DSM 5: What Changed?

If you study psychology, unless you have been living under a rock you have probably heard that the Diagnostic and Statistical Manual was Updated, and we are now using the 5th edition known as the DSM 5 (DSM-V). This update officially happened in 2013, but change is not easy so it took a couple years for agencies to completely switch over to the new diagnostic criteria.  Not everyone may need to read this, but if you still separate axis I and II disorders, use the term aspergers syndrome or dysthymia, or consider obsessive-compulsive disorder a sub category of an anxiety disorder, you may from benefit from this update.DSM 5

If you do not have a copy of the DSM-V you need to get one, and you should purchase it immediately.  You will need one once you are a fully registered psychologist, and considering how helpful it will be in helping you pass the EPPP, why wait! And I don’t mean purchasing the desk reference, while there is a place for the compact version, you will need the full version of the DSM-V in order to be effective in this profession (many agencies do NOT provide the full version for their employees).  Even if you don’t see yourself diagnosing your clients, the information in this book is essential in recognizing, assessing, a treating clients, as well as being able to work with other professionals who do use it to diagnose individuals.

The topic of Assessment and Diagnosis is weighted fairly high at 14%, so you will want to ensure you have a firm grasp of the material in the DSM-V.  This study guide points out the highlights, but you are expected to refer and study the DSM-V in conjunction with this material. The information is best used in collaboration with your own knowledge and what you have already been taught, your previous notes or textbooks, and research if you need more information on a particular topic.  Or you could check out the product reviews page for additional study material options.

Understanding the DSM-V

One of the major things to understand is that the DSM-V uses a nonaxial diagnosis system, which was a major change from the DSM-IV which had 5 axis.  So if you are still trying to keep track of axis I versus axis II disorders, don’t worry about it anymore.  It did add a section called emerging measures an models, which include the WHODAS, an alternative model for personality disorders, cultural formulation, and conditions for further study.  This allows for multiple diagnosis if a presentation meets criteria for more than one disorder.

The organization is laid out to follow development and lifespan, and also clusters disorders as either internalizing or externalizing. So it typically starts disorders that manifest early in life, followed by those more prevalent in adolescent and young adulthood that are internalizing, and then those that are externalizing, and then ending with those related to later life.  Not everything in the DSM-V is considered a “mental disorder” such as medication-induced movement disorder, appropriate responses to stressors or loss, and a note that deviant behavior is not necessarily a disorder (although it can be a result of a disorder).  The next section will look specifically at some of the updates from the DSM-IV-TR to the DSM-V as you can be sure to expect some questions on the EPPP specific to these changes.

Neurodevelopmental Disorders

  • Rather than using the term “mental retardation” the term “intellectual disability” is used (such as intellectual developmentl disorder).
  • The category of communication disorders replaced phonological disorders and stuttering, and includes language disorder, childhood-onset fluencey disorder, speech sound disorder, and a new category called social communication disorder.
  • Autism Spectrum Disorder is new and incorporated Aspergers disorder, Pervasive Developmental Disorder Not Otherwise Specified, and Childhood disintegrative disorder. It has 2 dimensions: Social interaction and repetitive patterns of behavior.
  • Motor Disorders is new and includes developmental coordination disorder, stereotypic movement disorder, and tic disorders.
  • ADHD age of onset has been changed to prior to age 12, it can not be comorbid with autism spectrum disorder, and adults only need 5 symptoms instead of 6 (as is required by younger people).
  • Specific Learning Disorder combines reading, math, and written expression disorder, but there are specifiers to indicate which domain is impaired.

Schizophrenia Spectrum and Other Psychotic Disorders

  • There are no longer schizophrenia subtypes such as paranoid, disorganized, catatonic, undifferentiated, and residual.
  • You now need at least 2 symptoms to qualify for diagnosis (as opposed to bizzarre delusions or voices being enough to diagnose schizophrenia), and at least one MUST be delusions, hallucinations, or disorganized speech.
  • A major mood episode must be present for schizoaffective disorder, and must last the majority of the disorder’s duration.
  • A delusional disorder may not include bizzare delusions (as opposed to just non-bizzare) and is nor longer separated from shared delusional disorder.
  • Catatonia may also be present for depressive, bipolar and psychotic disorders, and requres 3 out of 12 symptoms to be diagnosed.
  • Schizotypal personality disorders is included both under schizophrenia spectrum and personality disorders.bipolar

Bipolar and Related Disorders

  • There is a new specifier labeled “with mixed features” that can be used for both bipolar I and bipolar II
  • Anxious Distress is added as a specifier when anxiety symptoms are present.

