association; Proposed Revisions (2011).  Retrieved from http://www.dsm5.org/Pages/Default.aspx

American Psychiatric Association; Autism Spectrum Disorder (2011). Retrieved from http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=94

American Psychiatric Association Development of the DSM-5 (2011). Retrieved from http://www.dsm5.org/Pages/Default.aspx

Herrod, E., Conners, E. (2011, May 4). New Framework Proposed for Manual of Mental Disorders. Retrieved from http://www.dsm5.org/Newsroom/Documents/DSM5Structure_050411.pdf

 

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