If you’ve ever been evaluated by a mental health professional such as a psychologist, psychiatrist, or clinical social worker, any diagnosis you received was based on the clinical criteria from a manual known as the DSM. DSM is short for “Diagnostic and Statistical Manual of Mental Disorders“; it’s essentially the diagnostic “bible” for anyone in the mental health profession.
The DSM has been around since 1952, when the first version was published by the American Psychiatric Association. Over the years, it has been revised multiple times, with the 5th edition – the DSM-5 – scheduled for release May, 2013. Considering it’s been almost 20 years since the last revision – the DSM-IV, which came out in 1994 – this newest edition is long overdue. With advances in research and a variety of other factors that contribute to each change that is made, the DSM has changed a lot over the past 60 years.
What’s in the DSM?
The DSM provides a thorough overview of all mental health disorders, from ADHD to schizophrenia and everything in between. In addition to specific criteria that must be met in order for a diagnosis to be made, each overview provides important information pertinent to the particular disorder.
The overall discussion of each disorder includes statistical information, a fairly in depth look at each symptom as well as related symptoms and features, and a section on differential diagnosis, which helps clinicians distinguish the pattern of symptoms from other, similar disorders. Each listing also includes information regarding things such as age, gender, cultural issues, and / or family patterns that are specific to that disorder. The typical course that each disorder takes (e.g. when symptoms first start and whether or not they get worse over time) is also discussed.
The DSM doesn’t just cover each diagnostic category. The manual provides guidelines and thorough instructions on how mental health professionals are to use it. It also discusses mental health conditions that need more research and don’t yet meet the requirements for inclusion in the diagnostic section.
The Impact of DSM Changes
As mentioned above, the changes in each new version of the DSM come about due to many different things. Findings from research lead to many of the changes. But research isn’t the only factor. Feedback and input regarding additions, revisions, and other changes – obtained from mental health and other healthcare professionals, like psychiatrists, neurologists, and psychologists, to name a few – are also part of the process. These changes can play an important role in how you are diagnosed and the treatment you receive. They can also impact whether or not your health insurance company will cover treatment. This is why there is often controversy when significant changes are made.
Prominent Changes in the DSM-5
Below is a brief discussion of the most significant changes in the soon-to-be-released 5th version of the DSM:
Whenever new disorders are added to the diagnostic section of the DSM, it can significantly benefit those who’ve been living with those disorders. It can also, however, lead to undesirable “labeling” (of “mental illness”) and misdiagnosis. The new additions in the DSM-5 are:
Hoarding Disorder – Historically, individuals who hoard compulsively have frequently been given a diagnosis of OCD. Now that hoarding disorder is a separate disorder, it may lead to changes in the way it is treated and also lead to more people receiving the treatment they need.
Binge Eating Disorder – This was previously diagnosed as “eating disorder, NOS”. NOS is the abbreviation for “not otherwise specified”. Although there is some overlap of symptoms with anorexia nervosa and bulimia nervosa, individuals with this eating disorder don’t do anything to compensate for their binges, like taking laxatives, exercising to extreme, or purging the excessive food they just ate.
Excoriation Disorder – This disorder involves compulsive skin picking, and has often been called “dermatillomania”. It was regarded as an “impulse control disorder” and will now be listed in the “Obsessive-Compulsive and Related Disorders” chapters of the DSM-5.
Disruptive Mood Dysregulation Disorder – DMDD is one of the more controversial additions to the new DSM. Proponents of this addition hope it will result in fewer children being misdiagnosed with Bipolar Disorder. Symptoms include frequent tantrums and a persistent, irritable mood. Opponents of this addition argue that it will result in some children being wrongly labeled as mentally ill.
Several diagnoses in the new DSM have been revised from prior versions of the manual. These include:
Autism Spectrum Disorder – This revised diagnosis essentially combines four disorders that had been listed separately:
- Autistic Disorder
- Asperger’s Syndrome
- Pervasive Developmental Disorder
- Childhood Disintegrative Disorder
Some people are glad to see this change, while others are concerned that it will impact treatment and other vital issues for individuals currently diagnosed with one of the 4 disorders listed above.
Substance Use Disorder – Formerly comprised of two separate disorders: Substance Abuse and Substance Dependence.
Removal of Bereavement Exclusion – This revision is based on the fact that grief is often a trigger for major depression.
Posttraumatic Spectrum Disorder (PTSD) – the primary changes here pertain to changes in diagnostic clusters, as well as how the disorder impacts children and adolescents.
Pedophilic Disorder – This was formerly listed as pedophilia. The change is in the name only, and does not affect the diagnostic criteria.
Specific Learning Disorder – This new diagnosis will be used in place of the disorders listed separately under Learning Disorders (Reading Disorder, Mathematics Disorder, Disorder of Written Expression, Learning Disorder NOS). A “specifier” will show in which area (e.g. mathematics, oral language, etc.) the learning problem occurs.
One of the additional changes to the DSM-5 includes the removal of the multiaxial assessment system. The former system will be replaced by one that is simpler, and consists of three assessment categories instead of the previous 5. Another change to this new edition involves how the chapters are structured. These two changes are primarily for clinicians who use the manual.
The DSM-5 will also discuss conditions that need further research. These include:
- Attenuated Psychosis Syndrome (this is a precursor to schizophrenia)
- Internet Use Gaming Disorder
- Non-Suicidal Self-Injury
- Suicidal Behavioral Disorder
Many clinicians regard these as legitimate conditions in need of treatment. However, due to insufficient research at this point in time, health insurance companies typically do not cover treatment for these disorders.
Only time will tell how these changes to the DSM-5 will impact the mental health field. Hopefully, the changes will be positive overall and lead to improvements in how disorders are diagnosed and treated.
http:www.psych.org – American Psychiatric Association, Dec. 1, 2012 press release