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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
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
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
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!
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