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DSM-5

March 23, 2023

For the album of the same name, see Blood from the Soul.
Further information: Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. The DSM-5 is the only DSM to use a Hindu-Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.[1]

DSM-5
AuthorAmerican Psychiatric Association
CountryUnited States
LanguageEnglish
SeriesDiagnostic and Statistical Manual of Mental Disorders
SubjectClassification and diagnosis of mental disorders
PublishedMay 18, 2013
Media typePrint (hardcover, softcover); e-book
Pages947
ISBN978-0-89042-554-1
OCLC830807378
616.89'075
LC ClassRC455.2.C4
Preceded byDSM-IV-TR 
TextDSM-5 online

The DSM-5 is not a major revision of the DSM-IV-TR but there are significant differences. Changes in the DSM-5 include the reconceptualization of Asperger syndrome from a distinct disorder to an autism spectrum disorder; the elimination of subtypes of schizophrenia; the deletion of the "bereavement exclusion" for depressive disorders; the renaming and reconceptualization of gender identity disorder to gender dysphoria; the inclusion of binge eating disorder as a discrete eating disorder; the renaming and reconceptualization of paraphilias, now called paraphilic disorders; the removal of the five-axis system; and the splitting of disorders not otherwise specified into other specified disorders and unspecified disorders.

Many authorities criticized the fifth edition both before and after it was published. Critics assert, for example, that many DSM-5 revisions or additions lack empirical support; inter-rater reliability is low for many disorders; several sections contain poorly written, confusing, or contradictory information; and the psychiatric drug industry may have unduly influenced the manual's content, given many DSM-5 workgroup participants had ties to pharmaceutical companies.[2]

Changes from DSM-IV

The DSM-5 is divided into three sections, using Roman numerals to designate each section.

Section I

Section I describes DSM-5 chapter organization, its change from the multiaxial system, and Section III's dimensional assessments.[3] The DSM-5 dissolved the chapter that includes "disorders usually first diagnosed in infancy, childhood, or adolescence" opting to list them in other chapters.[3] A note under Anxiety Disorders says that the "sequential order" of at least some DSM-5 chapters has significance that reflects the relationships between diagnoses.[3]

The introductory section describes the process of DSM revision, including field trials, public and professional review, and expert review. It states its goal is to harmonize with the International Statistical Classification of Diseases and Related Health Problems (ICD) systems and share organizational structures as much as is feasible. Concern about the categorical system of diagnosis is expressed, but the conclusion is the reality that alternative definitions for most disorders are scientifically premature.

DSM-5 replaces the Not Otherwise Specified (NOS) categories with two options: other specified disorder and unspecified disorder to increase the utility to the clinician. The first allows the clinician to specify the reason that the criteria for a specific disorder are not met; the second allows the clinician the option to forgo specification.

DSM-5 has discarded the multiaxial system of diagnosis (formerly Axis I, Axis II, Axis III), listing all disorders in Section II. It has replaced Axis IV with significant psychosocial and contextual features and dropped Axis V (Global Assessment of Functioning, known as GAF). The World Health Organization's Disability Assessment Schedule is added to Section III (Emerging measures and models) under Assessment Measures, as a suggested, but not required, method to assess functioning.[4]

Section II: diagnostic criteria and codes

Neurodevelopmental disorders

Schizophrenia spectrum and other psychotic disorders

  • All subtypes of schizophrenia were removed from the DSM-5 (paranoid, disorganized, catatonic, undifferentiated, and residual) in favor of a severity-based rating approach.[3]
  • A major mood episode is required for schizoaffective disorder (for a majority of the disorder's duration after criterion A [related to delusions, hallucinations, disorganized speech or behavior, and negative symptoms such as avolition] is met).[3]
  • Criteria for delusional disorder changed, and it is no longer separate from shared delusional disorder.[3]
  • Catatonia in all contexts requires 3 of a total of 12 symptoms. Catatonia may be a specifier for depressive, bipolar, and psychotic disorders; part of another medical condition; or of another specified diagnosis.[3]

Bipolar and related disorders

Depressive disorders

Anxiety disorders

  • For the various forms of phobias and anxiety disorders, DSM-5 removes the requirement that the subject (formerly, over 18 years old) "must recognize that their fear and anxiety are excessive or unreasonable". Also, the duration of at least 6 months now applies to everyone (not only to children).[3]
  • Panic attack became a specifier for all DSM-5 disorders.[3]
  • Panic disorder and agoraphobia became two separate disorders.[3]
  • Specific types of phobias became specifiers but are otherwise unchanged.[3]
  • The generalized specifier for social anxiety disorder (formerly, social phobia) changed in favor of a performance only (i.e., public speaking or performance) specifier.[3]
  • Separation anxiety disorder and selective mutism are now classified as anxiety disorders (rather than disorders of early onset).[3]

Obsessive-compulsive and related disorders

  • A new chapter on obsessive-compulsive and related disorders includes four new disorders: excoriation (skin-picking) disorder, hoarding disorder, substance-/medication-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition.[3]
  • Trichotillomania (hair-pulling disorder) moved from "impulse-control disorders not elsewhere classified" in DSM-IV, to an obsessive-compulsive disorder in DSM-5.[3]
  • A specifier was expanded (and added to body dysmorphic disorder and hoarding disorder) to allow for good or fair insight, poor insight, and "absent insight/delusional" (i.e., complete conviction that obsessive-compulsive disorder beliefs are true).[3]
  • Criteria were added to body dysmorphic disorder to describe repetitive behaviors or mental acts that may arise with perceived defects or flaws in physical appearance.[3]
  • The DSM-IV specifier "with obsessive-compulsive symptoms" moved from anxiety disorders to this new category for obsessive-compulsive and related disorders.[3]
  • There are two new diagnoses: other specified obsessive-compulsive and related disorder, which can include body-focused repetitive behavior disorder (behaviors like nail biting, lip biting, and cheek chewing, other than hair pulling and skin picking) or obsessional jealousy; and unspecified obsessive-compulsive and related disorder.[3]

Trauma- and stressor-related disorders

  • Post traumatic stress disorder (PTSD) is now included in a new section titled "Trauma- and Stressor-Related Disorders."[11]
  • The PTSD diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of DSM-IV.[12]
  • Separate criteria were added for children six years old or younger.[3]
  • For the diagnosis of acute stress disorder and PTSD, the stressor criteria (Criterion A1 in DSM-IV) was modified to some extent. The requirement for specific subjective emotional reactions (Criterion A2 in DSM-IV) was eliminated because it lacked empirical support for its utility and predictive validity.[12] Previously certain groups, such as military personnel involved in combat, law enforcement officers and other first responders, did not meet criterion A2 in DSM-IV because their training prepared them to not react emotionally to traumatic events.[13][14][15]
  • Two new disorders that were formerly subtypes were named: reactive attachment disorder and disinhibited social engagement disorder.[3]
  • Adjustment disorders were moved to this new section and reconceptualized as stress-response syndromes. DSM-IV subtypes for depressed mood, anxious symptoms, and disturbed conduct are unchanged.[3]

Dissociative disorders

Somatic symptom and related disorders

  • Somatoform disorders are now called somatic symptom and related disorders.
  • Patients that present with chronic pain can now be diagnosed with the mental illness somatic symptom disorder with predominant pain; or psychological factors that affect other medical conditions; or with an adjustment disorder.[3][17][18][19][20]
  • Somatization disorder and undifferentiated somatoform disorder were combined to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms.[3]
  • Somatic symptom and related disorders are defined by positive symptoms, and the use of medically unexplained symptoms is minimized, except in the cases of conversion disorder and pseudocyesis (false pregnancy).[3]
  • A new diagnosis is psychological factors affecting other medical conditions. This was formerly found in the DSM-IV chapter "Other Conditions That May Be a Focus of Clinical Attention".[3]
  • Criteria for conversion disorder (functional neurological symptom disorder) were changed.[3]

Feeding and eating disorders

Elimination disorders

  • No significant changes.[3]
  • Disorders in this chapter were previously classified under disorders usually first diagnosed in infancy, childhood, or adolescence in DSM-IV. Now it is an independent classification in DSM 5.[3]