Depressive Disorders

  • The addition of Disruptive Mood Dysregulation Disorder for children under 18 (in order to cut back on the number of children diagnosed with bipolar disorder).
  • There was a clause that depressive disorders could not be diagnosed at least 2 months after a loss while experiencing bereavement, but this has been removed.
  • Premenstrual Dysphoric Disorder is a new diagnosis.
  • Dysthymia is now called persistent depressive disorder.
  • There are now specifiers for mixed symptoms and anxiety.

Anxiety Disorders

  • Obsessive Compulsive Disorder and Post Traumatic Stress Disorder now have their own category.
  • The requirement that a person muct recognize their phobia or anxiety has been removed, and it must last at least 6 months for not just adults but children as well.
  • All anxiety disorders have a specifier to include panic attacks.
  • Panic disorder and agoraphobia have been separated.
  • Social anxiety disorder now includes a performance only specifier
  • separation anxiety and selective mutism are no longer considered disorders of early onset, but rather anxiety disorders.

Obsessive-Compulsive Disorders

  • This is a new chapter in the DSM 5 and includes excoriation (skin picking) and hoarding.
  • Trichotilliomania moved out of impulse control disorders into the OCD category.
  • A specifier regarding the individuals insight was added.
  • Body Dysmorphic Disorder is not longer a delusional disorder, rather in this category with the specifier of absent or delusional insight.
  • A tic-related specifier was added.
  • Obsessional Jealousy was added.

Trauma and Stressor Related Disorders

  • This is a new chapter.
  • There are now 4 symptom clusters instead of 3 (intrusive symptoms, persistent avoidance, negative alterations in mood, and arousal and reactivity).
  • Separate criteria for children 6 and under
  • Acute stress disorder no specifies if the event was experienced directly, indirectly, or witnessed.
  • 2 new disorders were added, Reactive attachment Disorder and Disinhibited Social Engagement Disorder.
  • Adjustment Disorder was moved to this section, and be after exposure to either traumatic or non-traumatic events.

Dissociative Disorders

  • Depersonalization Disorder is now Depersonalization/Derealization Disorder
  • Dissociative Fugue changed to dissociative amnesia.
  • Dissociative Identity Disorder may now be reported or observed by other people, and the gaps can occur for everyday events rather than just traumatic events.

Somatic Symptoms and Related Disorders

  • This title changed from Somatoform Disorders.
  • Individuals with chronic pain can be diagnosed with Somatic Symptom Disorder if it is accompanied with maladaptive thoughts, feelings and behaviors.  this came about by combining somatization disorder and undifferentiated somatoform disorder.
  • A new disgnosis of Psychological Factors Affecting Other Medical Conditions was added.
  • Conversion Disorder Criteria was changed and emphasizes neurological exams as an important function.
  • Factitious Disorder is now in this category.
  • The number of disorders and subcategories have been reduced, and the removal of somatization disorder, hypochodriasis, pain disorder, and undifferentiated somatoform.

Feeding and Eating Disorders

  • This is a new chapter and includes pica and rumination disorders
  • Binge eating is a new diagnosis, and requires recurrent episodes at least once a week for 3 months or more.
  • Bulimia requirements were changed from at least twice a week to at least once a week eating and compensatory behavior
  • Anorexia nervosa changed and no longer requires amenorrhea
  • “Feeding disorder of infancy or early childhood” has been renamed “avoidant/restrictive food intake disorder”

Elimination Disorders

  • This is a new chapter and include enuresis and encopresis

Sleep-Wake Disorders

  • Insomnia was renamed insomnia disorder and narcolepsy is separated from hypersomnolence
  • New disorder include Rapid eye movement sleep behavior disorder and resltless leg syndrome
  • New breathing related sleep disorders include obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation
  • Under the category Circadian rhythm sleep-wake disorder, it now includes advanced sleep phase syndrome, irregular sleep-wake typ, and non-24-hour sleep wake type.  Jet lag was removed.

