The American Psychiatric Association (APA) is in a perpetual quest to upgrade and renew the Diagnostic and Statistical Manual (DSM). As a result, even before each edition is published, plans are already in place to revise it. The fifth edition was recently released in May, 2013 and a few significant modifications were included. Here are some of the more salient ones:
- The way in which diagnoses are presented has been revised. In the past, evaluations would include what's called a multiaxial diagnosis, in this format:
Diagnosis:
Axis I: Clinical Disorders
Axis II: Personality Disorders
Axis III: Medical Conditions
Axis IV: Psychosocial Stressors
Axis V: GAF (Global Assessment of Functioning)
scale of 0 to 100
In DSM-5, the distinction between clinical and personality disorders and medical conditions has been done away with, and the first three axes presented above are grouped together, as are environmental and contextual factors (i.e., psychosocial stressors). The GAF has been discarded entirely. The industry has not yet reached a consensus on how to present diagnoses now that the old structure has been removed; you may see some clinicians still presenting diagnoses in the same format, just without Axis V. Others may take a more qualitative approach, listing diagnosis and then clarifying with medical and psychosocial factors. Until a consensus is come to, there will likely be variation in the ways evaluators choose to present diagnoses.
- Previously there was a discrepancy between Asperger's Disorder and Autism Disorder (the main differences being severity and a language delay in Autism). In the DSM-V, however, Asperger's Syndrome has been removed and subsumed under Autism Spectrum Disorder (ASD). Empirical evidence found that it did not make sense to differentiate between these two disorders, and rather proposed to think of people along an Autistic continuum. As such, the distinction has been removed and people are placed somewhere along the spectrum, depending on severity of the symptom picture.
- The subtypes of Schizophrenia (paranoid, catatonic, etc.) have been discarded and are now subsumed under, simply, Schizophrenia.
- Posttraumatic Stress Disorder (PTSD) now includes an entirely distinct set of criteria for children ages six and younger.
- The DSM-5 now has gender-specific sexual dysfunction disorders.
- There were significant modifications made to the classifications for substance abuse. The distinction between abuse and dependence has been removed. Tobacco use disorder and Gambling disorder have been added. Further, Caffeine and Cannibis withdrawal criteria were added.
- There is now a hybrid continuous/categorical model for describing and diagnosing personality disorders (previously placed on Axis II).
- Mental retardation has been rebranded as "intellectual disability."
This is an overview of the more relevant and important changes to the DSM with the new release and not a complete list; there are dozens of others, many relatively minor. As our understanding of the human psyche continues to evolve, so too does this document.
