Hani hamed dessoki, dsm 5 anxiety

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Hani hamed dessoki, dsm 5 anxiety

  1. 1. Changes from DSM-IV-TR to DSM-5 Dr. Hani Hamed Dessoki, M.D.Psychiatry Prof. Psychiatry Chairman of Psychiatry Department Beni Suef University Supervisor of Psychiatry Department El-Fayoum University APA member
  2. 2. Anxiety Disorders
  3. 3. Anxiety Disorders The anxiety must be out of proportion to the actual danger or threat in the situation” This chapter no longer includes OCD and PTSD DSM 5 creates new chapters for OCD and PTSD Chapter is arranged developmentally.  Sequenced by age of onset  Now includes Separation Anxiety and Selective Mutism
  4. 4. Anxiety Disorders Split into 3 chapters: – Anxiety Disorders: • Fight or flight system (Amygdala). – Trauma- & Stressor-Related Disorders. • Greater focus on affective response to external stressors. – OCD & Related Disorders. • Based on imaging and genetic studies, and treatment response. • Basal ganglia – movement circuit – focus on urge and behavior, less on anxiety.
  5. 5. Anxiety Disorders The DSM-5 chapter on anxiety disorder no longer includes obsessive-compulsive disorder (which is included with the obsessive-compulsive and related disorders) or posttraumatic stress disorder and acute stress disorder (which is included with the traumaand stressor-related disorders). However, the sequential order of these chapters in DSM-5 reflects the close relationships among them.
  6. 6. Anxiety Disorders  Separation Anxiety Disorder  Selective Mutism  Specific Phobia  Social Anxiety Disorder (Social Phobia)  Panic Disorder  Panic Attack (Specifier)  Agoraphobia  Generalized Anxiety Disorder  Substance/Medication-Induced Anxiety Disorder  Anxiety Disorder Due to Another Medical Condition  Other Specified Anxiety Disorder  Unspecified Anxiety Disorder
  7. 7. Agoraphobia, Specific Phobia, and Social Anxiety Disorder (Social Phobia) Changes in criteria : 1. Clients over 18 do not have to recognize that their anxiety is excessive or unreasonable. 2. Duration of 6 months or longer is required for all ages
  8. 8. Panic Attack The essential features of panic attacks remain unchanged DSM-IV terminology for describing different types of panic attacks is replaced with the terms unexpected and expected panic attacks.  panic attack can be listed as a specifier that is applicable to all DSM-5 disorders.
  9. 9. Panic Disorder and Agoraphobia Panic disorder and agoraphobia are unlinked in DSM-5.  are now replaced by two diagnoses, panic disorder and agoraphobia, each with separate criteria.
  10. 10. Specific Phobia The core features of specific phobia remain the same  but there is no longer a requirement that individuals over age 18 years must recognize that their fear and anxiety are excessive or unreasonable.  the duration requirement (“typically lasting for 6 months or more”) now applies to all ages. they are now referred to as specifiers, the different types of specific phobia have essentially remained unchanged.
  11. 11. Social Anxiety Disorder (Social Phobia) The essential features of social anxiety disorder remain the same.  However, a number of changes have been made: 1. deletion of the requirement that individuals over age 18 years must recognize that their fear or anxiety is excessive or unreasonable 2. duration criterion of “typically lasting for 6 months or more” is now required for all ages. 3. the “generalized” specifier has been deleted and replaced with a “performance only” specifier.
  12. 12. Separation Anxiety Disorder In DSM-IV, separation anxiety disorder was classified in the section “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence,” it is now classified as an anxiety disorder.  The core features remain mostly unchanged,  the wording of the criteria has been modified to more adequately represent the expression of separation anxiety symptoms in adulthood.  the diagnostic criteria no longer specify that age at onset must be before 18 years.  a duration criterion—“typically lasting for 6 months or more”—has been added for adults to minimize over diagnosis of transient fears.
  13. 13. Selective Mutism In DSM-IV, selective mutism was classified in the section “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence.” It is now classified as an anxiety disorder.  The diagnostic criteria are largely unchanged from DSM-IV.
  14. 14. Obsessive-Compulsive & Related Disorders      OCD. Hoarding Disorder. Excoriation (Skin Picking Disorder). Trichotillomania (Hair Pulling Disorder) Substance/Medication Induced ObsessiveCompulsive & Related Disorder.  Due to Another Medical Condition.
  15. 15. OCD The chapter on obsessive-compulsive and related disorders, which is new in DSM-5.  New disorders include hoarding disorder, excoriation (skin-picking) disorder, substance/medicaton-induced obsessive-compulsive disorder. trichotillomania is now termed trichotillomania (hair-pulling disorder) and has been moved from a DSM-IV classifcation of impulse-control disorders.
