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DSM 5
1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5)
by Burhan Hadi
Author American Psychiatric Association
Country United States
Language English
Series Diagnostic and Statistical Manual of Mental Disorders
Subject Classification and diagnosis of mental disorders
2. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTALDISORDERS Fifth edition (DSM-5)
Introduction
Differences in defining and describing mental illness and mental health led to a concerted effort
by psychiatrists to develop systems for classifying mental illness that would be relevant for use
across cultures and which could be used by clinicians to detect, diagnose, and treat mental
illness.
The two classification systems common used are the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association
(APA) in 2013, and the International Classification of Mental and Behavioral Disorders, now in
its eleventh vision (ICD-11), published by the World Health Organization in 2015.
Although student nurses do not use the DSM-5 to diagnose clients, they will find it a helpful
resource to understand the reason for the admission and to begin building knowledge about the
nature of psychiatric illnesses.
3. Systemclassifications of Psychiatry
1. ICD by WHO
2. DSM by APA
3. Chinese Classification of Mental Disorders [CCMD]
4. Latin American Guide for Psychiatric Diagnosis
4. Brief History of the DSM
• DSM I (1952) (106 disorders); very brief manuals, guided by psychoanalysis, gross categories
(e.g., neurosis, psychosis), lack of reliability, no research base.
• DSM II (1968) (185 disorders).
• DSM III (1980) (265 disorders).
• DSM IV (1994), DSM IV- TR (2000) (357 disorders). field trials to improve reliability, better
research base, multiaxial classification.
• DSM-5 (2013) ;( 20 categories - 157 disorder) field trials were conducted to evaluate the
clinical utility and feasibility of the proposed diagnosis and dimensional measurement.
5. DEVELOPMENTOF THE DSM-5
• Development started with 1999 meeting and task force recruited in 2006.
. Work Groups considered dimensional measures. e.g. severity scales or cross-
cutting across disorders, culture/gender issues.
. 2246 patients interviewed (86% twice) based on DSM-5 criteria.
• Interviews were conducted by 279 clinicians in various disciplines.
• Over 1000 members/consultants involved.
• Internet postings of changes for review done, and a Scientific Review Committee
reviewed evidence for validating revisions.
• Peer Review process with hundreds of experts considered clinical/public health
risks and benefits of proposed changes.
• Finally approved by the APA in November 2012 and by the Board of trustees in
December 2012
6. The DSM-5 has three purposes
1. Provide a standardized nomenclature and language for all mental health
professionals .
2. To distinguish one psychiatric diagnosis from another, so that clinicians can offer
the most effective treatment.
3. To explore the still unknown causes of many mental disorders.
7. •Why is the roman numeral
discarded? DSM –IV to DSM-
5,because
• the incremental updates will be identified with
decimals, i.e. DSM–5.1, DSM–5.2, etc., until a new
edition is required.
• Diagnostic codes will change from numeric to
alphanumeric e.g., Obsessive Compulsive Disorder
will change from 300.3 to F42
So what’s different?
8. ICD
•New version ICD-11: 2015.
•International-WHO
•Different criteria for clinical & research
•All languages
•Not include social factors (international)
•Part of general classification
•Approved by World Health Assembly
DSM
•New version DSM 5: 2013
•APA
•One version
•English
•Includes social factors (national)
•Only mental disorders
•Approved by APA Board of Trustees
and APAAssembly
Differentiation between DSMand ICD
9. Arguments for and against DSM-5
Arguments for DSM-5
• Enables more accurate diagnoses that help
people to access appropriate treatment, care,
services, and benefits
• Mental disorder is often uncertain, and it
helps to have a diagnostic guide to which
people can refer for information
• The best available method of classifying
mental disorder
• Includes a large amount of practical
knowledge in a useful format
Arguments against DSM-5
• Lack of empirical validity for many
of the conditions listed
• Over medical of mental health.
• Focus on conditions rather than on
people.