Sleep–wake disorders

Sexual dysfunctions

  • DSM-5 has sex-specific sexual dysfunctions.[3]
  • For females, sexual desire and arousal disorders are combined into female sexual interest/arousal disorder.[3]
  • Sexual dysfunctions (except substance-/medication-induced sexual dysfunction) now require a duration of approximately 6 months and more exact severity criteria.[3]
  • A new diagnosis is genito-pelvic pain/penetration disorder which combines vaginismus and dyspareunia from DSM-IV.[3]
  • Sexual aversion disorder was deleted.[3]
  • Subtypes for all disorders include only "lifelong versus acquired" and "generalized versus situational" (one subtype was deleted from DSM-IV).[3]
  • Two subtypes were deleted: "sexual dysfunction due to a general medical condition" and "due to psychological versus combined factors".[3]

Gender dysphoria

Further information: Gender dysphoria
  • DSM-IV's gender identity disorder is similar to, but not the same as, gender dysphoria in DSM-5. Separate criteria for children, adolescents and adults that are appropriate for varying developmental states are added.
  • Subtypes of gender identity disorder based on sexual orientation were deleted.[3]
  • Among other wording changes, criterion A and criterion B (cross-gender identification, and aversion toward one's gender) were combined.[3] Along with these changes comes the creation of a separate gender dysphoria in children as well as one for adults and adolescents. The grouping has been moved out of the sexual disorders category and into its own. The name change was made in part due to stigmatization of the term "disorder" and the relatively common use of "gender dysphoria" in the GID literature and among specialists in the area.[22] The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing and ability to express it in the event that they have insight.[23]

Disruptive, impulse-control, and conduct disorders

Some of these disorders were formerly part of the chapter on early diagnosis, oppositional defiant disorder; conduct disorder; and disruptive behavior disorder not otherwise specified became other specified and unspecified disruptive disorder, impulse-control disorder, and conduct disorders.[3] Intermittent explosive disorder, pyromania, and kleptomania moved to this chapter from the DSM-IV chapter "Impulse-Control Disorders Not Otherwise Specified".[3]

  • Antisocial personality disorder is listed here and in the chapter on personality disorders (but ADHD is listed under neurodevelopmental disorders).[3]
  • Symptoms for oppositional defiant disorder are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. The conduct disorder exclusion is deleted. The criteria were also changed with a note on frequency requirements and a measure of severity.[3]
  • Criteria for conduct disorder are unchanged for the most part from DSM-IV.[3] A specifier was added for people with limited "prosocial emotion", showing callous and unemotional traits.[3]
  • People over the disorder's minimum age of 6 may be diagnosed with intermittent explosive disorder without outbursts of physical aggression.[3] Criteria were added for frequency and to specify "impulsive and/or anger based in nature, and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences".[3]

Substance-related and addictive disorders

  • Gambling disorder and tobacco use disorder are new.[3]
  • Substance abuse and substance dependence from DSM-IV-TR have been combined into single substance use disorders specific to each substance of abuse within a new "addictions and related disorders" category.[24] "Recurrent legal problems" was deleted and "craving or a strong desire or urge to use a substance" was added to the criteria.[3] The threshold of the number of criteria that must be met was changed[3] and severity from mild to severe is based on the number of criteria endorsed.[3] Criteria for cannabis and caffeine withdrawal were added.[3] New specifiers were added for early and sustained remission along with new specifiers for "in a controlled environment" and "on maintenance therapy".[3]

There are no more polysubstance diagnoses in DSM-5; the substance(s) must be specified.[25]

Neurocognitive disorders

  • Dementia and amnestic disorder became major or mild neurocognitive disorder (major NCD, or mild NCD).[3][26] DSM-5 has a new list of neurocognitive domains.[3] "New separate criteria are now presented" for major or mild NCD due to various conditions.[3] Substance/medication-induced NCD and unspecified NCD are new diagnoses.[3]

Personality disorders

  • Personality disorder (PD) previously belonged to a different axis than almost all other disorders, but is now in one axis with all mental and other medical diagnoses.[27] However, the same ten types of personality disorder are retained.[27]
  • There is a call for the DSM-5 to provide relevant clinical information that is empirically based to conceptualize personality as well as psychopathology in personalities. The issue(s) of heterogeneity of a PD is problematic as well. For example, when determining the criteria for a PD it is possible for two individuals with the same diagnosis to have completely different symptoms that would not necessarily overlap.[28] There is also concern as to which model is better for the DSM - the diagnostic model favored by psychiatrists or the dimensional model that is favored by psychologists. The diagnostic approach/model is one that follows the diagnostic approach of traditional medicine, is more convenient to use in clinical settings, however, it does not capture the intricacies of normal or abnormal personality. The dimensional approach/model is better at showing varied degrees of personality; it places emphasis on the continuum between normal and abnormal, and abnormal as something beyond a threshold whether in unipolar or bipolar cases.[29]

Paraphilic disorders

  • New specifiers "in a controlled environment" and "in remission" were added to criteria for all paraphilic disorders.[3]
  • A distinction is made between paraphilic behaviors, or paraphilias, and paraphilic disorders.[30] All criteria sets were changed to add the word disorder to all of the paraphilias, for example, pedophilic disorder is listed instead of pedophilia.[3] There is no change in the basic diagnostic structure since DSM-III-R; however, people now must meet both qualitative (criterion A) and negative consequences (criterion B) criteria to be diagnosed with a paraphilic disorder. Otherwise they have a paraphilia (and no diagnosis).[3]

Section III: emerging measures and models

It includes dimensional measures for the assessment of symptoms, criteria for the cultural formulation of disorders and an alternative proposal for the conceptualization of personality disorders, as well as a description of the currently studied clinical conditions. It presents selected tools and research techniques focused on diagnosis, taking into account the sociocultural context, and also presents a hybrid-dimensional-categorical model of personality disorders. Specific personalities (antisocial, borderline, avoidant, narcissistic, obsessive-compulsive, schizotypal) and non-specific disorders were distinguished.

Conditions for further study

These conditions and criteria are set forth to encourage future research and are not meant for clinical use.

  • Attenuated psychosis syndrome
  • Depressive episodes with short-duration hypomania
  • Persistent complex bereavement disorder
  • Caffeine use disorder
  • Internet gaming disorder
  • Neurobehavioral disorder associated with prenatal alcohol exposure
  • Suicidal behavior disorder
  • Non-suicidal self-injury[31]

Development

In 1999, a DSM-5 Research Planning Conference, sponsored jointly by APA and the National Institute of Mental Health (NIMH), was held to set the research priorities. Research Planning Work Groups produced "white papers" on the research needed to inform and shape the DSM-5[32] and the resulting work and recommendations were reported in an APA monograph[33] and peer-reviewed literature.[34] There were six workgroups, each focusing on a broad topic: Nomenclature, Neuroscience and Genetics, Developmental Issues and Diagnosis, Personality and Relational Disorders, Mental Disorders and Disability, and Cross-Cultural Issues. Three additional white papers were also due by 2004 concerning gender issues, diagnostic issues in the geriatric population, and mental disorders in infants and young children.[35] The white papers have been followed by a series of conferences to produce recommendations relating to specific disorders and issues, with attendance limited to 25 invited researchers.[35]

On July 23, 2007, the APA announced the task force that would oversee the development of DSM-5. The DSM-5 Task Force consisted of 27 members, including a chair and vice chair, who collectively represent research scientists from psychiatry and other disciplines, clinical care providers, and consumer and family advocates. Scientists working on the revision of the DSM had a broad range of experience and interests. The APA Board of Trustees required that all task force nominees disclose any competing interests or potentially conflicting relationships with entities that have an interest in psychiatric diagnoses and treatments as a precondition to appointment to the task force. The APA made all task force members' disclosures available during the announcement of the task force. Several individuals were ruled ineligible for task force appointments due to their competing interests.[36]

The DSM-5 field trials included test-retest reliability which involved different clinicians doing independent evaluations of the same patient—a common approach to the study of diagnostic reliability.[37]

About 68% of DSM-5 task-force members and 56% of panel members reported having ties to the pharmaceutical industry, such as holding stock in pharmaceutical companies, serving as consultants to industry, or serving on company boards.[38]

