dsm-iv-tr to dsm-v; what you might want to know
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
Tiffany Wynn, MA, PCC
Prescott College
August 2013
DSM-IV-TR to DSM-V; What you might want to know
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
Purpose
Conceptual Development
DSM-I Presumed Etiology
DSM-IIGlossary Definitions
DSM-IIIReconceptualizationExplicit Criteria
DSM-III-RCriteria Broadened
DSM-IVRequires Clinically
Significant Distress
Impairment
• 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
DSM-V
• 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
Perceived shortcomings in DSM-IV
Multi-Axial Diagnosis
NO MORE
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.
Definition of a Mental Disorder
• 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
When making a diagnosis
DSM-IV- TR DSM-V
Disorders usually first diagnosed in childhood
Neurodevelopmental disorders
Delirium, Dementia, and Amnestic and other cognitive disorders
Schizophrenia Spectrum and other Psychotic Disorders
Mental Disorders due to e a general medical condition
Bipolar and related disorders
Mood disorders Depressive disorders
Anxiety disorders Anxiety disorders
Somatoform disorders Obsessive compulsive and related disorders
Factitious disorders Trauma and stressor-related disorders
Dissociative disorders Dissociative disorders
Sexual and gender identity disorders
Somatic symptom related disorder
Chapter Structure DSM-IV to V
DSM-IV- TR DSM-V
Eating disorders Somatic symptoms and related disorders
Sleep disorders Feeding and eating disorders
Impulse control not elsewhere classified
Elimination disorders
Adjustment disorders Sleep-Wake disorders
Personality disorders Sexual dysfunctions
Other conditions that may be a focus of clinical attention
Gender dysphoria
Disruptive, impulse control, conduct disorders
Substance related and addictive disorders
Personality disorders
Chapter Structure DSM-IV to V
DSM-IV- TR DSM-V
Paraphilic Disorders
Other disorders
Medication induced movement disorders and other adverse effects of medication
Other conditions that may be a focus of lcincial attention
Chapter Structure DSM-IV to V
DSM-IV-TR
• Total 172 specific mental disorders
DSM-V
• Total 157 specific mental disorders
Net Change
New Disorders
1. Social (pragmatic) Communication Disorder
2. Disruptive Mood Disorder
3. Premenstrual Dysphoric Disorder
4. Hoarding Disorder
5. Excoriation (Skin picking) Disorder
6. Disinhibited Social Engagement Disorder (split from RAD)
7. Binge eating disorder
8. Central Sleep Apnea (split from breathing related disorder)
9. Rapid Eye Movement Sleep Behavior Disorder
10.Restless Legs Syndrome (Dyssmnia NOS)
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
1. Sexual Aversion Disorder
2. Polysubstance-Related Disorder
New and eliminated in DSM-V
• 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 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
I am not going to cover the following:
• Mental Retardation was renamed intellectual disability
• Greater emphasis on adaptive functioning deficits rather than IQ score
Intellectual Disability (Intellectual Developmental Disorder)
ASD replaces DSM-IV’s autistic disorder, Asperger’s disorder, childhood disintegration disorder, and pervasive developmental disorder not other wise specified
Autism Spectrum 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
Attention deficit/ Hyperactivity Disorder
Now presented as a single disorder with specifies for: Reading, Writing and Mathematics
Specific Learning Disorder
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
• 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
Mania and Hypomania(Bipolar and Related Disorders)
• Newly added to DSM-V
Disruptive Mood Dysregulation Disorder (DMDD)
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
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
• 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)
Trauma and Stress Related Disorders
RAD and DSED
• Reactive Attachment subtypes are now two distinct sdisorders• RAD
• Disinhibited Social Engagement Disorder
T & SR Disorders Continued
• Newly added separate diagnostic class
• Now includes two separate sets of diagnostic criteria for children and adult/adolescents
Gender Dysphoria
Provides more specific criteria to define types of outbursts and the frequency needed to meet threshold.
CANNOT diagnosis before age 6
Intermittent explosive disorder
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
Substance-Related and Addictive 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.
Personality Disorders
Tiffany Wynn, MA, PCC, NCC
Skype: Tiffany_Wynn; Galloway, Ohio
Thank you!