Dsm iv tr to dsm v what you might want to know
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DSM-IV-TR to DSM-V; What you might want to know. Tiffany Wynn, MA, PCC Prescott College August 2013. Purpose. Workshop for practitioners and students who are already familiar with the DSM-IV-TR. Including: Content Use Limitations

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DSM-IV-TR to DSM-V; What you might want to know

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Dsm iv tr to dsm v what you might want to know

DSM-IV-TR to DSM-V; What you might want to know

Tiffany Wynn, MA, PCC

Prescott College

August 2013


Purpose

Purpose

  • Workshop for practitioners and students who are already familiar with the DSM-IV-TR. Including:

  • Content

  • Use

  • Limitations

  • Solely for the purpose of facilitating the first step in transitioning from DSM-IV-TR to DSM-V

  • Disclaimer


Conceptual development

Conceptual Development

DSM-III-R

Criteria

Broadened

DSM-III

Reconceptualization

Explicit Criteria

DSM-IV

Requires Clinically Significant Distress

Impairment

DSM-II

Glossary Definitions

DSM-I Presumed Etiology


Dsm v

DSM-V

  • New approaches considered

  • Dimensional Spectra

  • Developmental structures included

  • Culture Included

  • Impairment

  • Considered a living document

  • Intentional move away from expert consensus and relying more on empirical data


Perceived shortcomings in dsm iv

Perceived shortcomings in DSM-IV

  • High rates of comorbidity

  • High use of NOS category

  • Treatment non-specificity

  • Inability to find laboratory markers/ tests

  • DSM is starting to hinder research progress


Multi axial diagnosis

Multi-Axial Diagnosis

NOMORE


Definition of a mental disorder

Definition of a Mental Disorder

  • A mental disorder is a syndrome characterized by clinically significant disturbance in a individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.


When making a diagnosis

When making a diagnosis

  • Consider contextual information (course, differential), distress, clinical judgment, culture

  • Diagnosis is given, DSM-V provides severity assessments that can help you differentiate and specify

  • Apply codes and follow coding and recording procedures

  • Develop a treatment plan and outcome monitoring approach


Chapter structure dsm iv to v

Chapter Structure DSM-IV to V


Chapter structure dsm iv to v1

Chapter Structure DSM-IV to V


Chapter structure dsm iv to v2

Chapter Structure DSM-IV to V


Net change

Net Change

  • DSM-IV-TR

  • Total 172 specific mental disorders

  • DSM-V

  • Total 157 specific mental disorders


New and eliminated in dsm v

New and eliminated in DSM-V

  • New Disorders

  • Social (pragmatic) Communication Disorder

  • Disruptive Mood Disorder

  • Premenstrual Dysphoric Disorder

  • Hoarding Disorder

  • Excoriation (Skin picking) Disorder

  • Disinhibited Social Engagement Disorder (split from RAD)

  • Binge eating disorder

  • Central Sleep Apnea (split from breathing related disorder)

  • Rapid Eye Movement Sleep Behavior Disorder

  • Restless Legs Syndrome (Dyssmnia NOS)


New and eliminated in dsm v1

New and eliminated in DSM-V

  • New Disorders

  • 11. Caffeine withdrawal

  • 12. Cannabis Withdrawal

  • 13. Major Neurocognitive Disorder with Lewy Body Disease (Dementia Due to Other Medical Conditions)

  • Eliminated Disorders

  • Sexual Aversion Disorder

  • Polysubstance-Related Disorder


I am not going to cover the following

I am not going to cover the following:

  • Dissociative Disorders, there are however a number of changes made regarding increased awareness and acceptance of cultural and religiuos practices.

  • Somatic Symptom and Related Disorders, medically unexplained symptoms and disorders

  • Binge eating: IT has been elevated to the main body of the DSM-V and is under eating and feeding disorders

  • Anorexia: no Longer requires amenorrhea

  • Avoidant/ restrictive food intake disorder: This is the new name for what was feeding disorders of childhood

  • Sleep wake disorders: primary insomnia renamed insomnia disorder, Rapid eye movement disorder and restless leggs syndrome moved to the main body of the DSM


I am not going to cover the following1

I am not going to cover the following:

  • Circadian Rhythm Sleep disorders

  • Breathing Related Sleep Disorders

  • Sexual Dysfunctions: Vaginismus and dyspareunia and merged into genito-pelvic pain penetration disorder