Revisions and updates

Beginning with the fifth edition, it is intended that diagnostic guideline revisions will be added incrementally.[39] The DSM-5 is identified with Arabic rather than Roman numerals, marking a change in how future updates will be created. Incremental updates will be identified with decimals (DSM-5.1, DSM-5.2, etc.), until a new edition is written.[40] The change reflects the intent of the APA to respond more quickly when a preponderance of research supports a specific change in the manual. The research base of mental disorders is evolving at different rates for different disorders.[39]

Criticism

General

Robert Spitzer, the head of the DSM-III task force, publicly criticized the APA for mandating that DSM-5 task force members sign a nondisclosure agreement, effectively conducting the whole process in secret: "When I first heard about this agreement, I just went bonkers. Transparency is necessary if the document is to have credibility, and, in time, you're going to have people complaining all over the place that they didn't have the opportunity to challenge anything."[41] Allen Frances, chair of the DSM-IV task force, expressed a similar concern.[42]

Although the APA has since instituted a disclosure policy for DSM-5 task force members, many still believe the association has not gone far enough in its efforts to be transparent and to protect against industry influence.[43] In a 2009 Point/Counterpoint article, Lisa Cosgrove, PhD and Harold J. Bursztajn, MD noted that "the fact that 70% of the task force members have reported direct industry ties—an increase of almost 14% over the percentage of DSM-IV task force members who had industry ties—shows that disclosure policies alone, especially those that rely on an honor system, are not enough and that more specific safeguards are needed".[44]

David Kupfer, chair of the DSM-5 task force, and Darrel A. Regier, MD, MPH, vice chair of the task force, whose industry ties are disclosed with those of the task force,[45] countered that "collaborative relationships among government, academia, and industry are vital to the current and future development of pharmacological treatments for mental disorders". They asserted that the development of DSM-5 is the "most inclusive and transparent developmental process in the 60-year history of DSM". The developments to this new version can be viewed on the APA website.[46] During periods of public comment, members of the public could sign up at the DSM-5 website[47] and provide feedback on the various proposed changes.[48]

In June 2009, Allen Frances issued strongly worded criticisms of the processes leading to DSM-5 and the risk of "serious, subtle, [...] ubiquitous" and "dangerous" unintended consequences such as new "false 'epidemics'". He writes that "the work on DSM-V has displayed the most unhappy combination of soaring ambition and weak methodology" and is concerned about the task force's "inexplicably closed and secretive process".[49] His and Spitzer's concerns about the contract that the APA drew up for consultants to sign, agreeing not to discuss drafts of the fifth edition beyond the task force and committees, have also been aired and debated.[50]

The appointment, in May 2008, of two of the taskforce members, Kenneth Zucker and Ray Blanchard, led to an internet petition to remove them.[51] According to MSNBC, "The petition accuses Zucker of having engaged in 'junk science' and promoting 'hurtful theories' during his career, especially advocating the idea that children who are unambiguously male or female anatomically, but seem confused about their gender identity, can be treated by encouraging gender expression in line with their anatomy."[52] According to The Gay City News,

"Dr. Ray Blanchard, a psychiatry professor at the University of Toronto, is deemed offensive for his theories that some types of transsexuality are paraphilias, or sexual urges. In this model, transsexuality is not an essential aspect of the individual, but a misdirected sexual impulse."[53]

Blanchard responded, "Naturally, it's very disappointing to me there seems to be so much misinformation about me on the Internet. [They didn't distort] my views, they completely reversed my views."[53] Zucker "rejects the junk-science charge, saying there 'has to be an empirical basis to modify anything' in the DSM. As for hurting people, 'in my own career, my primary motivation in working with children, adolescents and families is to help them with the distress and suffering they are experiencing, whatever the reasons they are having these struggles. I want to help people feel better about themselves, not hurt them.'"[52]

In 2011, psychologist Brent Robbins co-authored a national letter for the Society for Humanistic Psychology that brought thousands into the public debate about the DSM. Approximately 13,000 individuals and mental health professionals signed a petition in support of the letter. Thirteen other American Psychological Association divisions endorsed the petition.[54] In a November 2011 article about the debate in the San Francisco Chronicle, Robbins notes that under the new guidelines, certain responses to grief could be labeled as pathological disorders, instead of being recognized as being normal human experiences.[55] In 2012, a footnote was added to the draft text which explains the distinction between grief and depression.[56]

The DSM-5 has been criticized for purportedly saying nothing about the biological underpinnings of mental disorders.[57] A book-long appraisal of the DSM-5, with contributions from philosophers, historians and anthropologists, was published in 2015.[58]

The financial association of DSM-5 panel members with industry continues to be a concern for financial conflict of interest.[59] Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members.[59]

A 2015 essay from an Australian university criticized the DSM-5 for having poor cultural diversity, stating that recent work done in cognitive sciences and cognitive anthropology is still only accepting western psychology as the norm.[60]

DSM-5 includes a section on how to conduct a "cultural formulation interview", which gives information about how a person's cultural identity may be affecting expression of signs and symptoms. The goal is to make more reliable and valid diagnoses for disorders subject to significant cultural variation.[61]

Borderline personality disorder controversy

In 2003, the Treatment and Research Advancements National Association for Personality Disorders (TARA-APD) campaigned to change the name and designation of borderline personality disorder in DSM-5.[62] The paper How Advocacy is Bringing BPD into the Light[63] reported that "the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing stigma." Instead, it proposed the name "emotional regulation disorder" or "emotional dysregulation disorder." There was also discussion about changing borderline personality disorder, an Axis II diagnosis (personality disorders and mental retardation), to an Axis I diagnosis (clinical disorders).[64]

The TARA-APD recommendations do not appear to have affected the American Psychiatric Association, the publisher of the DSM. As noted above, the DSM-5 does not employ a multi-axial diagnostic scheme, therefore the distinction between Axis I and II disorders no longer exists in the DSM nosology. The name, the diagnostic criteria for, and description of, borderline personality disorder remain largely unchanged from DSM-IV-TR.[65]

British Psychological Society response

The British Psychological Society stated in its June 2011 response to DSM-5 draft versions, that it had "more concerns than plaudits".[66] It criticized proposed diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements... not value-free, but rather reflect[ing] current normative social expectations", noting doubts over the reliability, validity, and value of existing criteria, that personality disorders were not normed on the general population, and that "not otherwise specified" categories covered a "huge" 30% of all personality disorders.

It also expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences... which demand helping responses, but which do not reflect illnesses so much as normal individual variation".

The Society suggested as its primary specific recommendation, a change from using "diagnostic frameworks" to a description based on an individual's specific experienced problems, and that mental disorders are better explored as part of a spectrum shared with normality:

[We recommend] a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are the most strongly-evidenced causal factors. Rather than applying preordained diagnostic categories to clinical populations, we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or 'symptoms' or 'complaints'... We would like to see the base unit of measurement as specific problems (e.g. hearing voices, feelings of anxiety etc.)? These would be more helpful too in terms of epidemiology.

While some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their problems are recognised (in both senses of the word) understood, validated, explained (and explicable) and have some relief. Clients often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. Since – for example – two people with a diagnosis of 'schizophrenia' or 'personality disorder' may possess no two symptoms in common, it is difficult to see what communicative benefit is served by using these diagnoses. We believe that a description of a person's real problems would suffice. Moncrieff and others have shown that diagnostic labels are less useful than a description of a person's problems for predicting treatment response, so again diagnoses seem positively unhelpful compared to the alternatives.

— British Psychological Society, June 2011 response

Many of the same criticisms also led to the development of the Hierarchical Taxonomy of Psychopathology, an alternative, dimensional framework for classifying mental disorders.

National Institute of Mental Health

National Institute of Mental Health director Thomas R. Insel, MD,[67] wrote in an April 29, 2013 blog post about the DSM-5:[68]

The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a "Bible" for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been "reliability" – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity ... Patients with mental disorders deserve better.

