The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) will be the first update to the diagnostic manual since the DSM-IV-TR in 2000. Changes to the DSM have broad implications including the categorization of disorders for research purposes, the way disorders are conceptualized and what disorders will qualify for insurance reimbursement.
We've compiled a list of the biggest changes in the DSM-5. This list is not exhaustive—it covers the changes that are perceived as being the most influential, or simply the most interesting.
Autism Spectrum Disorder
The DSM-5 has done away with the old distinction of Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder, in favor of the single autism spectrum disorder diagnosis. There is consensus that these disorders represent a single condition at varying levels of severity.
Specific Learning Disorder
Reading disorder, mathematics disorder, disorder of written expression, and learning disorder not otherwise specified have been combined under the single diagnosis of specific learning disorder.
Due to low reliability and poor validity, the subtypes of schizophrenia (paranoid, disorganized, catatonic, and undifferentiated) have been eliminated. These subtypes were poor predictors of treatment response and longitudinal course of schizophrenia. A new approach will be used to rate the severity of schizophrenia's core symptoms.
The specifier of "mixed episode" no longer requires the full criteria for both a manic and depressive episode to occur simultaneously. The new specifier, "with mixed features", can be applied to depressive or manic episodes when features of the other are present.
Major Depressive Disorder
The core criteria of major depressive disorder are unchanged. However, the specifier "with mixed features" can be affixed to a diagnosis of major depressive disorder to indicate symptoms of mania without meeting the full criteria for a manic or hypomanic episode.
The DSM-IV requirement that individuals over age 18 recognize their anxiety as excessive or unreasonable has been removed. Additionally, the DSM-5 requires that fears must exist for at least 6 months before being categorized as phobic.
Obsessive-Compulsive and Related Disorders
Obsessive compulsive disorder has been removed from the anxiety disorders and moved under the new heading, Obsessive-Compulsive and Related Disorders. Disorders in this category include body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling), excoriation (skin-picking) disorder, obsessive-compulsive disorder, and more.
Somatic Symptoms Disorder
Somatization disorder from the DSM-IV has been renamed to Somatic Symptom Disorder. DSM-5 criteria emphasize maladaptive thoughts, feelings, and behaviors, in addition to somatic symptoms. This deviates from the previous emphasis on medically unexplained symptoms.
Disruptive, Impulse-Control, and Conduct Disorders
The DSM-5 introduces a new chapter—Disruptive, Impulse-Control, and Conduct Disorders—which includes disorders characterized by difficulty with emotional and behavioral self-control. Some of these include oppositional defiant disorder, conduct disorder, and intermittent explosive disorder.
Substance-Related and Addictive Disorders
The DSM-5 has expanded the addictions chapter to include non-substance-related addictions. Addictions will no longer be categorized as abuse or dependence, but instead by the rankings mild disorder, moderate disorder, or severe disorder. Rankings are determined by the number of criteria that have been met.
Because gambling has been found to activate the brain's reward system in ways similar to drugs of abuse, and the symptoms are similar to those of substance use disorders, it will now be recognized in the addictions chapter of the DSM-5.
Personality traits and functioning can now be assessed in clients who do not meet criteria for a personality disorder. The DSM-5 emphasizes the functionality of personality traits rather than the diagnosis of personality disorders. Additionally, the threshold of diagnosis for specific personality disorders has been changed to reduce misdiagnosis.
Other Changes in the DSM-5
- Mental retardation has been renamed to "intellectual disability".
- Gender dysphoria will emphasize "gender incongruence" rather than cross-gender identification.
- The bereavement exclusion has been removed from major depressive disorder.
- Agoraphobia and panic disorder are no longer linked, and are now two unique diagnoses.
- Hypochondriasis has been replaced by illness anxiety disorder.
- The criteria for anorexia nervosa no longer require amenorrhea (the absence of menstruation).