DSM-IV-TR to DSM-V

Report
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
• Solely for the purpose of facilitating the first step in transitioning from
DSM-IV-TR to DSM-V
• Disclaimer
Conceptual Development
DSM-III-R
Criteria
Broadened
DSM-III
Reconceptualization
Explicit Criteria
DSM-II
Glossary
Definitions
DSM-I
Presumed
Etiology
DSM-IV
Requires
Clinically
Significant
Distress
Impairment
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
• 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
Multi-Axial Diagnosis
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
• 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
Chapter Structure DSM-IV to V
DSM-IV- TR
DSM-V
Disorders usually first diagnosed in
childhood
Neurodevelopmental disorders
Delirium, Dementia, and Amnestic and Schizophrenia Spectrum and other
other cognitive disorders
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
Net Change
DSM-IV-TR
• Total 172 specific mental disorders
DSM-V
• Total 157 specific mental disorders
New and eliminated in DSM-V
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
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 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 nonconsenting 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)
• Mental Retardation was renamed intellectual disability
• Greater emphasis on adaptive functioning deficits rather than IQ score
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
• 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
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)
• 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)
• 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
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
• 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
RAD and DSED
• Reactive Attachment subtypes are now two distinct sdisorders
•
RAD
•
Disinhibited Social Engagement Disorder
Gender Dysphoria
• Newly added separate diagnostic class
• Now includes two separate sets of diagnostic criteria for children and
adult/adolescents
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 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
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!
Tiffany Wynn, MA, PCC, NCC
twynn@prescott.edu
Skype: Tiffany_Wynn; Galloway, Ohio

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