Insel also discussed an NIMH effort to develop a new classification system, Research Domain Criteria (RDoC), currently for research purposes only.[69] Insel's post sparked a flurry of reaction, some of which might be termed sensationalistic, with headlines such as "Goodbye to the DSM-V",[70] "Federal institute for mental health abandons controversial 'bible' of psychiatry",[71] "National Institute of Mental Health abandoning the DSM",[72] and "Psychiatry divided as mental health 'bible' denounced".[73] Other responses provided a more nuanced analysis of the NIMH Director's post.[74]

In May 2013, Insel, on behalf of NIMH, issued a joint statement with Jeffrey A. Lieberman, MD, president of the American Psychiatric Association,[75] that emphasized that DSM-5 "... represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5." Insel and Lieberman say that DSM-5 and RDoC "represent complementary, not competing, frameworks" for characterizing diseases and disorders.[75] However, epistemologists of psychiatry tend to see the RDoC project as a putative revolutionary system that in the long run will try to replace the DSM, its expected early effect being a liberalization of the research criteria, with an increasing number of research centers adopting the RDoC definitions.[76]

See also

References

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External links

  • . American Psychiatric Association. Archived from the original on November 19, 2008.
  • "DSM-5 Update: Supplement to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (PDF). PsychiatryOnline. American Psychiatric Association Publishing. September 2016.

