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Changes in DSM-5: An Overview

Sheila L. Videbeck, PhD, RN

Overview
The focus of this overview is major changes
between DSM-IV-TR (2000) and DSM-5
(2013).
Both organizational and conceptual changes in
diagnoses are included.
Further, inclusive and detailed changes and
explanations for changes are available at
www.DSM5.org/HighlightsofChanges

Major DSM-5 Changes


Elimination of the only age-based section:
Disorders Usually First Diagnosed in Infancy,
Childhood or Adolescence. Diagnoses from this
section have been distributed to other sections
based on disorder categories.
Creation of new sections: Neurodevelopmental
Disorders; Obsessive-Compulsive and Related
Disorders; Trauma- and Stressor-Related
Disorders.

Major DSM-5 Changes (continued)


Sections renamed to better reflect disorders in
the section
Change in the name of diagnoses (with
minimal change in individual diagnosis)
Change in conceptual approach to a set of
diagnoses, specifically Autism Spectrum
Disorder
Changes in definition, criteria for diagnoses,
and/or specifiers of the disorder

Major DSM-5 Changes (continued)


The term General medical condition has been
replaced throughout DSM-5 with Another
medical condition
Diagnoses are no longer placed on the multiaxial system of Axes I-V
The Global Assessment of Functioning Scale
(GAF) has been eliminated

Disorders Usually First Diagnosed


in Infancy, Childhood, or
Adolescence
This category has been eliminated
Disorders formerly in the section have been
distributed in other sections
Neurodevelopmental Disorders is a new section
that contains many of the diagnoses from this
old section

Intellectual Disability
Mental Retardation diagnosis has been
replaced with Intellectual Disability
Both cognitive capacity (IQ) and adaptive
functioning are assessed with severity based
on adaptive functioning rather than IQ

Communication Disorders is a
category in Neurodevelopmental
Disorders that includes:
1. Language Disorder (combines Expressive and
Mixed Receptive-Expressive Disorder)
2. Speech Sound Disorder (replaces
Phonological Disorder)
3. Childhood Onset Fluency Disorder (formerly
Stuttering)
4. Social Pragmatic Disorder (New)

Autism Spectrum Disorder


A conceptual change defines Autism Spectrum
Disorder as a single condition with different
levels of symptom severity 2 symptom
categories are: social communication &
interaction; and repetitive, behavior, interests,
& activities
Encompasses previous diagnoses of Autistic
Disorder, Aspergers Disorder, Childhood
Disintegrative Disorder, and Pervasive
Developmental Disorder NOS

Additional Neurodevelopmental
Disorder Diagnoses
Attention Deficit/Hyperactivity Disorder
Specific Learning Disorder (includes former
reading, math, written expression, and NOS
diagnoses)
Motor Disorders (includes Developmental
Coordination Disorder, Stereotypic Movement
Disorder, Tourettes Disorder, and other vocal
and motor tics, & unspecified disorders)

Schizophrenia Spectrum and other


Psychotic Disorders
Elimination of paranoid, undifferentiated,
disorganized, and residual subtypes
Delusional Disorder can now include bizarre
delusion(s)
Schizoaffective Disorder major mood episode
must be present for a majority of the total
duration of disorder

Bipolar and Related Disorders


Criteria for mania and hypomania now include
changes in activity and energy as well as mood
changes
Changes in diagnosis of Bipolar Disorder in
children on slide #13

Depressive Disorders
Disruptive Mood Dysregulation Disorder for
children under age 18 who have persistent
irritability and frequent extreme out of control
behavior (to address concerns about potential
overdiagnosis of Bipolar Disorder)
Persistent Depressive Disorder (replaces
Dysthymic Disorder)
Bereavement no longer excluded from
depression diagnosis

Anxiety Disorders
PTSD moved to new section called Trauma and
Stressor Related Disorders
OCD moved to new section called ObsessiveCompulsive and Related Disorders
Social Anxiety Disorder (replaces Social
Phobia)
Panic Disorder with Agoraphobia now 2
diagnoses, no longer one diagnosis
Separation Anxiety Disorder moved from the
old First Diagnosed in Infancysection

Obsessive-Compulsive and Related


Disorders
Obsessive-Compulsive Disorder moved from
Anxiety Disorder section
New Diagnosis: Hoarding Disorder
Body Dysmorphic Disorder moved from old
Somatoform Disorder section
Trichotillomania
Skin-picking Disorder
Substance-induced OCD and OCD due to
another medical condition

Trauma and Stressor-Related Disorders


Reactive Attachment Disorder moved from
the old First Diagnosed in Infancysection
Disinhibited Social Engagement Disorder
PTSD moved from Anxiety Disorders section
Acute Stress Disorder moved from Anxiety
Disorder Section
Adjustment Disorders old section of
Adjustment Disorders eliminated

Dissociative Disorders
Depersonalization/Derealization Disorder
concepts of depersonalization and derealization
combined to replace former Depersonalization
Disorder
Dissociative Fugue now a specifier under
Dissociative Amnesia instead of a stand-alone
diagnosis

Somatic Symptom and Related Disorders


Formerly called Somatoform Disorders
Somatic Symptom Disorder (replaces
Somatization Disorder)
Illness Anxiety Disorder (replaces
Hypochondirasis)
Conversion Disorder also called Functional
Neurological Symptom Disorder
Factitious Disorder: Imposed on self or
Imposed on other colloquially known as
Munchausens Syndrome and Munchausens by
proxy)

Feeding and Eating Disorders


Adult diagnoses of Anorexia Nervosa and
Bulimia Nervosa are essentially unchanged
New Diagnosis: Binge Eating Disorder
New Diagnosis: Avoidant/Restrictive Food
Intake Disorder
Pica and Rumination Disorder - moved from
former First Diagnosed in Infancysection

Disruptive, Impulse-Control, and


Conduct Disorders
Conduct Disorder and Oppositional Defiant
Disorder moved from former First Diagnosed
in Infancysection
Intermittent Explosive Disorder, Kleptomania,
& Pyromania moved from former ImpulseControl Disorder section

Substance-Related and Addictive


Disorders
Gambling moved from former ImpulseControl Disorder section
No longer a separation of substance abuse and
dependence
Categories reduced by combining
amphetamine and cocaine into stimulants;
phencyclidine included in hallucinogens; and
nicotine expanded to tobacco

Neurocognitive Disorders
Formerly Delirium, Dementia, and Amnestic
and other Cognitive Disorders section
Delirium remains in section
Amnestic Disorder and Dementia are now in a
new category called Mild or Major
Neurocognitive Disorder specified according to
etiology (vascular, HIV Infection, Traumatic
Brain Injury, Alzheimers Parkinsons
Huntingtons, Prion, other medical condition,
multiple etiologies), location (Frontotemporal),
or characteristics (with Lewy Bodies)

Personality Disorders

Personality Disorder diagnoses remain


unchanged in Section II
Another alternative approach is proposed in
Section III to be used for further study; it
contains changes proposed in drafts of DSM-5
which were not ultimately accepted
The alternate section has 6 rather than 10
diagnoses with criteria focusing on
personality traits and personality functioning

Additional Changes
For changes in criteria, definitions, or specifiers
that are routinely used by clinicians making
diagnoses, see the website
www.DSM5/HighlightsofChanges

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