• Overly strong influence of the
pharmacological industry
• Lack of prognostic value
11. Axis –II
Personality disorder & mental
retardation
Axis –I
Psychiatric disorders
Axis III
Medical problems
Diagnosis
Axis IV
Psychosocial and environment
problem
Axis V (GAF)
Global assessment of functions
Psychosocial & contextual factors
World Health Organization
Disability Assessment
Schedule (WHODAS)
DSM–IV TR DSM-5
12. Chapter Organization for DSM-5
A. Neurodevelopmental Disorders
B. Schizophrenia Spectrum and Other
Psychotic Disorders
C. Bipolar and Related Disorders
D. Depressive Disorders
E. Anxiety Disorders
F. Obsessive-Compulsive and Related
Disorders
13. Chapter Organization for DSM-5 (cont’d)
G. Trauma- and Stressor-Related Disorders
H. Dissociative Disorders
I. Somatic Symptom and Related Disorders
J. Feeding and Eating Disorders
K. Elimination Disorders
L. Sleep-Wake Disorders
M.Sexual Dysfunctions
N. Gender Dysphoria
14. Chapter Organization for DSM-5 (cont’d)
O. Disruptive, Impulse Control, and
Conduct Disorders
P. Substance-Related and Addictive
Disorders
Q. Neurocognitive Disorders
R. Personality Disorders
T. Paraphilic Disorders
U. Other Mental Disorders
16. Neurodevelopmental Disorders: Autism
Spectrum Disorder
DSM-IV-TR DSM-5
Autistic Disorder
Rett’s Disorder
Childhood Disintegrative Disorder
Asperger’s Disorder
Pervasive Developmental Disorder NOS
Autism Spectrum Disorder
Social (Pragmatic) Communication
Disorder
16
17. Childhood Disintegrative
disorder
Autistic Disorder
Asperger's Disorder
Autism Spectrum Disorder
Pervasive Developmental
Disorder NOS
Rett’s Disorder
Can still be diagnosed as ASD but
with specifier ‘with known genetic
or medical condition’
PervasiveDevelopmentalDisorder DSM-5
18. Neurodevelopmental Disorder:
Attention-Deficit/Hyperactivity DisorderADHD
DSM-IV-TR DSM-5
Attention-Deficit/Hyperactivity
Disorder
Attention-Deficit/Hyperactivity
Disorder
• Inattention
• Hyperactivity-impulsivity
• Inattention
• Hyperactivity and impulsivity
• Age of onset: before age 7 • Age of onset: before age 12
• Symptoms described so as to better
able to diagnose adolescents and
adults
19. Intellectual Disability
• Formerly Mental retardation. Previously part of Axis II
of DSM- IV TR
• In DSM IV Levels of Retardation based on Intelligence
Quotient (IQ Scores):
• Mild (IQ = 50/55 to 70),
• Moderate (IQ=35/40 to 50/55),
• Severe (IQ= 20/25 to 35/40),
• Profound (IQ= <20/25)
• Severity Unspecified (Un measurable)
• DSM-5 focus is on adaptive functioning assessment
with severity based on adaptive functioning rather than
(IQ Scores) and all symptoms must have an onset
during the developmental period.
20. Communication disorders
• Speech sound disorder (replace phonological disorder)
• stuttering (replace Childhood-onset fluency disorder)
• Social (pragmatic) communication disorder, a new condition
for persistent difficulties in the social uses of verbal and
nonverbal communication.
21. paranoid disorganized catatonic undifferentiated Residual
Schizophrenia
No more subtypes
Schizophrenia Spectrumand Other Psychotic Disorders
23. Psychotic disorders time frames
Unchanged from DSM-IV
Brief psychotic
disorder
Less than 1 month
Schizophreniform
disorder
1-6 months
Schizophrenia
Greater than
6 months
Duration of disturbance
24. Bipolar and Related Disorders
Disorders in this group:
• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder
• Substance/Medication-Induced Bipolar and Related Disorder
• Bipolar and Related Disorder Due to Another Medical Condition
• Other Specified…
• Unspecified.