March 23, 2023
album, same, name, blood, from, soul, further, information, diagnostic, statistical, manual, mental, disorders, diagnostic, statistical, manual, mental, disorders, fifth, edition, 2013, update, diagnostic, statistical, manual, mental, disorders, taxonomic, dia. For the album of the same name see Blood from the Soul Further information Diagnostic and Statistical Manual of Mental Disorders The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM 5 is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders the taxonomic and diagnostic tool published by the American Psychiatric Association APA In the United States the DSM serves as the principal authority for psychiatric diagnoses Treatment recommendations as well as payment by health care providers are often determined by DSM classifications so the appearance of a new version has practical importance The DSM 5 is the only DSM to use a Hindu Arabic numeral instead of a Roman numeral in its title as well as the only living document version of a DSM 1 DSM 5AuthorAmerican Psychiatric AssociationCountryUnited StatesLanguageEnglishSeriesDiagnostic and Statistical Manual of Mental DisordersSubjectClassification and diagnosis of mental disordersPublishedMay 18 2013Media typePrint hardcover softcover e bookPages947ISBN978 0 89042 554 1OCLC830807378Dewey Decimal616 89 075LC ClassRC455 2 C4Preceded byDSM IV TR TextDSM 5 onlineThe DSM 5 is not a major revision of the DSM IV TR but there are significant differences Changes in the DSM 5 include the reconceptualization of Asperger syndrome from a distinct disorder to an autism spectrum disorder the elimination of subtypes of schizophrenia the deletion of the bereavement exclusion for depressive disorders the renaming and reconceptualization of gender identity disorder to gender dysphoria the inclusion of binge eating disorder as a discrete eating disorder the renaming and reconceptualization of paraphilias now called paraphilic disorders the removal of the five axis system and the splitting of disorders not otherwise specified into other specified disorders and unspecified disorders Many authorities criticized the fifth edition both before and after it was published Critics assert for example that many DSM 5 revisions or additions lack empirical support inter rater reliability is low for many disorders several sections contain poorly written confusing or contradictory information and the psychiatric drug industry may have unduly influenced the manual s content given many DSM 5 workgroup participants had ties to pharmaceutical companies 2 Contents 1 Changes from DSM IV 1 1 Section I 1 2 Section II diagnostic criteria and codes 1 2 1 Neurodevelopmental disorders 1 2 2 Schizophrenia spectrum and other psychotic disorders 1 2 3 Bipolar and related disorders 1 2 4 Depressive disorders 1 2 5 Anxiety disorders 1 2 6 Obsessive compulsive and related disorders 1 2 7 Trauma and stressor related disorders 1 2 8 Dissociative disorders 1 2 9 Somatic symptom and related disorders 1 2 10 Feeding and eating disorders 1 2 11 Elimination disorders 1 2 12 Sleep wake disorders 1 2 13 Sexual dysfunctions 1 2 14 Gender dysphoria 1 2 15 Disruptive impulse control and conduct disorders 1 2 16 Substance related and addictive disorders 1 2 17 Neurocognitive disorders 1 2 18 Personality disorders 1 2 19 Paraphilic disorders 1 3 Section III emerging measures and models 2 Conditions for further study 3 Development 4 Revisions and updates 5 Criticism 5 1 General 5 2 Borderline personality disorder controversy 5 3 British Psychological Society response 5 4 National Institute of Mental Health 6 See also 7 References 8 External linksChanges from DSM IV EditThe DSM 5 is divided into three sections using Roman numerals to designate each section Section I Edit Section I describes DSM 5 chapter organization its change from the multiaxial system and Section III s dimensional assessments 3 The DSM 5 dissolved the chapter that includes disorders usually first diagnosed in infancy childhood or adolescence opting to list them in other chapters 3 A note under Anxiety Disorders says that the sequential order of at least some DSM 5 chapters has significance that reflects the relationships between diagnoses 3 The introductory section describes the process of DSM revision including field trials public and professional review and expert review It states its goal is to harmonize with the International Statistical Classification of Diseases and Related Health Problems ICD systems and share organizational structures as much as is feasible Concern about the categorical system of diagnosis is expressed but the conclusion is the reality that alternative definitions for most disorders are scientifically premature DSM 5 replaces the Not Otherwise Specified NOS categories with two options other specified disorder and unspecified disorder to increase the utility to the clinician The first allows the clinician to specify the reason that the criteria for a specific disorder are not met the second allows the clinician the option to forgo specification DSM 5 has discarded the multiaxial system of diagnosis formerly Axis I Axis II Axis III listing all disorders in Section II It has replaced Axis IV with significant psychosocial and contextual features and dropped Axis V Global Assessment of Functioning known as GAF The World Health Organization s Disability Assessment Schedule is added to Section III Emerging measures and models under Assessment Measures as a suggested but not required method to assess functioning 4 Section II diagnostic criteria and codes Edit Neurodevelopmental disorders Edit Mental retardation was renamed intellectual disability intellectual developmental disorder 5 Speech or language disorders are now called communication disorders which include language disorder formerly expressive language disorder and mixed receptive expressive language disorder speech sound disorder formerly phonological disorder childhood onset fluency disorder stuttering and a new condition characterized by impaired social verbal and nonverbal communication called social pragmatic communication disorder 5 Autism spectrum disorder incorporates Asperger disorder childhood disintegrative disorder and pervasive developmental disorder not otherwise specified PDD NOS see Diagnosis of Asperger syndrome DSM 5 changes 6 A new sub category motor disorders encompasses developmental coordination disorder stereotypic movement disorder and the tic disorders including Tourette syndrome 7 Attention deficit hyperactivity disorder ADHD Schizophrenia spectrum and other psychotic disorders Edit All subtypes of schizophrenia were removed from the DSM 5 paranoid disorganized catatonic undifferentiated and residual in favor of a severity based rating approach 3 A major mood episode is required for schizoaffective disorder for a majority of the disorder s duration after criterion A related to delusions hallucinations disorganized speech or behavior and negative symptoms such as avolition is met 3 Criteria for delusional disorder changed and it is no longer separate from shared delusional disorder 3 Catatonia in all contexts requires 3 of a total of 12 symptoms Catatonia may be a specifier for depressive bipolar and psychotic disorders part of another medical condition or of another specified diagnosis 3 Bipolar and related disorders Edit New specifier with mixed features can be applied to bipolar I disorder bipolar II disorder bipolar disorder NED not elsewhere defined previously called NOS not otherwise specified and MDD 8 Allows other specified bipolar and related disorder for particular conditions 3 Anxiety symptoms are a specifier called anxious distress added to bipolar disorder and to depressive disorders but are not part of the bipolar diagnostic criteria 3 Depressive disorders Edit The bereavement exclusion in DSM IV was removed from depressive disorders in DSM 5 9 New disruptive mood dysregulation disorder DMDD 10 for children up to age 18 years 3 Premenstrual dysphoric disorder moved from an appendix for further study and became a disorder 3 Specifiers were added for mixed symptoms and for anxiety along with guidance to physicians for suicidality 3 The term dysthymia now also would be called persistent depressive disorder Anxiety disorders Edit For the various forms of phobias and anxiety disorders DSM 5 removes the requirement that the subject formerly over 18 years old must recognize that their fear and anxiety are excessive or unreasonable Also the duration of at least 6 months now applies to everyone not only to children 3 Panic attack became a specifier for all DSM 5 disorders 3 Panic disorder and agoraphobia became two separate disorders 3 Specific types of phobias became specifiers but are otherwise unchanged 3 The generalized specifier for social anxiety disorder formerly social phobia changed in favor of a performance only i e public speaking or performance specifier 3 Separation anxiety disorder and selective mutism are now classified as anxiety disorders rather than disorders of early onset 3 Obsessive compulsive and related disorders Edit A new chapter on obsessive compulsive and related disorders includes four new disorders excoriation skin picking disorder hoarding disorder substance medication induced obsessive compulsive and related disorder and obsessive compulsive and related disorder due to another medical condition 3 Trichotillomania hair pulling disorder moved from impulse control disorders not elsewhere classified in DSM IV to an obsessive compulsive disorder in DSM 5 3 A specifier was expanded and added to body dysmorphic disorder and hoarding disorder to allow for good or fair insight poor insight and absent insight delusional i e complete conviction that obsessive compulsive disorder beliefs are true 3 Criteria were added to body dysmorphic disorder to describe repetitive behaviors or mental acts that may arise with perceived defects or flaws in physical appearance 3 The DSM IV specifier with obsessive compulsive symptoms moved from anxiety disorders to this new category for obsessive compulsive and related disorders 3 There are two new diagnoses other specified obsessive compulsive and related disorder which can include body focused repetitive behavior disorder behaviors like nail biting lip biting and cheek chewing other than hair pulling and skin picking or obsessional jealousy and unspecified obsessive compulsive and related disorder 3 Trauma and stressor related disorders Edit Post traumatic stress disorder PTSD is now included in a new section titled Trauma and Stressor Related Disorders 11 The PTSD diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of DSM IV 12 Separate criteria were added for children six years old or younger 3 For the diagnosis of acute stress disorder and PTSD the stressor criteria Criterion A1 in DSM IV was modified to some extent The requirement for specific subjective emotional reactions Criterion A2 in DSM IV was eliminated because it lacked empirical support for its utility and predictive validity 12 Previously certain groups such as military personnel involved in combat law enforcement officers and other first responders did not meet criterion A2 in DSM IV because their training prepared them to not react emotionally to traumatic events 13 14 15 Two new disorders that were formerly subtypes were named reactive attachment disorder and disinhibited social engagement disorder 3 Adjustment disorders were moved to this new section and reconceptualized as stress response syndromes DSM IV subtypes for depressed mood anxious symptoms and