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As many of you know, in May the fifth version of the "Diagnostic and Statistical Manual" (DSM-V) was released. We wanted to focus this month's newsletter on the changes in the new edition regarding Autism and provide you with some great resources.
In this newsletter you will see more than just information on the DSM changes for Autism. We recognize that some individuals have co-morbid diagnoses and not all of us work exclusively with individuals on the spectrum. We thought it was very important to share with you a comprehensive view of all the DSM changes.
We have included fabulous fact sheets- available for download- that will explain the changes within the new DSM-V. There are also links for free trainings on the DSM changes. We hope that this newsletter makes the changes easy to understand, and empowers you with the information you need as you advocate for and/or work with others.
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 Overview of DSM-V Changes
by Dan Karlow, National Training Coordinator - Clinical
The American Psychiatric Association's (APA) Board of Trustees approved the DSM-V and released the fifth edition of the Diagnostic Statistical Manual (DSM -V) in May of 2013. TThis was the result of a decade-plus revision process, involving more than 1500 experts in psychiatry, psychology, social work, psychiatric nursing, pediatrics, neurology, and other related fields from 39 countries.
The DSM is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. The DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders. It also provides a common language for researchers to study the criteria for potential future revisions and to aid in the development of medications and other interventions.
The DSM-V is organized into three sections:
- Section 1 is an introduction to the DSM-V and contains information on how to use the manual.
- Section 2 is the heart of the manual. It outlines the formal diagnoses.
- Section 3 includes areas that require further research before they are considered formal disorders. Also, a glossary and list of those aiding in the development of this edition are included.
The DSM V contains a number of major changes, along with minor tweaks:
Overall Changes
- The chapter order is restructured to align with the International Classification of Diseases, eleventh edition (ICD-11). The ICD-11 is the official system used in the United States to classify and assign codes to health conditions and related information. The use of standardized codes improves consistency among physicians in recording patient symptoms and diagnoses.
- Removal of the multiaxial system. Axis I, II, and III will be combined, and the information from Axis IV and V will be used as separate notations.
Disorder Changes
- Autism Spectrum Disorder: Several diagnoses- Autistic Disorder, Asperger's Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorder (NOS)- have been combined to help more accurately and consistently diagnose children with autism. Falling under the umbrella diagnosis of "Autism", there is now a continuum from mild to severe, with explicit criteria to assess the level for each category. This is an important change because previously some states did not accept Aspergers Disorders for access into their Mental Health services. This DSM-V change will allow more individuals to receive much needed support.
- Binge Eating Disorder is an official disorder.
- Disruptive Mood Dysregulation Disorder has been added to address concerns about over-diagnosing Bipolar Disorder in children. DMDD is defined by persistent irritability and frequent episodes of behavior outbursts (three or more times per week for at least a year).
- Excoriation (skin-picking) Disorder was added to the DSM-V, in the OCD and Related Disorders section.
- Hoarding Disorder was added based on extensive scientific research. Hoarding Disorder includes persistent difficulty discarding or parting with possessions, regardless of their value.
- Pedophilia changes its name to Pedophilic Disorder.
- A new trait-specific method of studying personality disorders will be added to section 3 for further study.
- Post-Traumatic Stress Disorder (PTSD) has been moved to a new category "Trauma- and Stress-Related Disorders." The DSM-V adds a fourth classification of PTSD, and adds focuses on behavior symptoms that are sensitive to the development of children and adolescents.
- Removal of Bereavement Exclusion: Instead, the DSM-V notes the differences between grief and depression are added.
- Specific Learning Disorder: expands the criteria to represent specific disorders that interfere with oral language, reading, written language, or mathematics.
- Substance Use Disorder now includes what previously was identified as Substance Abuse or Substance Dependence from the DSM-IV. This new disorder will also require more symptoms present for a formal diagnosis.
Further Study Needed
Addition to Section 3: Internet Use Gaming Disorder. The DSM-V suggests further study is needed in this area. After the massive following of the Massively Multiplayer Online Game (MMO) "World of Warcraft," many individuals and families have been negatively affected by this type of gaming addiction.
For more information, and specific news around the DSM-V publication, go to www.dsm5.org.
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DSM Changes and Autism Diagnosis
by Ann Branning
National Autism Training Coordinator
With the new DSM-V, many people are curious how this will assist in the diagnosis of autism. For many, we see these changes as positive because the diagnosis is now recognizing that some individuals have sensory difficulties. Previously this has not been completely recognized as part of the autism diagnosis.
Prior to these changes, some services were limited to only those with an Autism diagnosis, excluding individuals who needed support, but had PDD-NOS or Asperger's. Now, more individuals will be eligible to receive supportive services since the diagnosis is now viewed as one (Autism) instead of three (Autism, PDD-NOS, Asperger's).
Finally, we don't know how exactly how the new diagnosis will assist in treatment throughout the different services provided. However, we do know that the diagnosis is starting to look at the whole person, which is a very good thing.
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APA Fact Sheets
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Changes in Terminology: "Intellectual Disability" replaces "Mental Retardation"
YAP has been utilizing the term Intellectual Disability for several years. We have been ahead of the curve. Finally, the changes have been made to the DSM. Read more.
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The information and points of view contained in this newsletter are intended only to stimulate interest about topics of possibly shared concern. Youth Advocate Programs, Inc. ("YAP") does not represent or endorse the accuracy, completeness, timeliness or reliability of any information contained in, linked, or otherwise accessed through this newsletter. This newsletter does not contain medical advice and YAP accepts no responsibility for any errors (or omissions) contained in this newsletter.
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