  16. 16. Hoarding is no longer a variant of obsessivecompulsive disorder. Separate diagnosis of hoarding disorder, reflects persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them. Hoarding disorder may have unique neurobiological correlates.
  17. 17. Specifiers DSM-5 to allow a distinction between individuals with good or fair insight, poor insight, and “absent insight/delusional” obsessive-compulsive disorder beliefs (i.e., complete conviction that obsessive-compulsive disorder beliefs are true). This warrants a diagnosis of the relevant obsessive-compulsive or related disorder, rather than a schizophrenia spectrum and other psychotic disorder.
  18. 18. OCD and Related Disorders Specifiers listed for each OCD disorder -Specifier “with poor insight” in DSM- IV has been expanded in DSM- 5 -New Specifiers are - “with good or fair insight” - “with poor insight” - “with absent insight/delusional beliefs” Intent of these specifiers is to improve differential diagnoses
  19. 19. Body dysmorphic disorder “with muscle dysmorphia” specifier has been added to reflect a growing literature on the diagnosis. The delusional variant of body dysmorphic disorder (is no longer coded as both delusional disorder, somatic type, and body dysmorphic disorder; in DSM-5 this presentation is designated only as body dysmorphic disorder with the absent insight/delusional beliefs specifier.
  20. 20. DSM-5 includes new categories for substance-/medication-induced obsessivecompulsive and related disorder and  for obsessive-compulsive and related disorder due to another medical condition.
  21. 21. Other Specified and Unspecified Obsessive-Compulsive and Related Disorders DSM-5 includes conditions in this chapter such as Body-focused repetitive behavior disorder - other than excoriation and trichotillomania i.e. nail biting, lip chewing Obsessional jealousy
  22. 22. Truama and Stress related disorder Qualifying traumatic events were experienced directly, witnessed, or experienced indirectly. individuals may meet diagnostic criteria in DSM-5 for acute stress disorder if they exhibit any 9 of 14 listed symptoms in these categories: intrusion, negative mood, dissociaition, avoidance, and arousal.
  23. 23. Trauma- and Stressor-Related Disorders New chapter in DSM-5 brings together anxiety disorders that are preceded by a distressing or traumatic event Reactive Attachment Disorder Disinhibited Social Engagement Disorder (new) PTSD (includes PTSD for children 6 years and younger) Acute Stress Disorder Adjustment Disorders
  24. 24. Trauma- and Stressor-Related Disorders Disinhibited Social Engagement Disorder “The essential feature of disorder is a pattern of behavior that involves culturally inappropriate, overly familiar behavior with relative strangers. This behavior violates the social boundaries of the culture.” DSM-5, p. 269
  25. 25. Trauma- and Stressor-Related Disorders Acute Stress Disorder -Stressor criterion in DSM -5 is changed -Criterion requires being explicit whether qualifying traumatic events were experienced directly, witnessed, or experienced indirectly. -DSM-IV Criterion A2 regarding reaction to the event- “the person’s response involved intense fear, helplessness, or horror” – has been eliminated
  26. 26. Trauma- and Stressor-Related Disorders Adjustment Disorders -DSM-5 Adjustment Disorders are redefined as an array of stress-response syndromes occurring after exposure to a distressing event. Adjustment Disorder subtypes are unchanged - with depressed mood - with anxiety - with disturbance of conduct
  27. 27. PTSD Postraumatic stress disorder is now developmentally sensitive in that diagnostic thresholds have been lowered for children and adolescents and separate criteria have been added for children age 6 years or younger.
  28. 28. Trauma- and Stressor-Related Disorders Changes in PTSD Criteria Four symptom clusters, rather than three -Re-experiencing -Avoidance -Persistent negative alterations in mood and cognition -Arousal: describes behavioral symptoms
  29. 29. Trauma- and Stressor-Related Disorders Changes in PTSD Criteria DSM-5 more clearly defines what constitutes a traumatic event Sexual assault is specifically included Recurring exposure, that could apply to first responders
  30. 30. Trauma- and Stressor-Related Disorders Changes in PTSD Criteria Recognition of PTSD in Young children Developmentally sensitive: Criteria have been modified for children age 6 years and younger Thresholds – number of symptoms in each cluster - have been lowered
  31. 31. Exploration of Delayed-Onset Posttraumatic Stress Disorder After Severe Injury  Approximately half of the patients with delayedonset PTSD had minimal PTSD symptoms at 3 months; therefore, their delayed-onset PTSD could not be accounted for by a small number of fluctuating symptoms. As we move toward DSMV, it is important that research continues to explore the factors that underpin the development of delayed-onset PTSD. (O’Donnell et al,Psychosom Med, Jan 2013; 75: 68 - 75)

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