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Neurodevelopmental Disorders

Intellectual Disability: Severity is determined by adaptive functioning rather than IQ score. Deficits in cognitive capacity beginning in the developmental period.

Communication Disorders: Expressive language disorders, speech sound disorder, fluency disorder, social communication disorder (not in the presence of restricted repetitive behaviors).

Autism Spectrum Disorder: Four previously seperate disorders (Autism, Asperger, Childhood disintegrative disorder, Pervasive developmental disorder). Deficits in social communication and social interaction, restricted repetitive behaviors).

Attention-Deficit/Hyperactivity Disorder: 18 symptoms, 2 domains (inattention, impulsivity). Application across lifespan, cross-situational, present before age of 12, presentation specifiers instead of subtypes, comorbid diagnosis with autism spectrum disorder allowed, symptom threshold change for adults.

Specific Learning Disorder: Deficits in the areas of reading, written expression, and mathematics.

Motor Disorders: Developmental coordination disorder, stereotypic movement disorder, Tourette’s disorder, persistent (chronic) motor or vocal tic disorder, provisional tic disorder, other specified tic disorder.

Schizophrenia Spectrum and Other Psychotic Disorders

Schizophrenia: Elimination of the special attribution of bizarre delusions and auditory hallucinations. Two Criterion A symptoms required for any diagnosis of schizophrenia. At least one of these three symptoms: delusions, hallucinations, or disorganized speech. Subtypes of schizophrenia removed (low reliability, and poor validity). Dimensional approach to rating severity for the core symptoms of schizophrenia.

Schizoaffective Disorder: Major mood episode be present for a majority of the disorder’s total duration after Criterion A has been met (conceptual and psychometric). Longitudinal instead of a cross-sectional. More comparable to schizophrenia, bipolar disorder, and major depressive disorder, which are bridged by this condition. Improvement of reliability, diagnostic stability, and validity of this disorder.

Delusional Disorder: No longer requirement that the delusions must be nonbizarre. Demarcation of delusional disorder from psychotic variants of obsessive-compulsive disorder. Symptoms must not be better explained by conditions such as obsessive-compulsive or body dysmorphic disorder with absent insight/delusional beliefs. DSM-5 no longer separates delusional disorder from shared delusional disorder.

Catatonia: Diagnosed as a specifier for depressive, bipolar, and psychotic disorders; as a separate diagnosis in the context of another medical condition; or as an other specified diagnosis.

Bipolar and Related Disorders

Criterion A includes an emphasis on changes in activity and energy as well as mood. The diagnosis of mixed episodes, requiring that the individual simultaneously meet full criteria for both mania and major depressive episode, has been removed.

Other Specified Bipolar and Related Disorder

Specification of particular conditions for other specified bipolar and related disorder, including categorization for individuals with a past history of a major depressive disorder who meet all criteria for hypomania except the duration criterion.

Anxious Distress Specifier

Is intended to identify patients with anxiety symptoms that are not part of the bipolar diagnostic criteria.

Depressive Disorders

Several new depressive disorders, including disruptive mood dysregulation disorder and premenstrual dysphoric disorder added. To address concerns about potential overdiagnosis and overtreatment of bipolar disorder in children, a new diagnosis, disruptive mood dysregulation disorder, is included for children up to age 18 years who exhibit persistent irritability and frequent episodes of extreme behavioral dyscontrol.

Major Depressive Disorder

Criterion 1 (mood, interest) and requirement for clinically significant distress or impairment in social, occupational, or other important areas of life, listed as Criterion B. Coexistence with at least three manic symptoms  acknowledged by the specifier “with mixed features.”

Bereavement Exclusion

Exclusion for two month due to death is omitted for several reasons. First, duration is more commonly 1–2 years. Second, bereavement is recognized as a severe psychosocial stressor that can precipitate a major depressive episode. When major depressive disorder occurs in the context of bereavement, it adds an additional risk for suffering, feelings of worthlessness, suicidal ideation, poorer somatic health, worse interpersonal and work functioning, and an increased risk for persistent complex bereavement disorder. Third, bereavement-related major depression is most likely to occur in individuals with past personal and family histories of major depressive episodes. It is genetically influenced and is associated with similar personality characteristics, patterns of comorbidity, and risks of chronicity and/or recurrence as non–bereavement-related major depressive episodes. Finally, the depressive symptoms associated with bereavement-related depression respond to the same psychosocial and medication treatments as non–bereavement-related depression.

