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

1. DSM-IV-TR to DSM-V; What you might want to know Tiffany Wynn, MA, PCC Prescott College August 2013

2. 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

3. 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

4. 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

5. 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

6. Multi-Axial Diagnosis NOMORE

7. 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.

8. 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

9. Chapter Structure DSM-IV to V

10. Chapter Structure DSM-IV to V

11. Chapter Structure DSM-IV to V

12. Net Change • DSM-IV-TR • Total 172 specific mental disorders • DSM-V • Total 157 specific mental disorders

13. 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)

14. 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

15. 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

16. 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

17. Intellectual Disability (Intellectual Developmental Disorder) • Mental Retardation was renamed intellectual disability • Greater emphasis on adaptive functioning deficits rather than IQ score

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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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)

25. T & SR Disorders Continued • RAD and DSED • Reactive Attachment subtypes are now two distinct sdisorders • RAD • Disinhibited Social Engagement Disorder

26. Gender Dysphoria • Newly added separate diagnostic class • Now includes two separate sets of diagnostic criteria for children and adult/adolescents

27. Intermittent explosive disorder • Provides more specific criteria to define types of outbursts and the frequency needed to meet threshold. • CANNOT diagnosis before age 6

28. 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

29. 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.

30. Thank you! • Tiffany Wynn, MA, PCC, NCC • twynn@prescott.edu • Skype: Tiffany_Wynn; Galloway, Ohio