Classification systems in psychiatry “part 2” : DSM-5

Contents

• Introduction • Background information• Proposed DSM-5 organizational structure and

disorder names• Proposed changes• Conclussion• References

Introduction• Development of DSM-5 , more than a decade in

process, has been the object of immense public and professional interest

• Process began in 1999• APA is working on the DSM-5 together with;NIMHWHONational institute on drug abuseNational institute on Alcohol abuse and

alcoholism

Cont ...• Currently in the final stages of consultation

and preparation• Due for publication in May 2013• Work groups are to address major gaps that

are in current DSM• Working with WHO on an ongoing basis to

develop harmonization between d/o included in both DSM-5 and ICD-11( ICD-11 due for publication in 2015

Background • DSM-5 task force was formed in 2007• Composed of world-renowned leaders in

psychiatric research, dx , and treatment• Has 13 work groups• 160 members• 97 psychiatrists, 47 psychologists, 2 peads

neurologists, 3epidem ,• and there’s 1 representative each from paeds,

social work, paediatric nursing, speech therapy and consumer groups

• Also more than 300 outside advisors• Public input through the DSM5 website

Proposed DSM-5 organizational structure and disorder names

1. Neurodevelopmental Disorders2. Schizophrenia Spectrum and Other Psychotic Disorders3. Bipolar and Related Disorders4. Depressive Disorders5. Anxiety Disorders6. Obsessive-Compulsive and Related Disorders7. Trauma and Stressor Related Disorders8. Dissociative Disorders9. Somatic Symptom Disorders10. Feeding and Eating Disorders11. Elimination Disorders12. Sleep-Wake Disorders13. Sexual Dysfunctions14. Gender Dysphoria15. Disruptive, Impulse Control, and Conduct Disorders16. Substance Use and Addictive Disorders17. Neurocognitive Disorders18. Personality Disorders19. Paraphilias20. Other Disorders

Proposed “major” changes• Proposed changes represent an opportunity to

improve the field from clinical and public health perspectives

• Integrating new dimensional applications to current categorical approaches

• Changing the definition of Mental/Psychiatric d/o

Changing of some terminology in the def Removal of the clinical significance criterion

(CSC)

Child and adolescent psych changes

• Chapter now neurodevelopmental d/o• Proposal for single “autism spectrum d/o”

category that will incl. the current DSM-IV-TR diagnoses

AutismAsperger’sCDDPDD

Psychotic d/o group

• Suggestion of inclusion in the schizophrenia spectrum and related d/o of a new d/o attenuated psychosis syndrome

• For early diagnosis and intervention• To avoid prolonged DUP

Mood d/o

• Separation of “bipolar and related d/o” and “depressive d/o”

• The group is putting forth a proposal for the addition of Mixed anxiety/Depression as a new diagnosis

Personality d/o

• Reformulation of approach to assessment and diagnosis of personality psychopathology incl

Revised gen. CriteriaEvaluation based on impairments in

personality fxning and pathological personality traits

An overall measure of personality dysfxn• Dimensional-categorical model proposed

Cont...• Six specific PD types proposedAntisocialAvoidantBorderlineNarcissisticObsessive-compulsiveSchizotypal• Also a new diagnosis of PDTS(Personality D/O Trait Specified)

Cont...

• Aim is to describe the personality characteristics of all pts, whether they have a personality d/o or not

Trauma- and Stressor-Related d/o

• New category• Incl diagnoses previosly listed under anxiety

d/o and adjustment d/o i.e. AD,ASD,PTSD• Recommendation to shift ASD and PTSD out of

the anxiety d/o section reflects increased recognition of trauma as a precipitant,

• Emphasizing common etiology over common phenomenology

Others

• “Somatoform d/o category” to “ somatic symptom d/o

• “Sleep d/o” to “ sleep-wake d/o”• “Sexual dysfxn” and “gender dysphoria”• And other minor changes to existing DSM-IV-

TR D/O names

Conclusion

• DSM-5 is a work in progress• There’s still room for improvement or change• It is clear that the forthcoming version of the

DSM cannot exhaustively address all the limitations and questions posed by the current nosology

• Others will have to be addressed by DSM 5.1 or 5.2

August 2009 paper III (special psychiatry)

If you were a member of the task team currently planning the new DSM-V(due for publication in 2012), what changes to this classification system would you recommend? Justify your recommendation fully.

References

1. www.DSM5.org

2. DSM-IV-TR

3. KUPFER , Am J Psychiatry 168:7,july 2011