disturbed conduct are unchanged 3 Dissociative disorders Edit Depersonalization disorder is now called depersonalization derealization disorder 16 Dissociative fugue became a specifier for dissociative amnesia 3 The criteria for dissociative identity disorder were expanded to include possession form phenomena and functional neurological symptoms It is made clear that transitions in identity may be observable by others or self reported 3 Criterion B was also modified for people who experience gaps in recall of everyday events not only trauma 3 Somatic symptom and related disorders Edit Somatoform disorders are now called somatic symptom and related disorders Patients that present with chronic pain can now be diagnosed with the mental illness somatic symptom disorder with predominant pain or psychological factors that affect other medical conditions or with an adjustment disorder 3 17 18 19 20 Somatization disorder and undifferentiated somatoform disorder were combined to become somatic symptom disorder a diagnosis which no longer requires a specific number of somatic symptoms 3 Somatic symptom and related disorders are defined by positive symptoms and the use of medically unexplained symptoms is minimized except in the cases of conversion disorder and pseudocyesis false pregnancy 3 A new diagnosis is psychological factors affecting other medical conditions This was formerly found in the DSM IV chapter Other Conditions That May Be a Focus of Clinical Attention 3 Criteria for conversion disorder functional neurological symptom disorder were changed 3 Feeding and eating disorders Edit Criteria for pica and rumination disorder were changed and can now refer to people of any age 3 Binge eating disorder graduated from DSM IV s Appendix B Criteria Sets and Axes Provided for Further Study into a proper diagnosis 21 Requirements for bulimia nervosa and binge eating disorder were changed from at least twice weekly for 6 months to at least once weekly over the last 3 months The criteria for anorexia nervosa were changed there is no longer a requirement of amenorrhea Feeding disorder of infancy or early childhood a rarely used diagnosis in DSM IV was renamed to avoidant restrictive food intake disorder and criteria were expanded 3 Elimination disorders Edit No significant changes 3 Disorders in this chapter were previously classified under disorders usually first diagnosed in infancy childhood or adolescence in DSM IV Now it is an independent classification in DSM 5 3 Sleep wake disorders Edit Sleep disorders related to another mental disorder and sleep disorders related to a general medical condition were deleted 3 Primary insomnia became insomnia disorder and narcolepsy is separate from other hypersomnolence 3 There are now three breathing related sleep disorders obstructive sleep apnea hypopnea central sleep apnea and sleep related hypoventilation 3 Circadian rhythm sleep wake disorders were expanded to include advanced sleep phase syndrome irregular sleep wake type and non 24 hour sleep wake type 3 Jet lag was removed 3 Rapid eye movement sleep behavior disorder and restless legs syndrome are each a disorder instead of both being listed under dyssomnia not otherwise specified in DSM IV 3 Sexual dysfunctions Edit DSM 5 has sex specific sexual dysfunctions 3 For females sexual desire and arousal disorders are combined into female sexual interest arousal disorder 3 Sexual dysfunctions except substance medication induced sexual dysfunction now require a duration of approximately 6 months and more exact severity criteria 3 A new diagnosis is genito pelvic pain penetration disorder which combines vaginismus and dyspareunia from DSM IV 3 Sexual aversion disorder was deleted 3 Subtypes for all disorders include only lifelong versus acquired and generalized versus situational one subtype was deleted from DSM IV 3 Two subtypes were deleted sexual dysfunction due to a general medical condition and due to psychological versus combined factors 3 Gender dysphoria Edit Further information Gender dysphoria DSM IV s gender identity disorder is similar to but not the same as gender dysphoria in DSM 5 Separate criteria for children adolescents and adults that are appropriate for varying developmental states are added Subtypes of gender identity disorder based on sexual orientation were deleted 3 Among other wording changes criterion A and criterion B cross gender identification and aversion toward one s gender were combined 3 Along with these changes comes the creation of a separate gender dysphoria in children as well as one for adults and adolescents The grouping has been moved out of the sexual disorders category and into its own The name change was made in part due to stigmatization of the term disorder and the relatively common use of gender dysphoria in the GID literature and among specialists in the area 22 The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing and ability to express it in the event that they have insight 23 Disruptive impulse control and conduct disorders Edit Some of these disorders were formerly part of the chapter on early diagnosis oppositional defiant disorder conduct disorder and disruptive behavior disorder not otherwise specified became other specified and unspecified disruptive disorder impulse control disorder and conduct disorders 3 Intermittent explosive disorder pyromania and kleptomania moved to this chapter from the DSM IV chapter Impulse Control Disorders Not Otherwise Specified 3 Antisocial personality disorder is listed here and in the chapter on personality disorders but ADHD is listed under neurodevelopmental disorders 3 Symptoms for oppositional defiant disorder are of three types angry irritable mood argumentative defiant behavior and vindictiveness The conduct disorder exclusion is deleted The criteria were also changed with a note on frequency requirements and a measure of severity 3 Criteria for conduct disorder are unchanged for the most part from DSM IV 3 A specifier was added for people with limited prosocial emotion showing callous and unemotional traits 3 People over the disorder s minimum age of 6 may be diagnosed with intermittent explosive disorder without outbursts of physical aggression 3 Criteria were added for frequency and to specify impulsive and or anger based in nature and must cause marked distress cause impairment in occupational or interpersonal functioning or be associated with negative financial or legal consequences 3 Substance related and addictive disorders Edit Gambling disorder and tobacco use disorder are new 3 Substance abuse and substance dependence from DSM IV TR have been combined into single substance use disorders specific to each substance of abuse within a new addictions and related disorders category 24 Recurrent legal problems was deleted and craving or a strong desire or urge to use a substance was added to the criteria 3 The threshold of the number of criteria that must be met was changed 3 and severity from mild to severe is based on the number of criteria endorsed 3 Criteria for cannabis and caffeine withdrawal were added 3 New specifiers were added for early and sustained remission along with new specifiers for in a controlled environment and on maintenance therapy 3 There are no more polysubstance diagnoses in DSM 5 the substance s must be specified 25 Neurocognitive disorders Edit Dementia and amnestic disorder became major or mild neurocognitive disorder major NCD or mild NCD 3 26 DSM 5 has a new list of neurocognitive domains 3 New separate criteria are now presented for major or mild NCD due to various conditions 3 Substance medication induced NCD and unspecified NCD are new diagnoses 3 Personality disorders Edit Personality disorder PD previously belonged to a different axis than almost all other disorders but is now in one axis with all mental and other medical diagnoses 27 However the same ten types of personality disorder are retained 27 There is a call for the DSM 5 to provide relevant clinical information that is empirically based to conceptualize personality as well as psychopathology in personalities The issue s of heterogeneity of a PD is problematic as well For example when determining the criteria for a PD it is possible for two individuals with the same diagnosis to have completely different symptoms that would not necessarily overlap 28 There is also concern as to which model is better for the DSM the diagnostic model favored by psychiatrists or the dimensional model that is favored by psychologists The diagnostic approach model is one that follows the diagnostic approach of traditional medicine is more convenient to use in clinical settings however it does not capture the intricacies of normal or abnormal personality The dimensional approach model is better at showing varied degrees of personality it places emphasis on the continuum between normal and abnormal and abnormal as something beyond a threshold whether in unipolar or bipolar cases 29 Paraphilic disorders Edit New specifiers in a controlled environment and in remission were added to criteria for all paraphilic disorders 3 A distinction is made between paraphilic behaviors or paraphilias and paraphilic disorders 30 All criteria sets were changed to add the word disorder to all of the paraphilias for example pedophilic disorder is listed instead of pedophilia 3 There is no change in the basic diagnostic structure since DSM III R however people now must meet both qualitative criterion A and negative consequences criterion B criteria to be diagnosed with a paraphilic disorder Otherwise they have a paraphilia and no diagnosis 3 Section III emerging measures and models Edit It includes dimensional measures for the assessment of symptoms criteria for the cultural formulation of disorders and an alternative proposal for the conceptualization of personality disorders as well as a description of the currently studied clinical conditions It presents selected tools and research techniques focused on diagnosis taking into account the sociocultural context and also presents a hybrid dimensional categorical model of personality disorders Specific personalities antisocial borderline avoidant narcissistic obsessive compulsive schizotypal and non specific disorders were distinguished Conditions for further study EditThese conditions and criteria are set forth to encourage future research and are not meant for clinical use Attenuated psychosis syndrome Depressive episodes with short duration hypomania Persistent complex bereavement disorder Caffeine use disorder Internet gaming disorder Neurobehavioral disorder associated with prenatal alcohol exposure Suicidal behavior disorder Non suicidal self injury 31 Development EditIn 1999 a DSM 5 Research Planning Conference sponsored jointly by APA and the National Institute of Mental Health NIMH was held to set the research priorities Research Planning Work Groups produced white papers on the research needed to inform and shape the DSM 5 32 and the resulting work and recommendations were reported in an APA monograph 33 and peer reviewed literature 34 There were six workgroups each focusing on a broad topic Nomenclature Neuroscience and Genetics Developmental Issues and Diagnosis Personality and Relational Disorders Mental Disorders and Disability and Cross Cultural Issues Three additional white papers were also due by 2004 concerning gender issues diagnostic issues in the geriatric population and mental disorders in infants and young children 35 The white papers have been followed by a series of conferences to produce recommendations relating