DSM 5 Essentials

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been the standard used in
the assessment and diagnosis of psychopathology in the United States within the last 60 years.
The latest edition incorporates the codes utilized by the International Classification of Diseases-
Clinical Modifications (ICD-CM 10) by the World Health Organization.
It incorporates researches on the brain, human behavior, and genetics.
The DSM 5 is divided into three sections:
Section 1 talks about the correct use of the manual, the diagnosis using a non-axial
format, and the definition of mental disorder.
Section 2 includes the 20 classifications of disorders including their diagnostic criteria
and codes
Section 3 talks about the emerging measures and models, including assessment
procedures, cultural formulations, an alternative model of personality disorders, and
conditions for further study

Using a non-axial system

The DSM 5 has dropped the multiaxial system that was used within the former editions of the
DSM.
The rational for this is that the ICD-CM 10 does not utilize a multiaxial format, and would just list
as many conditions applicable, with the most important condition that needs immediate
intervention listed first.
There are two labels utilized once the diagnosis has been given:
Principal Diagnosis given to the most important diagnosis if the patient was diagnosed
in an in-patient setting
Reason for Visit given to the most important diagnosis if the patient was diagnosed in
an out-patient setting
The Global Assessment of Functioning was replaced with the utility of the WHO Disability
Assessment Schedule which measures effectiveness in ones activities of daily living (ADLs).

Dimensional Approach to Diagnosis

The former editions of the DSM utilized a categorical approach that based their diagnosis on the
mere presence or absence of a symptom.
The DSM5 utilizes a dimensional approach to diagnosis, placing the symptom in a spectrum that
ranges from very mildly present to being cripplingly severe.
The result of this is that the patient being assessed could be properly placed to where his
condition resides, which in-turn leads to a more effective intervention.

Use of Other Specified and Unspecified Disorders

In the prior editions of the DSM, the patients whose characteristic and number of symptoms did
not fit the criteria for diagnosis were given a Not Otherwise Specified (NOS) diagnosis. This
became a safer diagnosis that most assessments ended up with it.
For the DSM 5, this was changed to the Other Specified and Unspecified Diagnostic labels
Other Specified Disorder this is utilized if the patients symptoms do not exactly fit the
criteria given by the DSM in terms of number (e.g. need 4, the patient only has 2) or
duration (e.g. the symptoms should be present for 6 months, the patient only has 4), but
 has a close similarity to a specific disorder. In lieu of this, the clinician needs to explain
the reason for not fitting the patient to a specific disorder.
Unspecified Disorder this is utilized if the patients symptoms do not exactly fit the
criteria given by the DSM, but the clinician chooses not to disclose the reason or does
not have complete information about the case to warrant a specific diagnostic

Classification and Organization of the Disorders

When possible, the DSM 5 chapters have been organized in keeping with a developmental focus
across the lifespan. This is the reason why the book starts on Neurodevelopmental disorders
(which are seen in younger people), and Neurocognitive disorders (which are seen among older
people) are bringing up the rear.
In addition, they also follow a developmental approach
The disorders have also been classified in clusters based on internalizing or externalizing factors.
Internalizing disorders have anxiety, depression, and somatic symptoms as more
prevalent.
Externalizing disorders have disturbances of conduct, impulse control, and substance
use as more prevalent.
Some of the diagnostic criteria have been made more gender and culturally sensitive.

20 Classifications of Disorders
1. Neurodevelopmental Disorders
1. Schizophrenia Spectrum and
Psychotic Disorders
2. Bipolar and Related Disorders
3. Depressive Disorders
4. Anxiety Disorders
5. Obsessive-Compulsive and Related
Disorders
6. Trauma-and Stressor-Related Disorders
7. Dissociative Disorders
8. Somatic Symptom and Related Disorders
9. Feeding and Eating Disorders
11. Elimination Disorders
Other 12. Sleep-Wake Disorders
13. Sexual Dysfunctions
14. Gender Dysphoria
15. Disruptive, Impulse-Control, and Conduct
Disorders
16. Substance-Related and Addictive Disorders
17. Neurocognitive Disorders
18. Personality Disorders
19. Medication-Induced Movement Disorders
and Other Adverse Effects of Medications
20. Other Conditions that may be a focus of
Clinical Attention

