This document provides an overview of proposed changes to the DSM-5 classification system. It discusses the development process, organizational structure, proposed disorder names and categories, and major proposed changes. Some key changes include integrating dimensional approaches, changing some terminology and removing the clinical significance criterion. It also outlines proposed changes to specific disorder categories like autism, psychosis, mood disorders, personality disorders, and trauma/stressor disorders. The conclusion notes that DSM-5 is a work in progress with room for further improvement in future editions.

1. Classification systems in
psychiatry “part 2” : DSM-5

2. Contents
• Introduction
• Background information
• Proposed DSM-5 organizational structure and
disorder names
• Proposed changes
• Conclussion
• References

3. Introduction
• Development of DSM-5 , more than a decade in
process, has been the object of immense public
and professional interest
• Process began in 1999
• APA is working on the DSM-5 together with;
 NIMH
 WHO
 National institute on drug abuse
 National institute on Alcohol abuse and
alcoholism

4. Cont ...
• Currently in the final stages of consultation
and preparation
• Due for publication in May 2013
• Work groups are to address major gaps that
are in current DSM
• Working with WHO on an ongoing basis to
develop harmonization between d/o included
in both DSM-5 and ICD-11( ICD-11 due for
publication in 2015

5. Background
• DSM-5 task force was formed in 2007
• Composed of world-renowned leaders in
psychiatric research, dx , and treatment
• Has 13 work groups
• 160 members
• 97 psychiatrists, 47 psychologists, 2 peads
neurologists, 3epidem ,
• and there’s 1 representative each from paeds,
social work, paediatric nursing, speech therapy
and consumer groups
• Also more than 300 outside advisors
• Public input through the DSM5 website

6. Proposed DSM-5 organizational
structure and disorder names
1. Neurodevelopmental Disorders
2. Schizophrenia Spectrum and Other Psychotic Disorders
3. Bipolar and Related Disorders
4. Depressive Disorders
5. Anxiety Disorders
6. Obsessive-Compulsive and Related Disorders
7. Trauma and Stressor Related Disorders
8. Dissociative Disorders
9. Somatic Symptom Disorders
10. Feeding and Eating Disorders
11. Elimination Disorders
12. Sleep-Wake Disorders
13. Sexual Dysfunctions
14. Gender Dysphoria
15. Disruptive, Impulse Control, and Conduct Disorders
16. Substance Use and Addictive Disorders
17. Neurocognitive Disorders
18. Personality Disorders
19. Paraphilias
20. Other Disorders

7. Proposed “major” changes
• Proposed changes represent an opportunity to
improve the field from clinical and public
health perspectives
• Integrating new dimensional applications to
current categorical approaches
• Changing the definition of Mental/Psychiatric
d/o
 Changing of some terminology in the def
 Removal of the clinical significance criterion
(CSC)

8. Child and adolescent psych
changes
• Chapter now  neurodevelopmental d/o
• Proposal for single “autism spectrum d/o”
category that will incl. the current DSM-IV-TR
diagnoses
 Autism
 Asperger’s
 CDD
 PDD

9. Psychotic d/o group
• Suggestion of inclusion in the schizophrenia
spectrum and related d/o of a new d/o
attenuated psychosis syndrome
• For early diagnosis and intervention
• To avoid prolonged DUP

10. Mood d/o
• Separation of “bipolar and related d/o” and
“depressive d/o”
• The group is putting forth a proposal for the
addition of Mixed anxiety/Depression as a
new diagnosis

11. Personality d/o
• Reformulation of approach to assessment and
diagnosis of personality psychopathology incl
 Revised gen. Criteria
 Evaluation based on impairments in
personality fxning and pathological
personality traits
 An overall measure of personality dysfxn
• Dimensional-categorical model proposed

12. Cont...
• Six specific PD types proposed
 Antisocial
 Avoidant
 Borderline
 Narcissistic
 Obsessive-compulsive
 Schizotypal
• Also a new diagnosis of PDTS(Personality D/O Trait Specified)

13. Cont...
• Aim is to describe the personality
characteristics of all pts, whether they have a
personality d/o or not

14. Trauma- and Stressor-Related d/o
• New category
• Incl diagnoses previosly listed under anxiety
d/o and adjustment d/o i.e. AD,ASD,PTSD
• Recommendation to shift ASD and PTSD out of
the anxiety d/o section reflects increased
recognition of trauma as a precipitant,
• Emphasizing common etiology over common
phenomenology

15. Others
• “Somatoform d/o category” to “ somatic
symptom d/o
• “Sleep d/o” to “ sleep-wake d/o”
• “Sexual dysfxn” and “gender dysphoria”
• And other minor changes to existing DSM-IV-
TR D/O names

16. Conclusion
• DSM-5 is a work in progress
• There’s still room for improvement or change
• It is clear that the forthcoming version of the
DSM cannot exhaustively address all the
limitations and questions posed by the current
nosology
• Others will have to be addressed by DSM 5.1
or 5.2

17. August 2009 paper III (special
psychiatry)
If you were a member of the task team
currently planning the new DSM-V(due for
publication in 2012), what changes to this
classification system would you recommend?
Justify your recommendation fully.

18. References
1. www.DSM5.org
2. DSM-IV-TR
3. KUPFER , Am J Psychiatry 168:7,july 2011