Specifiers for Depressive Disorders

Suicidality represents a critical concern. Guidance on assessment of suicidal thinking, plans, and the presence of other risk factors in order to make a determination of the prominence of suicide prevention in treatment planning for a given individual. New specifier to indicate the presence of mixed symptoms, allowing for the possibility of manic features.

Anxiety Disorders

Anxiety disorder no longer includes OCD, PTSD and acute stress disorder. However close relationships.

Agoraphobia, Specific Phobia an Social Anxiety Disorder

Deletion of the requirement that individuals recognize that their anxiety is excessive or unreasonable. Often Overestimation of danger in “phobic” situations and older individuals misattribute “phobic” fears to aging. Anxiey must be out of proportion to the actual danger or threat in the situation, after taking cultural contextual factors into account. In addition 6 month duration necessary. Intended to minimize overdiagnosis of transient fears.

Panic Attack

DSM IV terminology for describing different types of panic attacks (i.e. situationally bound/cued, situationally predisposed, and unexpected/uncued) is replaced with the terms unexpected and expected panic attacks. Marker and commorbidity across array of disorders.

Panic Disorder and Agoraphobia

Panic disorder and agoraphobia are unlined to DSM-5 (before, with, without, history). Number of individuals with agroaphobia do not experience panic symptoms. Co-occurance diagnosed with two diagnoses. Endorsement of fears of individuls with agoraphobia do not experience panic symptoms. Endorsement of fears from two or mote agoraphobia situations is now required for distinguishing agoraphobia situations from specific phobias.  Criteria for agoraphobia are extended to be consistent with criteria sets for other anxiety disorders.

Specific Phobia

No longer requirement that individuals over 18 must recognize that their fear and anxiety is excessive or unreasonable. Duration requirement of 6 months.

Social Phobia

No longer requirement that individuals over 18 must recognize that their fear and anxiety is excessive or unreasonable. Duration requirement of 6 months. “Generalized” specifier (fear has been deleted, and replaced with a “performance only” specifier (f.e performing in front of audience).

Separation Anxiety Disorder

In DSM-IV classified under “disorders first diagnosed in infancy, childhood or adolescence  now as anxiety disorder. Modified wording of criteria to more adequately represent expression of separation anxiety in adulthood (f.e.: attachment figures may include children of adults with separation anxiety disorder, avoidance behavior may occure in workplace or in school). No longer requirement that individuals over 18 must recognize that their fear and anxiety is excessive or unreasonable. Duration requirement of 6 months.

Selective Mutism

In DSM-IV classified under “disorders first diagnosed in infancy, childhood or adolescence  now as anxiety disorder.

Obessive-Compulsive and Related Disorders

New chapter in DSM V due to increasing diagnostic evidence to group these disorders. New disorders include hoarding disorder, excoriation disorder, substance-/medication induced OCD. Trichotillomania removed from impulse control disorders to OCD.

Specifier of Obessive-Compulsive and Related Disorders

“Insight” specifiers refined (fair, poor, absent – conviction that OCD beliefs are true). Analogous specifiers for body dysmorphic disorder and hoarding disorder. Presence of absent/delusional insight warrants diagnosis of OCD rather than Schizophrenia and other psychotic disorder.

Body Dismorphic Disorder

Criterion for describing repetitive behaviors or mental acts in response to preoccupation with perceived defects in physical appearance has been added. A with muscle dysmorphia specifier has been added to reflect utility of making distinction in individuals with body dismorphic disorder. The delusional variant of BDD no longer coded as both delusional disorder and BDD, just BDD with absent insight.

Hoarding Disorder

Hoarding included as possible symptom of OCD. No indication that hoarding is a variant of OCD. Utility of seperate diagnosis of hoarding, reflecting difficulty discarding or parting with possessions, due to perceived need to save items and stress with discarding them. Unique neurobiological correlates, associated with impairment, responding to clinical intervetion.

Trichotilloania and Excoriation

New included.

Substance/Medication induced OCD

In DSM 4 specifier with OCD symptoms in diagnosis of anxiety disorders, now in category OCD.

Other specified and unspecified OCD

Can include conditions as body focussed repetitive behavior, obessive jealousy or unspecified OCD.