  • Neurocognitive Disorders: replace dementia and has a newly added Mild NCD; NCD subtypes are now present frontotemporal dementia, Lewy bodies

  • Paraphilic Disorders: separated into paraphilia's that do not involve non-consenting victims (transvestism) are not necessarily indicative of mental disorder…requires distress, impairment or abuse of non-consenting victim. Now has new specifier: in a controlled environment, in remission


Intellectual disability intellectual developmental disorder

Intellectual Disability (Intellectual Developmental Disorder)

  • Mental Retardation was renamed intellectual disability

  • Greater emphasis on adaptive functioning deficits rather than IQ score


Autism spectrum disorder

Autism Spectrum Disorder

  • ASD replaces DSM-IV’s autistic disorder, Asperger’s disorder, childhood disintegration disorder, and pervasive developmental disorder not other wise specified


Attention deficit hyperactivity disorder

Attention deficit/ Hyperactivity Disorder

  • Age of onset was raised from 7 to 12 years

  • Symptom threshold for adults age 17 years and older was reduced to five criteria


Specific learning disorder

Specific Learning Disorder

  • Now presented as a single disorder with specifies for: Reading, Writing and Mathematics

Schizophrenia

(Schizophrenia Spectrum and Other Psychotic Disorders)

Elimination of special treatment of bizarre delusions and “Special” hallucinations in Criterion A

At least one of two required symptoms to meet Criterion A must be delusions, hallucinations, or disorganized speech

Deletion of specific subtypes


Mania and hypomania bipolar and related disorders

Mania and Hypomania(Bipolar and Related Disorders)

  • Inclusion of increased energy. Activity as a Criterion A symptom of mania and hypomania

  • Mixed Episode is replaced with mixed features

    • Specifier for manic, hypomanic and major depressive episodes

  • With anxious distress also added as a specifier for bipolar and depressive disorders


Disruptive mood dysregulation disorder dmdd

Disruptive Mood Dysregulation Disorder (DMDD)

  • Newly added to DSM-V

Anxiety Disorders

Separation of DSM-IV anxiety disorders chapter into four distinct chapters

Anxiety can be a specifier code for most other disorders now

Panic Attack Specifier: Now a specifier for any mental disorder


Obsessive compulsive and related disorders

Obsessive Compulsive and Related Disorders

  • Hoarding Disorder

Newly added to DSM-V

Body Dysmorphic Disorder

Newly calssified as as an OCD-related disorder rather than a somatic dosorder

~ All now include expanded specifiers to indicate degree of insight present(i.e. good or fair; poor, absent or delusional


Trauma and stress related disorders

Trauma and Stress Related Disorders

  • PTSD

    • Stressor Criterion is more explicit

    • Expansion to four symptom clusters: intrusion symptoms, avoidance symptoms, negative alterations in mood and cognition and alterations in arousal and reactivity

    • Separate criteria are now available for PTSD occurring in preschool-age children (6 and younger)


T sr disorders continued

T & SR Disorders Continued

  • RAD and DSED

  • Reactive Attachment subtypes are now two distinct sdisorders

    • RAD

    • Disinhibited Social Engagement Disorder


Gender dysphoria

Gender Dysphoria

  • Newly added separate diagnostic class

  • Now includes two separate sets of diagnostic criteria for children and adult/adolescents


Intermittent explosive disorder

Intermittent explosive disorder

  • Provides more specific criteria to define types of outbursts and the frequency needed to meet threshold.

  • CANNOT diagnosis before age 6


Substance related and addictive disorders

Substance-Related and Addictive Disorders

  • Substance Use Disorder

  • Consolidated substance abuse with substance dependence

  • Will be coded with severity

  • Removal of legal criteria for abuse diagnosis

  • Added craving or strong desire or urge to use the substance


Personality disorders

Personality Disorders

  • ALL 10 DSM-IV PDs remain intact, there is a shift to an alternate trait based approach to assessing personality and PDs that includes specific types.

  • This means features can be identified and present in any diagnostic conceptualization but do not necessarily require a diagnosis.


Thank you

Thank you!

  • Tiffany Wynn, MA, PCC, NCC

  • [email protected]

  • Skype: Tiffany_Wynn; Galloway, Ohio


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