Sexual Dysfunctions

  • There are gender specific sexual disorders.
  • Femal sexual interest/arousal disorder was created and combines sexual desire and arousal disorder.
  • Sexual dysfunctions now requres a minimum of 6 months
  •  anew diagnosis of genito-pelvic paine/penetraion disorder was created which combines vaginismus and dyspareunia
  • Sexual aversion disorder was removed
  • Subtypes include lifelong or aquired, and generalized or situational.  it has also added the non-medical features of: partner factors, relationship facotrs, individual vulnerability factors, cultural or religious factors, and medical factors.

Gender Dysphoria

  • This was a change from gender identity disorder and gender identity disorder based on sexual orientation was deleted
  • Posttransition specifiers were included for those that have had medical procedures to change gender.

Disruptive, Impulse Control, and Conduct Disorders

  • This is a new chapter and it includes oppositional defiant disorder, conduct disorder, intermittent explosive disorder, pyromania, and kleptomania.  ADHD may occur alongside these disorder but is not included in this category, rather the neurodevelopment chapter.
  • Antisocial personality disorder is in both this chapter and the personality disorder chapter. oppositional defiant disorder has 3 types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness.
  • Conduct disorder added a specifier with limited prosocial emotions.
  • In intermittent explosive disorder the minimum age is 6, and now includes verbal aggression and nondestructive physical aggression.

Substance-Related and Addictive Disordersgambling

  • Gambling disorder and tobacco use disorder are new.
  • It no longer separates substance abuse and substance dependence
  • Removed the criteria of recurrent substance related legal problems and included a criteria for cravings
  • The minimum threshold is at least 2 criteria, and severity is measured by how many criteria are met.
  • Cannabis withdrawal and Caffeine withdrawal are new.
  • Specifier for early remission and sustained remission were added, as well as specifiers for in a controlled environment and on maintenance therapy

Neurocognitive Disorders

  • This now includes dementia and amnestic disorder, as well as separating major from mild neurocognitive disorder.
  • Substance/medication induced NCD is a new diagnosis, and there is a new list neurocognitive domains.

Personality Disorders

  • Instead of being on a separate axis, personality disorders are now included with the other medical diagnosis.  Otherwise they remain unchanged, although there is an “alternative approach” for personality disorder under emerging measures and models.

Paraphilic Disorders

  • The addition of specifiers “in a controlled environment” and “in remission”
  • The distinction between paraphillia and paraphillic disorder is included.

***If I was bored writing this, I’m sure you were bored reading it!  Yet it is still necessary to know if you are preparing for the EPPP. If you are not familiar with the DSM, perhaps you were surprised at the medically labeling language used in this assessment tool?  It is one of the major criticisms of the DSM. Was there anything that stood out to you that may show these changes are keeping up with our ever changing culture? Share your thoughts in the comments below!

You may find the information on this site is not enough to help you feel confident about your ability to pass the exam, That is OK and only you can be the judge of what you need. If this information seems overwhelming to you it does NOT mean you will fail the exam, but you may require a little more in depth material than is offered here. That is why there is a Product Reviews page which will give you a variety of additional options, as well as practice exam questions which I highly recommend as explained on the Study Tips page.

4 thoughts on “DSM 5: What Changed?

  1. Hello, Hden, thank you for your review of the Diagnostic and Statistical Manual. I needed this.

    I was surprised at how much I learned, I thought I understood the changes but this shows there was more than I originally thought.

    I want to get a copy of my DSM 5 and take time to read and understand what I need to find out answers for some questions.

    Good work, you maybe surprised but you are not boring at all. It was on point and is relevant and educational. People need this information dear. Keep up the good work.

    1. Thank you, I’m glad you didn’t find it too boring. And I too thought I had a really good grasp on the changes, but it was really helpful to go through this again to make sure I am really familiar. It’s hard to shake those hard learned topics from the DSM-IV and switch to the DSM-V

  2. Hi,
    I was certainly not bored reading this post. I am an RN so I am familiar with the DSM. It was very interesting to me to read all of the changes that has been made to the DSM manual.
    I remember doing rotations in the Mental Facilities and was intrigued and very interested in the diagnoses of the patients.
    I am glad that they have made the changes. It seems more encompassing.

    1. I agree, it is far more encompassing. There is a push to integrate the DSM and the European system (ICD). I think by seeing how they have changed even some of the small details, shows how much thought and effort is put into the process of diagnosing. It is not something that is every done on a whim or by gut feeling. Thanks for your comment.

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