A. Neurodevelopmental Disorders
Disorders that first appear during childhood, often before the child starts school
The resulting deficits cause difficulties in personal, social, and academic functioning
Some deficits are discrete (e.g. specific learning disorder), while others are global deficits
or delays (e.g. autism spectrum disorder)
This cluster includes the following:
Intellectual Disability (Formerly known as Mental Retardation)
Should include impairments across conceptual, social, and pragmatic domains
Communication Disorder
Autism Spectrum Disorder
 Combined from Autism, Asperger, childhood Disintegrative disorder, and
Pervasive Developmental Disorder
Attention Deficit/Hyperactivity Disorder
With a focus on the symptoms that surfaced before age 12
Specific Learning Disorder
Motor Disorders
Tic Disorders

B. Schizophrenia Spectrum and Other Psychotic Disorders

Deals with the impairment of reality functioning
Schizophrenia lost the subtypes that it had in prior versions of the DSM
Catatonia is now a specifier for Psychotic, Bipolar, Depressive, and Obsessive-Compulsive
thoughts
Includes the following conditions:
Schizotypal Personality Disorder
Delusional Disorder
Brief Psychotic Disorder
Schizophreniform Disorder
Schizophrenia
Schizoaffective Disorder (Bipolar or Depressive type)
Substance/Medication-Induced Psychotic Disorder
Psychotic Disorder due to Another Medical Condition
Catatonia (Associated with Another Mental Disorders/Due to Another Medical
Disorder)

C. Bipolar and Related Disorders

Characterized by having two or three distinct moods (i.e. manic, hypomanic, and
depressive) that alternate with one another
Includes the following conditions:
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Substance/Medication-Induced Bipolar and Related Disorder

D. Depressive Disorders
Characterized by a unipolar dysphoric mood
Includes two new disorders:
Disruptive Mood Dysregulation Disorder (DMDD): seen in children with extreme
irritability, as well as behavioral and emotional dysregulation
Premenstrual Dysphoric Disorder: a dysphoric mood present seen in women prior
to their menstrual period, and ceases as the menstrual period progresses
Dysthymia and Chronic Major Depressive Disorder were combined to become Persistent
Depressive Disorder
Includes the following conditions:
Disruptive Mood Dysregulation Disorder
Major Depressive Disorder
Persistent Depressive Disorder
 Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive Disorder

E. Anxiety Disorders
One out of the three divisions done from the Anxiety Disorders known in DSM IV
(Obsessive-Compulsive and Trauma-related disorders are the other two)
Characterized by an extreme apprehension towards things that are supposed to happen
Includes the following conditions:
Separation Anxiety Disorder
Selective Mutism
Specific Phobia
Social Anxiety Disorder
Substance/Medication-Induced Anxiety Disorder

F. Obsessive-Compulsive and Related Disorders

Characterized by having recurrent thoughts that could only be extinguished by a
repetitive action
Includes the following conditions:
Obsessive-Compulsive Disorder
Body Dysmorphic Disorder
Hoarding Disorder
Trichotillomania
Excoriation Disorder
Substance/Medication-Induced Obsessive-Compulsive and Related Disorder

G. Trauma-and Stressor-Related Disorder

Characterized by having a stress-inducing experiences that cause significant distress and
dysfunction in ones activities of daily living
Includes the following conditions:
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
Posttraumatic Stress Disorder (both for Children and Adults)
Acute Stress Disorder
Adjustment Disorder

H. Dissociative Disorders
Characterized by a discontinuity and disruption of experience and consciousness, with a
difficulty in recalling what has transpired during the shift
Includes the following conditions:
Dissociative Disorders
Dissociative Amnesia
Depersonalization/Derealization Disorder

I. Somatic Symptom and Related Disorders

 Characterized by the excessive concern about physical symptoms or a medical disorder,
which is responded by compensating for the said bodily concern through medical
procedures
Includes the following conditions:
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder
Psychological Factors Affecting Other Medical Conditions

