DSM 5 - What has changed in the Bible

Dictionary?

Dr Scott Eaton, MBChB, MRCPsych, FRANZCP Sternberg Clinic, Bendigo

Sternberg S

History

First published 1952 to have a unified classification system.

1980 DSM 3 Dropped psychodynamic for the empirical

Axial system introduced

Process

Started in 1999 with DSM 5 research planning conference

Six working groups: Nomenclature , Neuroscience and Genetics, Developmental issues and Diagnosis, Personality Disorder, Mental Disorders and Disability, and Cross-cultural Issues

Developed Peer reviewed White papers. Followed by recommendations by research oriented panels.

2007 Task Force to develop DSM 5

scientists from psychiatry and other disciplines, clinical care providers, and consumer and family advocates.

Scientists working on the revision of the DSM have experience in research, clinical care, biology, genetics, statistics, epidemiology, public health, and consumer advocacy

DSM 5 Field Trials - reliability of diagnoses

Major Changes

Diagnostic reorganisation

removal infant/child disorders

Axis II

Neurodevelopmental Disorders

Intellectual Disability - Mental retardation

Assess cognitive AND functional capacity

Severity dependent on FUNCTION

Communication Disorders (language, speech, fluency, social communication)

Autism Spectrum Disorder - Autism, Asperger’s, Childhood disintegrative disorder, Pervasive developmental disorder

ADHD: Put in neurodevelpmental disorder category

No change to symptom checklist and remain in subgroups - inattention and hyperactive

Symptoms can occur later in life - before 12 rather than 7

Adults only require 5 not 6 symptoms

Schizophrenia

removal of special attribution symptoms - bizarre deusions and Schneiderian hallucinations

Must have 1 of delusions, hallucinations or disorganised speech

Subtypes have been removed

Schizoaffective disorder requires major mood disorder throughout much of the episode

Delusional disorder - demarcation from BDD and OCD

Catatonia - same criteria throughout - previously different for some disorders!

Bipolar Disorders

Manic/Hypomanic symptoms emphasis on changes in ACTIVITY ENERGY MOOD

“with mixed features” - previously stricter criteria - needed full diagnosis of both episodes. Now only need feature(s)

“Other specified” - flexibility (attenuated) of diagnosis with qualifiers

“anxious distress” qualifier

Depressive disorders

Disruptive mood dysregulation disorder - <18, irritable, frequent behavioural dyscontrol

Premenstral dysphoric disorder

Persistent depressive disorder - Dysthymia Chronic Depressive Disorder

Major Depression - no change. “Mixed” - 3 manic sx. Bereavement exclusion.

Anxiety Disorders

OCD related disorders NOT

Trauma related disorders NOT

Phobias - anxiety out of proportion with the threat

Panic attacks - expected/unexpected, qualifier

Separation Anxiety Disorder

Selective mutism

6 month duration

Obsessive Compulsive

Reorganisation

specifiers - insight, delusional, tic-related

BDD

Hoarding Disorder - persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them

Trichotillomania

Excoriating disorder

Medically/substance induced OCD

Trauma

Acute stress - direct/witnessed/indirect and less emphasis on dissociative sx

Adjustment - traumatic/non-traumatic

PTSD - exposure to traumatic/catastrophic , 4 clusters - reexperiencing, avoindance, numbing, arousal

Reactive Attachment D - separated from disinhibited social engagement disorder

Dissociative Disorders

depersonalization added to derealization disorder

fugue added to dissociative amnesia

Dissociative identity disorder

Somatic Symptom and related disorders

Maladaptive thoughts, emotions and behaviours with somatic symptoms

may or may not have medical condition

removed the high symptom criteria

medically unexplained symptoms - less emphasis

Hypochondriasis now illness anxiety disorder

Pain disorder-recognition of psychological factors in all pain, “specifier” status

Conversion disorder - do not need to demonstrate psychological factors initially

Eating Disorder

avoidant/restrictive food intake disorder - catchall

Anorexia Nervosa - amenorrhoea

Bulaemia lower threshold - 1xweekly

Gender Dysphoria

Gender incongruence

rather than cross gender identification

remove references to sex

Gambling to addictive disorders

mild neurocognitive disorder

DEBATE

Lack of transparency initially - issues of non-disclosure clause, greater public input, development process - ongoing scrutiny

Higher level of contributors (70%) with affiliation to pharma - disclosure of interest required

Borderline Personality Disorder

British Psychological Society

 It criticized proposed diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements... not value-free, but rather reflect[ing] current normative social expectations", noting doubts over the reliability, validity, and value of existing criteria.

suggested a change from using "diagnostic frameworks" to a description based on an individual's specific experienced problems, and that mental disorders are better explored as part of a spectrum shared with 

normality.

NIMH

Research Domain Criteria - matrix

Constructs - concepts regarding brain organization and function

domains of activity - brain circuits

units of analysis - genes, molecules, cells, circuits, physiology, behaviour, self-report

The scientific foundation of psychiatric medicine has grown by leaps and bounds in the last fifty years. The emergence of psychopharmacology, neuroimaging, molecular genetics and biology, and the disciplines of neuroscience and cognitive psychology have launched our field into the mainstream of medicine and on a course for future growth and success. Though not everyone, including ourselves, is satisfied with the rate of our field’s progress, no one can argue with one simple fact; if you or a loved one suffers from a mental illness, your ability to receive effective treatment, recover and lead a productive life is better now than ever in human history.