DSM V released

Psychiatry’s newly revised diagnostic manual was released this week after several years in development.

I have written a couple of columns over the past two years or so about some of the proposed changes coming to the DSM and today I’ll give a brief overview of the major areas that have changed and what that will mean for the way psychiatry is practiced.

For those who may not be familiar with the DSM – it stands for Diagnostic and Statistical Manual and it is a document containing the names and diagnostic criteria for all mental health disorders officially recognized by the American Psychiatric Association (APA). It is intended for use by clinicians as they diagnose and treat patients with mental illness.

The DSM-V is the fifth edition of this document – the first revision since 2000 -- and has a variety of significant updates and changes.

One of the most widely discussed changes in the new manual is its treatment of autism. The name autism spectrum disorder now encompasses what used to be four separate conditions. I have written about this in more detail in a previous column.

The criteria for ADD/ADHD have also been modified to better reflect the reality that this condition often carries over into adulthood and is no longer considered strictly a childhood disorder. Criteria have also changed to allow for diagnosis in adulthood. This brings the official criteria into line with what has been known about the disorder for several years and is already widely happening in practice.

In childhood disorders, bipolar disorder has been re-named as disruptive mood dysregulation disorder. It is intended to address difficulties in diagnosing and treating children. It can be diagnosed in children up to 18 years of age who have persistent and extreme issues with controlling their behaviour. This condition warrants its own column and I will write one on it soon.

In the new manual, binge eating disorder, pre-menstrual dysphoric disorder and hoarding are officially recognized as their own conditions with diagnostic criteria distinct from other similar conditions. I have written about each of these in more detail in previous columns as well.

Major depression can now also be diagnosed even if a person is in the first stages of bereavement. Until now, clinical depression was ruled out if a person was less than two months into the process of grieving. This was widely thought to be an arbitrary limit with no basis in research.

An over-arching change also took place removing the multi-axis system classifying mental health conditions. This system organized each diagnosis into five axes to define different aspects of the disorder.

These categories separated disorders thought to be physical in nature such as brain injuries or medical disorders and those such as depression or anxiety thought to be purely psychological.

It is now believed these categorizations placed too much emphasis on the difference between psychiatric and other medical conditions. The more we learn about mental health conditions and the human brain, the more we see the distinctions between ‘mental’ and ‘physical’ are largely artificial.

More could be said about the DSM-V and I will explore specific changes in future columns. These changes are useful in that they reflect new research and knowledge in the field and ensure the language and criteria used by most mental health professionals remain consistent and up-to-date.

 

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