25. Depressive Disorders
DSM-IV-TR DSM-5
Disruptive Mood Dysregulation Disorder
Major Depressive Episode Major
Depressive Disorder (Single,
Recurrent)
Major Depressive Disorder
Bereavement as an exclusion criterion
deleted
Dysthymic Disorder Persistent Depressive Disorder
(Dysthymia)
Premenstrual Dysphoric Disorder Premenstrual Dysphoric Disorder
Mood Disorder Not Other Specified
(NOS)
Other Specified Depressive Disorder
Unspecified Depressive Disorder
26. Anxiety Disorders
DSM-IV-TR DSM-5
Separation Anxiety Disorder Separation Anxiety Disorder
Selective Mutism Selective Mutism
Specific Phobia Specific Phobia
Social Phobia (Social Anxiety Disorder) Social Anxiety Disorder (Social Phobia)
Panic Disorder Without Agoraphobia Panic Disorder
Panic Disorder With Agoraphobia Agoraphobia
Generalized Anxiety Disorder Primary Anxiety Disorder
27. Obsessive-Compulsive and Related Disorders
DSM-IV-TR DSM-5
Obsessive-Compulsive Disorder Obsessive-Compulsive Disorder
Body Dysmorphic Disorder Body Dysmorphic Disorder
Hoarding Disorder
Trichotillomania Trichotillomania (Hair-Pulling)
Disorder
Excoriation (Skin-Picking) Disorder
28. Trauma- and Stressor-Related Disorders
DSM-IV-TR DSM-5
Reactive Attachment Disorder of Infancy
or Early Childhood
•Inhibited type
•Disinhibited type
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
Posttraumatic Stress Disorder Posttraumatic Stress Disorder
(separate criteria for children 6 and younger)
Acute Stress Disorder Acute Stress Disorder
•experienced directly
•witnessed
•experienced indirectly
Adjustment Disorders Adjustment Disorders
28
30. Feeding and Eating Disorders
DSM-IV-TR DSM-5
Pica Pica
Rumination Disorder Rumination Disorder
Feeding Disorder of Infancy or Early
Childhood
Avoidant/Restrictive Food Intake Disorder
(extended criteria)
Anorexia Nervosa Anorexia Nervosa
•Amenorrhea deleted
•<85% of expected body weight criterion
deleted
•Severity criteria based on BMI
Bulimia Nervosa Bulimia Nervosa تم
Binge-Eating Disorder Binge-Eating Disorder
31. Neuro cognitive Disorders
• Dementia and Amnestic disorder are now subsumed under the new name of
“Major Neurocognitive disorder.”
• DSM-5 recognizes a less severe level of cognitive impairment called mild NCD.
• Major or mild vascular NCD due to Alzheimer’s disease have been retained.
32. Substance-Related and Addictive Disorders
DSM-IV-TR DSM-5
Substance Dependence
Substance Abuse
Substance Use Disorders
Alcohol Use Disorder
Cannabis Use Disorder
Opioid Use Disorder
Stimulant Use Disorder
Tobacco Use Disorder
Substance-Induced Disorders Substance-Induced Disorders
Impulse-Control Disorders
Pathological Gambling
Non-Substance-Related
Disorders
•Gambling Disorder
33. Personality disorders
•No major changes
•Finally 10 categories were retained
•Borderline personality disorder had the highest reliability
35. References
• American Psychiatric Association. Diagnostic and statistical manual of
mental disorders (5th ed.). Arlington, VA: American Psychiatric
Publishing;2013.
• Halter,M.: Varcarolis' Foundations of Psychiatric Mental Health
Nursing,7edition, 2014,
• American Psychiatric Association. Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Arlington, VA: American Psychiatric
Publishing; 2000.
• Stetka BS, Correll, CU. A Guide to DSM-5. Medscape Psychiatry. May 21,
2013. Retrived: 27th
Marchhttp://www.medscape.com/viewarticle/803884_15
• SOPHIA F. DZIEGIELEWSKI :DSM-5 in Action , 2015 by JohnWiley & Sons, Inc.
All rights reserved.
• https://www.youtube.com/watch?v=Oa2Ee5pFuhA
• https://www.youtube.com/watch?v=pGXQJyP4CaQ&list=PLdlFfrVsmlvBJSOy
VfpaR-TGQWJH6iQjW&index=4
Editor's Notes
19 main chapters (16 in DSM-IV)
A major change. Note also as first example of change in meta-structure: no longer a “child” chapter.
Modest changes, but note age of onset and more adult-friendly.
Modest diagnostic changes.
DMDD a major development; Bereavement a key site of controversy; PMDD.
Note that PD and A now distinct diagnoses.
Two new diagnoses.
IAD an an alternative to reduce stigma.
BED’s graduation appears to have solved the NOS problem for Eating Disorders.
Note the merging. Note the category of non-substance related disorders (a “behavioral” addiction)