to specific disorders and issues with attendance limited to 25 invited researchers 35 On July 23 2007 the APA announced the task force that would oversee the development of DSM 5 The DSM 5 Task Force consisted of 27 members including a chair and vice chair who collectively represent research scientists from psychiatry and other disciplines clinical care providers and consumer and family advocates Scientists working on the revision of the DSM had a broad range of experience and interests The APA Board of Trustees required that all task force nominees disclose any competing interests or potentially conflicting relationships with entities that have an interest in psychiatric diagnoses and treatments as a precondition to appointment to the task force The APA made all task force members disclosures available during the announcement of the task force Several individuals were ruled ineligible for task force appointments due to their competing interests 36 The DSM 5 field trials included test retest reliability which involved different clinicians doing independent evaluations of the same patient a common approach to the study of diagnostic reliability 37 About 68 of DSM 5 task force members and 56 of panel members reported having ties to the pharmaceutical industry such as holding stock in pharmaceutical companies serving as consultants to industry or serving on company boards 38 Revisions and updates EditBeginning with the fifth edition it is intended that diagnostic guideline revisions will be added incrementally 39 The DSM 5 is identified with Arabic rather than Roman numerals marking a change in how future updates will be created Incremental updates will be identified with decimals DSM 5 1 DSM 5 2 etc until a new edition is written 40 The change reflects the intent of the APA to respond more quickly when a preponderance of research supports a specific change in the manual The research base of mental disorders is evolving at different rates for different disorders 39 Criticism EditGeneral Edit Robert Spitzer the head of the DSM III task force publicly criticized the APA for mandating that DSM 5 task force members sign a nondisclosure agreement effectively conducting the whole process in secret When I first heard about this agreement I just went bonkers Transparency is necessary if the document is to have credibility and in time you re going to have people complaining all over the place that they didn t have the opportunity to challenge anything 41 Allen Frances chair of the DSM IV task force expressed a similar concern 42 Although the APA has since instituted a disclosure policy for DSM 5 task force members many still believe the association has not gone far enough in its efforts to be transparent and to protect against industry influence 43 In a 2009 Point Counterpoint article Lisa Cosgrove PhD and Harold J Bursztajn MD noted that the fact that 70 of the task force members have reported direct industry ties an increase of almost 14 over the percentage of DSM IV task force members who had industry ties shows that disclosure policies alone especially those that rely on an honor system are not enough and that more specific safeguards are needed 44 David Kupfer chair of the DSM 5 task force and Darrel A Regier MD MPH vice chair of the task force whose industry ties are disclosed with those of the task force 45 countered that collaborative relationships among government academia and industry are vital to the current and future development of pharmacological treatments for mental disorders They asserted that the development of DSM 5 is the most inclusive and transparent developmental process in the 60 year history of DSM The developments to this new version can be viewed on the APA website 46 During periods of public comment members of the public could sign up at the DSM 5 website 47 and provide feedback on the various proposed changes 48 In June 2009 Allen Frances issued strongly worded criticisms of the processes leading to DSM 5 and the risk of serious subtle ubiquitous and dangerous unintended consequences such as new false epidemics He writes that the work on DSM V has displayed the most unhappy combination of soaring ambition and weak methodology and is concerned about the task force s inexplicably closed and secretive process 49 His and Spitzer s concerns about the contract that the APA drew up for consultants to sign agreeing not to discuss drafts of the fifth edition beyond the task force and committees have also been aired and debated 50 The appointment in May 2008 of two of the taskforce members Kenneth Zucker and Ray Blanchard led to an internet petition to remove them 51 According to MSNBC The petition accuses Zucker of having engaged in junk science and promoting hurtful theories during his career especially advocating the idea that children who are unambiguously male or female anatomically but seem confused about their gender identity can be treated by encouraging gender expression in line with their anatomy 52 According to The Gay City News Dr Ray Blanchard a psychiatry professor at the University of Toronto is deemed offensive for his theories that some types of transsexuality are paraphilias or sexual urges In this model transsexuality is not an essential aspect of the individual but a misdirected sexual impulse 53 Blanchard responded Naturally it s very disappointing to me there seems to be so much misinformation about me on the Internet They didn t distort my views they completely reversed my views 53 Zucker rejects the junk science charge saying there has to be an empirical basis to modify anything in the DSM As for hurting people in my own career my primary motivation in working with children adolescents and families is to help them with the distress and suffering they are experiencing whatever the reasons they are having these struggles I want to help people feel better about themselves not hurt them 52 In 2011 psychologist Brent Robbins co authored a national letter for the Society for Humanistic Psychology that brought thousands into the public debate about the DSM Approximately 13 000 individuals and mental health professionals signed a petition in support of the letter Thirteen other American Psychological Association divisions endorsed the petition 54 In a November 2011 article about the debate in the San Francisco Chronicle Robbins notes that under the new guidelines certain responses to grief could be labeled as pathological disorders instead of being recognized as being normal human experiences 55 In 2012 a footnote was added to the draft text which explains the distinction between grief and depression 56 The DSM 5 has been criticized for purportedly saying nothing about the biological underpinnings of mental disorders 57 A book long appraisal of the DSM 5 with contributions from philosophers historians and anthropologists was published in 2015 58 The financial association of DSM 5 panel members with industry continues to be a concern for financial conflict of interest 59 Of the DSM 5 task force members 69 report having ties to the pharmaceutical industry an increase from the 57 of DSM IV task force members 59 A 2015 essay from an Australian university criticized the DSM 5 for having poor cultural diversity stating that recent work done in cognitive sciences and cognitive anthropology is still only accepting western psychology as the norm 60 DSM 5 includes a section on how to conduct a cultural formulation interview which gives information about how a person s cultural identity may be affecting expression of signs and symptoms The goal is to make more reliable and valid diagnoses for disorders subject to significant cultural variation 61 Borderline personality disorder controversy Edit In 2003 the Treatment and Research Advancements National Association for Personality Disorders TARA APD campaigned to change the name and designation of borderline personality disorder in DSM 5 62 The paper How Advocacy is Bringing BPD into the Light 63 reported that the name BPD is confusing imparts no relevant or descriptive information and reinforces existing stigma Instead it proposed the name emotional regulation disorder or emotional dysregulation disorder There was also discussion about changing borderline personality disorder an Axis II diagnosis personality disorders and mental retardation to an Axis I diagnosis clinical disorders 64 The TARA APD recommendations do not appear to have affected the American Psychiatric Association the publisher of the DSM As noted above the DSM 5 does not employ a multi axial diagnostic scheme therefore the distinction between Axis I and II disorders no longer exists in the DSM nosology The name the diagnostic criteria for and description of borderline personality disorder remain largely unchanged from DSM IV TR 65 British Psychological Society response Edit The British Psychological Society stated in its June 2011 response to DSM 5 draft versions that it had more concerns than plaudits 66 It criticized proposed diagnoses as clearly based largely on social norms with symptoms that all rely on subjective judgements not value free but rather reflect ing current normative social expectations noting doubts over the reliability validity and value of existing criteria that personality disorders were not normed on the general population and that not otherwise specified categories covered a huge 30 of all personality disorders It also expressed a major concern that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences which demand helping responses but which do not reflect illnesses so much as normal individual variation The Society suggested as its primary specific recommendation a change from using diagnostic frameworks to a description based on an individual s specific experienced problems and that mental disorders are better explored as part of a spectrum shared with normality We recommend a revision of the way mental distress is thought about starting with recognition of the overwhelming evidence that it is on a spectrum with normal experience and that psychosocial factors such as poverty unemployment and trauma are the most strongly evidenced causal factors Rather than applying preordained diagnostic categories to clinical populations we believe that any classification system should begin from the bottom up starting with specific experiences problems or symptoms or complaints We would like to see the base unit of measurement as specific problems e g hearing voices feelings of anxiety etc These would be more helpful too in terms of epidemiology While some people find a name or a diagnostic label helpful our contention is that this helpfulness results from a knowledge that their problems are recognised in both senses of the word understood validated explained and explicable and have some relief Clients often unfortunately find that diagnosis offers only a spurious promise of such benefits Since for example two people with a diagnosis of schizophrenia or personality disorder may possess no two symptoms in common it is difficult to see what communicative benefit is served by using these diagnoses We believe that a description of a person s real problems would suffice Moncrieff and others have shown that diagnostic labels are less useful than a description of a person s problems for predicting treatment response so again diagnoses seem positively unhelpful compared to the alternatives British Psychological Society June 2011 responseMany of the same criticisms also led to the development of the Hierarchical Taxonomy of Psychopathology an alternative dimensional framework