J. Feeding and Eating Disorder

Characterized by abnormal ingestion habits, including the way patients look at food, and
consequences that they perceive which come out from the eating process
Includes the following conditions:
Pica (both for children and adults)
Rumination Disorder
Avoidant/Restrictive Food Intake Disorder
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder

K. Elimination Disorders
Characterized by an abnormality towards voiding solid and liquid body wastes
Includes the following conditions:
Enuresis
Encopresis

L. Sleep-Wake Disorders
Characterized by abnormalities that occur whilst the person is under the sleeping state
of consciousness
Includes the following conditions:
Insomnia
Hypersomnolence Disorder
Narcolepsy
Breathing-Related Sleep Disorders
Parasomnia
Non-Rapid Eye Movement Sleep Arousal Disorders
Substance/Medication-Induced Sleep Disorder

M. Sexual Dysfunction
Characterized by abnormalities in Sexual Performance
Includes the following conditions:
Delayed Ejaculation
Erectile Disorder
Female Orgasmic Disorder
Female Sexual Interest/Arousal Disorder
Genito-Pelvic Pain/Penetration Disorder
Male Hypoactive Sexual Desire Disorder
 Premature (Early) Ejaculation
Substance/Medication-Induced Sexual Dysfunction

N. Gender Dysphoria/ Gender Identity Disorder

Characterized by a distress brought upon by a dissatisfaction with the current gender
orientation
Diagnosis is available for Children, Adolescents, and Adults

O. Disruptive, Impulse-Control, Conduct Disorders

Characterized by lack of emotional and behavioral self-control, which cause significant
distress to the people around the patient
Includes the following conditions:
Oppositional Defiant Disorder
Intermittent Explosive Disorder
Conduct Personality Disorder
Antisocial Personality Disorder
Pyromania
Kleptomania

P. Substance-Related and Addictive Disorders

Characterized by a resulting addiction towards a substance or concept
Substance Abuse and Dependence were combined into one called Substance-Use
Disorder
There is a need for the satisfaction of 2 criteria to warrant a diagnosis (increased from
one)
New Disorders: Cannabis and Caffeine Withdrawal
Gambling Disorder had been included because of its addictive nature
Includes the following conditions:
Substance-related
Substance Substance Substance Substance
Use Intoxication Withdrawal
Alcohol Yes Yes Yes
Caffeine No Yes Yes
Cannabis Yes Yes Yes
Hallucinogen
Phencyclidine Yes Yes No
Other Hallucinogen Yes Yes No
Inhalants Yes Yes No
Opioids Yes Yes Yes
Sedative, Hypnotic, and Anxiolytic Yes Yes Yes
Stimulant Yes Yes Yes
Tobacco Yes No Yes
Other (or Unknown) Substance Yes Yes Yes

Non-Substance Related
Gambling Disorder
Q. Neurocognitive Disorders
Characterized by acquired (rather than developmental) cognitive, behavioral and
functional impairments
Includes the following conditions:
Delirium
Major/Mild Neurocognitive Disorders
Etiologies:
Due to Alzheimers Disease
Frontotemporal Degeneration
With Lewy Bodies
Vascular Neurocognitive Disorders
Due to Traumatic Brain Injuries
Substance/medication-Induced
Due to HIV Infection
Due to Prions Disease
Due to Huntingtons Disease
Due to another medical condition
Due to multiple etiologies

R. Personality Disorders
Characterized by a pervasive, ego-syntonic condition that causes dysfunction and
disability
Includes the following conditions:
Cluster A: Weird
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Cluster B: Wild
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Cluster C: Worrying
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive Personality Disorder

S. Paraphilic Disorders
Characterized by an intense and persistent interest in sexual arousal and gratification
based on fantasizing and engaging in sexual behavior involving objects, suffering or
humiliation, children, and non-consenting partners
Includes the following conditions:
Voyeuristic Disorder
Exhibitionistic Disorder
Frotteuristic Disorder
Sexual Masochism Disorder
Sexual Sadism Disorder
 Pedophilic Disorder
Fetishistic Disorder
Transvestic Disorder