Trauma and Stress related disorders

Stressor criterion for accute stress disorder has been changed, requiring being explicit as weather traumatic events were experienced directly, witnessed or indirectly. Criterion regarding subjective reaction (fear, helplessness, horror) to traumatic event has been eliminated. Since posttraumatic reactions heterogenous, diagnostic criteria for accute stress disorder, if 9 of 14 criteria in categories intrusion, negative mood, dissociation, avoidance and arousal.

Adjustment disorders

Heterogenous array of stress responses that occur after exposure to a distressing event, rather than as residual category for individuals who exhibit significant distress. DSM IV subtypes depressive mood, anxious symptoms or disturbances in conduct retained.

Posttraumatic stress disorder

Stressor criterion A more explicit regarding how individual is experiencing traumatic events. Also criterion for subjective reaction has been eliminated. Major symptom clusters reexperiencing, arousal and avoidance modified by division of avoidance in avoidance and persistant negative alterations in cognition and mood (new or reconceptualized), including numbing symptoms. Cluster arousal containing most DSM IV symptoms, including irritable, agressive, reckless or self-destructive  behavior. PTSD now developmentally sensitive.

Reactive Attachment Disorder

Subtypes of childhood diagnosis reactive attachment disorder emotionally withdrawn/inhibited and indiscriminately social/disinhibited now distinct disorders: reactive attachment disorder and disinhibited social engagement disorder. Both are the result of social neglect ot other situations that limit opportunity to form selective attachment. Because of dampered positive affect reactive attachment disorder more closely resembles internalizing disorders, due to lack or incompletely formed preferred attachment to caregiving adults. Disinhibited social engagement more closely resembles ADHD, not requiring lack of attachment. Two disorders differing in other important ways: correlates, course and response to intervention.

Dissociative Disorders

Derealization included in name and symptom structure depersonalization/derealization disorder. Dissociative fugue now specifier of dissociative amnesia. Critria for dissociative identity disorder changed, that disruption may be reported as well as observed. Gaps in the recall may occur for everyday, not just traumatic events. Also experiences of pathological possession in some cultures included.

Dissociative Identity Disorders

Certain possession form phenomena and functional neurological symptoms included. Transitions in personality can be self reported or observed. Recurrent gaps in recall of everyday events, not just for traumatic experiences.

Somatic Symptom and Related Disorders

Somatoform disorders now referred to as somatic symptom disorders. Reduction of number of disorders to avoid overlap and increase clarity. Disorders primarily seen in medical settings somatoform diagnoses problematic to use. Diagnoses of somatization disorder, hypochondrias, pain disorder an undifferentiated somatoform disorder have been removed.

Somatic Symptom Disorders

Indiviuals with somatic symptoms plus abnormal thoughts, feelings and behaviors may or may not have a diagnosed medical condition. High symptom count for medically unexplained symptoms from DSM-IV did not accomodate spectrum between somatic symptoms and psychopathology. In DSM V only somatic symptom disorder, if maladaptive thoughts, feelings and behaviors in addition to their somatic symptoms. Undifferentiated somatoform disorder merged under somatic symptoms disorder.

Medically unexplained symptoms

DSM IV overemphasized importance of absence of a medical explanation for somatic symptoms. Unexplained symptoms present to various degrees, but somatic symptoms can accompany medical diagnoses. Reliability of medically unexplainable symptoms limited and diagnosis problematic. DSM 5 defines disorders on the basis of positive symptoms (distressing somatic symptoms plus abnormal thoughts, feelings an behaviors in response to these symptoms). Medically unexplained symptoms do remain a key feature in conversion disorder.

Hypochondria and Illness Anxiety Disorder

Hypochondrias eliminated because name perceived as pejorative and not conductive to effective therapeutical relationship. Most individuals diagnosed with hipochondriasis have significant somatic symptoms in addidition to high health anxiety, receiving diagnosis of somatic symptom disorder. Individuals with high health anxiey without somatic symptoms would receive diagnosis of illness anxiety disorder, unless health anxiety better explained by primary anxiety disorder.

Pain disorder

Different approach to realm of people with pain. Lack of evidence that distinction between solely psychological factors and medical diseases can be made as done in DSM IV, and evidence that psychological factors influence all sorts of pain. Most people with pain attribute it to combination of factors (somatic, psychological, environmental). In DSM V some individuals with chronic pain diagnosed as having somatic symptom disorder, others as suffering under psychlological factors affecting medical conditions or adjustment disorder.

