The new changes in Psychiatric Diagnosis in DSM 5

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DSM 5 was published in May 2013. Psychiatric diagnosis such as depression, bipolar disorder, schizophrenia, asperger's syndrome and many others were revised and changed. This is a summary of some of the major changes and the debate raised about its validity.

Published in: Health & Medicine

The new changes in Psychiatric Diagnosis in DSM 5

  1. 1. DSM 5 - What haschanged in the BibleDictionary?Dr Scott Eaton, MBChB, MRCPsych, FRANZCPSternberg Clinic, BendigoSternberg S
  2. 2. HistoryFirst published 1952 to have a unifiedclassification system.1980 DSM 3 Dropped psychodynamic for theempiricalAxial system introduced
  3. 3. ProcessStarted in 1999 with DSM 5 research planningconferenceSix working groups: Nomenclature ,Neuroscience and Genetics, Developmentalissues and Diagnosis, Personality Disorder,Mental Disorders and Disability, and Cross-cultural IssuesDeveloped Peer reviewed White papers.Followed by recommendations by researchoriented panels.
  4. 4. 2007 Task Force to develop DSM 5scientists from psychiatry and otherdisciplines, clinical care providers, andconsumer and family advocates.Scientists working on the revision of the DSMhave experience in research, clinical care,biology, genetics, statistics, epidemiology,public health, and consumer advocacyDSM 5 Field Trials - reliability of diagnoses
  5. 5. Major ChangesDiagnostic reorganisationremoval infant/child disordersAxis II
  6. 6. NeurodevelopmentalDisordersIntellectual Disability - Mental retardationAssess cognitive AND functional capacitySeverity dependent on FUNCTIONCommunication Disorders (language, speech,fluency, social communication)Autism Spectrum Disorder - Autism,Asperger’s, Childhood disintegrative disorder,Pervasive developmental disorder
  7. 7. ADHD: Put in neurodevelpmental disordercategoryNo change to symptom checklist and remainin subgroups - inattention and hyperactiveSymptoms can occur later in life - before 12rather than 7Adults only require 5 not 6 symptoms
  8. 8. Schizophreniaremoval of special attribution symptoms -bizarre deusions and SchneiderianhallucinationsMust have 1 of delusions, hallucinations ordisorganised speechSubtypes have been removedSchizoaffective disorder requires major mooddisorder throughout much of the episode
  9. 9. Delusional disorder - demarcation from BDDand OCDCatatonia - same criteria throughout -previously different for some disorders!
  10. 10. Bipolar DisordersManic/Hypomanic symptoms emphasis onchanges in ACTIVITY ENERGY MOOD“with mixed features” - previously strictercriteria - needed full diagnosis of bothepisodes. Now only need feature(s)“Other specified” - flexibility (attenuated) ofdiagnosis with qualifiers“anxious distress” qualifier
  11. 11. Depressive disordersDisruptive mood dysregulation disorder - <18,irritable, frequent behavioural dyscontrolPremenstral dysphoric disorderPersistent depressive disorder - DysthymiaChronic Depressive DisorderMajor Depression - no change. “Mixed” - 3manic sx. Bereavement exclusion.
  12. 12. Anxiety DisordersOCD related disorders NOTTrauma related disorders NOT
  13. 13. Phobias - anxiety out of proportion with thethreatPanic attacks - expected/unexpected, qualifierSeparation Anxiety DisorderSelective mutism6 month duration
  14. 14. Obsessive CompulsiveReorganisationspecifiers - insight, delusional, tic-relatedBDDHoarding Disorder - persistent difficulty discarding orparting with possessions due to a perceived need to save the itemsand distress associated with discarding themTrichotillomaniaExcoriating disorderMedically/substance induced OCD
  15. 15. TraumaAcute stress - direct/witnessed/indirect andless emphasis on dissociative sxAdjustment - traumatic/non-traumaticPTSD - exposure to traumatic/catastrophic , 4clusters - reexperiencing, avoindance,numbing, arousalReactive Attachment D - separated fromdisinhibited social engagement disorder
  16. 16. Dissociative Disordersdepersonalization added to derealizationdisorderfugue added to dissociative amnesiaDissociative identity disorder
  17. 17. Somatic Symptom andrelated disordersMaladaptive thoughts, emotions andbehaviours with somatic symptomsmay or may not have medical conditionremoved the high symptom criteria
  18. 18. medically unexplained symptoms - lessemphasisHypochondriasis now illness anxiety disorderPain disorder-recognition of psychologicalfactors in all pain, “specifier” statusConversion disorder - do not need todemonstrate psychological factors initially
  19. 19. Eating Disorderavoidant/restrictive food intake disorder -catchallAnorexia Nervosa - amenorrhoeaBulaemia lower threshold - 1xweekly
  20. 20. Gender DysphoriaGender incongruencerather than cross gender identificationremove references to sex
  21. 21. Gambling to addictive disordersmild neurocognitive disorder
  22. 22. DEBATELack of transparency initially - issues of non-disclosure clause, greater public input,development process - ongoing scrutinyHigher level of contributors (70%) withaffiliation to pharma - disclosure of interestrequiredBorderline Personality Disorder
  23. 23. British Psychological Society It criticized proposed diagnoses as "clearly based largely on social norms, withsymptoms that all rely on subjective judgements... not value-free, but rather reflect[ing]current normative social expectations", noting doubts over the reliability, validity, andvalue of existing criteria.suggested a change from using "diagnostic frameworks" to a description based onan individuals specific experienced problems, and that mental disorders are betterexplored as part of a spectrum shared with normality.
  24. 24. NIMHResearch Domain Criteria - matrixConstructs - concepts regarding brainorganization and functiondomains of activity - brain circuitsunits of analysis - genes, molecules, cells,circuits, physiology, behaviour, self-report
  25. 25. The scientific foundation of psychiatric medicine has grown by leapsand bounds in the last fifty years. The emergence ofpsychopharmacology, neuroimaging, molecular genetics and biology,and the disciplines of neuroscience and cognitive psychology havelaunched our field into the mainstream of medicine and on a course forfuture growth and success. Though not everyone, including ourselves,is satisfied with the rate of our field’s progress, no one can argue withone simple fact; if you or a loved one suffers from a mental illness, yourability to receive effective treatment, recover and lead a productive lifeis better now than ever in human history.

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