for classifying mental disorders National Institute of Mental Health Edit National Institute of Mental Health director Thomas R Insel MD 67 wrote in an April 29 2013 blog post about the DSM 5 68 The goal of this new manual as with all previous editions is to provide a common language for describing psychopathology While DSM has been described as a Bible for the field it is at best a dictionary creating a set of labels and defining each The strength of each of the editions of DSM has been reliability each edition has ensured that clinicians use the same terms in the same ways The weakness is its lack of validity Patients with mental disorders deserve better Insel also discussed an NIMH effort to develop a new classification system Research Domain Criteria RDoC currently for research purposes only 69 Insel s post sparked a flurry of reaction some of which might be termed sensationalistic with headlines such as Goodbye to the DSM V 70 Federal institute for mental health abandons controversial bible of psychiatry 71 National Institute of Mental Health abandoning the DSM 72 and Psychiatry divided as mental health bible denounced 73 Other responses provided a more nuanced analysis of the NIMH Director s post 74 In May 2013 Insel on behalf of NIMH issued a joint statement with Jeffrey A Lieberman MD president of the American Psychiatric Association 75 that emphasized that DSM 5 represents the best information currently available for clinical diagnosis of mental disorders Patients families and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care The National Institute of Mental Health NIMH has not changed its position on DSM 5 Insel and Lieberman say that DSM 5 and RDoC represent complementary not competing frameworks for characterizing diseases and disorders 75 However epistemologists of psychiatry tend to see the RDoC project as a putative revolutionary system that in the long run will try to replace the DSM its expected early effect being a liberalization of the research criteria with an increasing number of research centers adopting the RDoC definitions 76 See also Edit Psychiatry portalICD 11References Edit Wakefield Jerome C May 22 2013 DSM 5 An Overview of Changes and Controversies Clinical Social Work Journal 41 2 139 154 doi 10 1007 s10615 013 0445 2 ISSN 0091 1674 S2CID 144603715 Welch Steven Klassen Cherisse Borisova Oxana Clothier Holly 2013 The DSM 5 controversies How should psychologists respond Canadian Psychology 54 3 166 175 doi 10 1037 a0033841 a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj bk bl bm bn bo bp bq br bs bt bu bv bw Highlights of Changes from DSM IV TR to DSM 5 PDF American Psychiatric Association May 17 2013 Archived from the original PDF on February 26 2015 American Psychiatric Association 2013 Diagnostic and Statistical Manual of Mental Disorders Fifth ed Arlington VA American Psychiatric Publishing pp 5 25 ISBN 978 0 89042 555 8 a b A Guide to DSM 5 Neurodevelopmental Disorders Medscape com Archived from the original on June 7 2013 Retrieved May 26 2013 A Guide to DSM 5 Autism Spectrum Disorders Medscape com Archived from the original on June 7 2013 Retrieved May 26 2013 American Psychiatric Association 2013 Diagnostic and Statistical Manual of Mental Disorders Fifth ed Arlington VA American Psychiatric Publishing pp 74 85 ISBN 978 0 89042 555 8 A Guide to DSM 5 Mixed Mood Specifier Medscape com Archived from the original on June 7 2013 Retrieved May 26 2013 A Guide to DSM 5 Removal of the Bereavement Exclusion From MDD Medscape com Archived from the original on June 19 2013 Retrieved May 26 2013 A Guide to DSM 5 Disruptive Mood Dysregulation Disorder DMDD Medscape com Archived from the original on September 18 2017 Retrieved May 26 2013 Friedman M J Resick P A Bryant R A Strain J Horowitz M Spiegel D 2011 Classification of trauma and stressor related disorders in DSM 5 Depression and Anxiety 28 9 737 749 doi 10 1002 da 20845 PMID 21681870 S2CID 23325126 a b Friedman M J Resick P A Bryant R A Brewin C R 2011 Considering PTSD for DSM 5 Depression and Anxiety 28 9 750 769 doi 10 1002 da 20767 PMID 21910184 S2CID 38289406 Archived from the original on February 15 2020 Retrieved June 29 2019 Adler A B Wright K M Bliese P D Eckford R Hoge C W 2008 A2 diagnostic criterion for combat related posttraumatic stress disorder Journal of Traumatic Stress 21 3 301 308 doi 10 1002 jts 20336 PMID 18553417 Hathaway L M Boals A Banks J B 2010 PTSD symptoms and dominant emotional response to a traumatic event An examination of DSM IV criterion A2 Anxiety Stress amp Coping 23 1 119 126 doi 10 1080 10615800902818771 PMID 19337884 S2CID 42748380 Karam E G Andrews G Bromet E Petukhova M Ruscio A M Salamoun M et al 2010 The Role of Criterion A2 in the DSM IV Diagnosis of Posttraumatic Stress Disorder Biological Psychiatry 68 5 465 473 doi 10 1016 j biopsych 2010 04 032 PMC 3228599 PMID 20599189 American Psychiatric Association 2013 Diagnostic and Statistical Manual of Mental Disorders Fifth ed Arlington VA American Psychiatric Publishing p 302 ISBN 978 0 89042 555 8 Somatic Symptom Disorder PDF Archived from the original PDF on November 2 2013 Retrieved April 6 2014 Diagnostic Ethics Harms Benefits Somatic Symptom Disorder Psychology Today Archived from the original on December 14 2020 Retrieved January 29 2015 DSM 5 redefines hypochondriasis For Medical Professionals Mayo Clinic mayoclinic org Archived from the original on February 23 2015 Retrieved January 29 2015 Justina Pelletier The Case Continues Mad In America April 4 2014 Archived from the original on December 25 2014 Retrieved January 29 2015 A Guide to DSM 5 Binge Eating Disorder Medscape com Archived from the original on June 9 2013 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Robert F Hopwood Christopher J Wright Aidan G C Markon Kristian E September 1 2014 DSM 5 and the Path Toward Empirically Based and Clinically Useful Conceptualization of Personality and Psychopathology Clinical Psychology Science and Practice 21 3 245 261 doi 10 1111 cpsp 12073 ISSN 1468 2850 Crocq Marc Antoine 2013 Milestones in the History of Personality Disorders PDF Dialogues in Clinical Neuroscience 15 2 147 53 doi 10 31887 DCNS 2013 15 2 macrocq PMC 3811086 PMID 24174889 Archived from the original PDF on August 21 2016 Retrieved August 8 2016 A Guide to DSM 5 Paraphilias and Paraphilic Disorders Medscape com Archived from the original on June 19 2013 Retrieved May 26 2013 American Psychiatric Association 2013 Diagnostic and Statistical Manual of Mental Disorders Fifth ed Arlington VA American Psychiatric Publishing pp 783 808 ISBN 978 0 89042 555 8 First Michael B 2002 A Research Agenda for DSM V Summary of the DSM V Preplanning White Papers Published in May 2002 DSM V Prelude Project American Psychiatric Association archived from the original on April 13 2008 retrieved May 12 2012 Kupfer David J First Michael B Regier Darrel A eds 2002 A Research Agenda for DSM 5 Washington D C American Psychiatric Association ISBN 9780890422922 OCLC 49518977 archived from the original on December 13 2007 retrieved November 15 2009 Regier Darrel A Narrow William E First Michael B Marshall Tina 2002 The APA classification of mental disorders future perspectives Psychopathology 35 2 3 166 170 doi 10 1159 000065139 PMID 12145504 S2CID 36938074 a b DSM 5 Research Planning DSM V Prelude Project American Psychiatric Association DSM V Research White Papers archived from the original on April 24 2008 retrieved May 12 2012 Regier DA 2007 Somatic Presentations of Mental Disorders Refining the Research Agenda for DSM V PDF Psychosomatic Medicine 69 9 827 828 doi 10 1097 PSY 0b013e31815afbe4 PMID 18040087 Archived PDF from the original on February 28 2008 Retrieved December 21 2007 Reliability and Prevalence in the DSM 5 Field Trials PDF Archived from the original PDF on January 31 2012 Retrieved January 13 2012 Cosgrove Lisa Bursztajn Harold J Krimsky Sheldon May 7 2009 Developing Unbiased Diagnostic and Treatment Guidelines in Psychiatry New England Journal of Medicine 360 19 2035 2036 doi 10 1056 NEJMc0810237 PMID 19420379 a b About DSM 5 Frequently Asked Questions American Psychiatric Association Archived from the original on September 25 2011 Retrieved May 24 2015 Harold Eve March 9 2010 APA Modifies DSM Naming Convention to Reflect Publication Changes No Release No 10 17 The American Psychiatric Association Carey Benedict December 17 2008 Psychiatrists Revise the Book of Human Troubles The New York Times Archived from the original on December 7 2016 Retrieved February 24 2017 Psychiatrists Propose Revisions to Diagnosis Manual Archived January 22 2014 at the Wayback Machine via PBS Newshour February 10 2010 interviews Frances and Alan Schatzberg on some of the main changes proposed to the DSM 5 Cosgrove Lisa Krimsky Sheldon Vijayaraghavan Manisha Schneider Lisa April 2006 Financial Ties between DSM IV Panel Members and the Pharmaceutical Industry Psychotherapy and Psychosomatics 75 3 154 160 doi 10 1159 000091772 PMID 16636630 S2CID 11909535 Cosgrove L Bursztajn HJ Kupfer DJ Regier DA Toward Credible Conflict of Interest Policies in Clinical Psychiatry Psychiatric Times 26 1 DSM V Task Force Member Disclosure Report David J Kupfer MD PDF American Psychiatric Association Archived PDF from the original on December 26 2010 Retrieved May 6 2011 and DSM V Task Force Member Disclosure Report Darrel Alvin Regier M D PDF American Psychiatric Association May 2 2011 Archived PDF from the original on March 14 2012 Retrieved May 5 2011 DSM 5 Overview The Future Manual APA DSM 5 Archived December 17 2009 at the Wayback Machine Registration page for DSM 5 public comment Archived May 1 2011 at the Wayback Machine page found June 5 2011 Suggestions and 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of psychiatry Verge May 3 2013 Archived from the original on June 6 2013 Retrieved May 23 2013 National Institute of Mental Health abandoning the DSM Mind Hacks May 3 2013 Archived from the original on June 5 2013 Retrieved May 23 2013 Psychiatry divided as mental health bible denounced New Scientist Archived from the original on June 4 2013 Retrieved May 23 2013 Did the NIMH Withdraw Support for the DSM 5 No PsychCentral May 7 2013 Archived from the original on May 8 2013 Retrieved May 23 2013 Mental Health Researchers Reject Psychiatry s New Diagnostic Bible Time May 7 2013 Archived from the original on May 22 2013 Retrieved May 23 2013 THE RATS OF N I M H The New Yorker May 16 2013 Archived from the original on June 7 2013 Retrieved May 23 2013 Belluck Pam Carey Benedict May 6 2013 Psychiatry s Guide Is Out of Touch With Science Experts Say The New York Times Archived from the original on November 13 2013 Retrieved May 23 2013 a b DSM 5 and RDoC Shared Interests National Institute of Mental Health and American Psychiatric Association Archived from the original on April 4 2014 Retrieved May 23 2013 Aragona M 2014 Epistemological reflections about the crisis of the DSM 5 and the revolutionary potential of the RDoC project Archived June 2 2015 at the Wayback Machine Dialogues in Philosophy Mental and Neuro Sciences 7 11 20External links Edit DSM V The Future Manual American Psychiatric Association Archived from the original on November 19 2008 DSM 5 Update Supplement to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition PDF PsychiatryOnline American Psychiatric Association Publishing September 2016 Retrieved from https en wikipedia org w index php title DSM 5 amp oldid 1143440329, wikipedia, wiki, book, books, library,

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