Psychological factors affecting other medical conditions

New mental disorder with predominant somatic symptoms. Variants of psychological factors affecting conditions are removed in order to favor stem diagnosis.

Conversion Disorder

Emphasize importance of neurological examination in recognition that psychological factors may not be demonstrable.

Feeding and Eating Disorders

Feeding and eating disorders of infancy and childhood included. Brief description and preliminary diagnostic criteria provided for several conditions under other specified feeding and eating disorders. Insufficient information about these conditions currently available to provide definitive diagnostic criteria.

Pica and Rumination Disorder

Revised criteria and diagnoses for people of any age.

Avoidant/Restrictive Food Intake Disorders

Feeding disorder of infancy renamed avoidant/restrictive food intake disorder and criteria expanded. DSM IV disorder rarely used and limited information about characteristics, course and outcome. Large number of individuals restrict food intake and experience significant associated physiological or psychosocial problems but do not meet criteria for DSM IV eating disorder.

Anorexia Nervosa

Core criteria unchanged. Requirement for amenorrhea eliminated. As in DSM IV low body weight for development required. Criterion B expanded to include not only overtly expressed fear of weight gain but also behavior that interferes with weight gain.

Bulimia Nervosa

Reduction in the required minimum frequency of binge eating and in appropriate compensatory behavior frequency from twice to once weekly.

Binge Eating Disorder

Minimum average frequency of binge eating required for diagnosis has been changed from at least twice weekly for 6 months to at least once weekly over the last 3 months.

Sleep Wake Disorders

Sleep disorders related to another mental disorder and medical condition have been removed, due to need of concurrent specification of coexisting conditions in DSM V. Greater specification of coexisting conditions. Independence of phenomena, moving away from causal attributions of coexisting disorders. Consequently diagnosis of primary insomnia has been renamed insomnia disorder. Distinguishing narcolepsy associated with hypocretin (receptor) deficiency from other forms of hypersomnolence. Warranted by neurobiological and genetical evidence. Pediatric and developmental criteria integrated, when supported by science and experience.

Breathing related sleep disorders

Divided into three distinct disorders:  obstructive sleep apnea hyponpnea, central sleep apnea, sleep related hypoventilation, du to growing understanding of pathophysioloty in the genesis.

Circadian Rhythm Sleep Wake Disorders

The subtypes of circadian rhythm sleep-wake disorders have been expanded to include advanced sleep phase syndrom, irregular sleep-wake type and non 24-hour sleep-wake type, whereas the jet lag type has been removed.

Rapid Eye Movement Sleep Behavior Disorder and Restless Legs Syndrome

“Not otherwise specified” diagnoses reduced by designating rapid eye movement sleep behavior disorder and restless legs syndrome as independent disorders.

Sexual disfunctions

Referred to sexual pain or to a disturbance in one or more phases of the sexual response cycle. In DSM V gender specific sexual dysfunctions have been added. Minimum duration of 6 months and more precise severity criteria included.

Genito-Pelvic Pain/Penetration Disorder

New in DSM 5 merged categories of vaginismus and dyspareunia. Diagnosis of sexual aversion disorder removed.

Subtypes

Subtypes of sexual disorders include only lifelong versus aquired and generalized versus situational. Psychological versus combined factors and due to general medical condition eliminated. Associated features are described in the accompanying text: partner factors, relationship factors, individual vulnerability factors, cultural or religious factors and medical factors.

Gender Dysphoria

New diagnostic class in DSM V reflects change in conceptualization of disorder’s defining features. emphasizing incogruence rather than identification. Gender identity disorder neither sexual dysfunction nor paraphilia. Gender dysphoria is unique condition diagnosed by mental health care providers. Large proportion of treatment is endocrinological and surgical. Type and severity of gender dysphoria can be inferred from the number and type of indicators and from the severity measures. Considered as multicategory concept rather than dichotomy (wide variation of gender incongruent conditions). Seperate criteria for children, adolescents and adults. Previous criterion A (cross-gender identification) and B (aversion towards own’s gender) merged, due to factor analytic results. In wording “the other sex” is replaced by “some alternative gender”. Gender used instead of sex, because inadequate, when refering to a person with a disorder of sex development. For children “strong desire to be of the other gender” or “insistance that he/she is the other gender is now necessary.

Subtypes and specifiers

Subtyping on basis of sexual orientation removed. Posttransition specifier added, because many indiviuals no longer meet criteria for dysphoria and because they undergo continued treatments.

Disruptive, Impulse-Control and Conduct Disorders

New chapter in DSM V bringing together disorders previously included in chapters “Disorders usually first diagnosed in Infancy, Childhood, Adolescence” (oppositional defiant disorder, conduct disorder, disruptive behavior disorder) and “Impulse Control Disorders not otherwise specified” (intermittent explosive disorder, pyromania, kleptomania). All characterized by problems in emotional and behavioral self-control. Antisocial personality disorder has dual listing in this chapter and personality disorders. ADHD frequently comorbid.

Oppositional Defiant Disorder

Four refinements: First, symptoms grouped into three types (angry/irritable, argumentative/defiant, vindictiveness). Second, exclusion criterion for conduct disorder removed. Third, note about frequency added. Fourth, severity rating added.

Conduct Disorder

Criteria unchanged from DSM IV. Descriptive feature specifier for individuals also present with limited prosocial emotions and showing unemotional interpersonal style across multiple settings.

Intermittent Explosive Disorder

Physical agression necessary in DSM IV, verbal and nondestructive agression also meet criteria of DSM V. More specific criteria defining frequency and specifiers, that agressive outbursts are impulsive and/or anger based and must cause distress and impairment in occupational, interpersonal, financial and/or legal areas. Minimum age of 6 years now required. Relationship to other disorders specified.

Substance-Related and Addictive Disorders

Gambling Disorder

Substance-related chapter expanded with gambling disorder to reflect activation of reward system similar to drugs.

No separation of abuse and dependence, but  criteria for substance use disorder, accompanied by intoxication, withdrawal, included and induced disorders. Recurrant legal problems deleted, and strong desire to use a substance added. Threshold for substance use disorder set to two or more criteria. Cannabis and caffeine withdrawal new in DSM V. Criteria for tobacco use disorders the same as for other substance use disorders (none with DSM IV). Severity based on number of criteria endorsed. Specifier for a physiological subtype removed, as polysubstance dependence. Early remission defined as at least 3 months without substance use disorder criteria. Sustained remission defined as 12 months without criteria. Additional specifiers “in a controlled environment” and “on maintenance therapy”.

Neurocognitive Disorders

Delirium

Updated on basis of currently available data.

Major and mild Neurocognitive disorder

Subsumation of dementia and amnestic disorders. Term Dementia not decluded from etiological subtypes. DSM 5 recognizes less severe levels of impairment, that my be a focus of concern and treatment (mild NCD). Diagnostic criteria and neurocognitive domains for both and their etiological subtypes are provided. Major NCD consistent with rest of medicine. Mild NCD used in other fields of medicine (Alzheimer’s disease, cerebrovascular disorders, HIV and traumatic brain injury).

Etiological Subtypes

Major or mild vascular NCD and major or mild NCD due to Alzheimer retained, new seperate criteria for major and mild NCD due to frontotemporal NCD, Lewy bodies, traumatic brain injuries, Parkinson’s disease, HIV infection, Huntington’s disease, prion disease, another medical condition and multiple etiologies. Substance/medication induced and unspecified NCD also included.

Personality disorders

Criteria not changed, but alternative approach for further study integrated. Revised personality fuction criterion developed, based on reviews of clinical measures. Moderate level of impairment set empirically. With a single assessment of level of personality functioning, clinican can decide weather full assessment is necessary. Diagnostic criteria consistently defined by typical impairments in functioning and personality traits, empirically determined. Diagnostic thresholds for criterion A and B set empirically to minimize change in prevalence and overlap. Personality disorder – trait specified, replaces personality disorder not otherwise specified. Greater emphasis on functioning and traits, assessible not just for personality disorders.

Paraphilic disorders

Addition of course specifiers “in a controlled environment” and “in remission” to indicate important changes in an individual’s status. No consensus weather long-standing paraphilla can remit. Less argument, that consequent psychological distress, psychological impairment, or propensity to harm others can be reduced to aceptable levels.

Change to diagnostic names

Paraphilic disorder is paraphilia currently causing mental distress or impairment to the individual or paraphilia whose satisfaction is causing harm or risk of harm to others. Paraphilia itself not requiring clinical intervention. No changes in diagnostic criteria (criterion A, qualitative nature; criterion B, negative consequences). Individuals meeting criterion A and B now diagnosed as having paraphilic disorder. Approach leaving intact distinction between normative and non normative behavior, without labeling non normative as psychopathological.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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