Omar Bennett
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is the handbook used by clinicians and psychiatrists to diagnose psychiatric disorders. Published by the American Psychiatric Association (APA), the DSM-5 covers all categories of mental health disorders for both adults and children. The DSM-5-TR is the standard classification of mental disorders used by mental health professionals in the United States. The latest version, the DSM-5-TR, was published in 2022 and includes the most current text updates based on scientific literature with contributions from more than 200 subject matter experts. The process of deciding what constitutes a disorder being added to the DSM-V involves exploring the concept of mental disorder and emphasizing the need for additional work in this area.
| Characteristics | Values |
|---|---|
| Publication | Published by the American Psychiatric Association (APA) |
| Contributors | More than 160 mental healthcare professionals from around the world, including psychiatrists, psychologists, and experts from other fields. Hundreds of other professionals contributed as advisers. |
| Process | Field trials, public and professional review, and expert review. |
| Goal | To harmonize with the International Statistical Classification of Diseases and Related Health Problems (ICD) systems and share organizational structures as much as possible. |
| Disorders | All categories of mental health disorders for both adults and children. |
| Contents | Descriptions, symptoms, diagnostic criteria, codes, and other important diagnostic information. |
| Updates | The APA does not publish editions of the DSM on a regular schedule. Instead, they update the DSM as necessary. |
| Latest Edition | DSM-5-TR, published in 2022 |
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What You'll Learn
Changes from previous DSM models
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is the latest edition of the American Psychiatric Association's (APA) professional reference book on mental health and brain-related conditions. The DSM-5-TR, published in 2022, features several changes and updates from previous DSM models.
One significant change is the elimination of the multi-axial system used in previous versions such as DSM-IV. The multi-axial system involved a five-axis approach to psychiatric assessment and the organization of biopsychosocial information. Axis I consisted of mental health and substance use disorders, while Axis II was for personality disorders and mental retardation. Axis III was used for coding general medical conditions, and Axis IV noted psychosocial and environmental problems. Finally, Axis V provided an overall assessment of functioning, known as the GAF score. The GAF scale was removed from the DSM-5 due to its lack of clarity and questionable psychometric properties.
Another change in the DSM-5 is the reorganization and reclassification of disorders. Six new classes were added, while four were removed, reflecting a better understanding of disorder classifications from emerging research and clinical knowledge. As a result, many individual disorders were reclassified, such as moving disorders from the "mood disorders" class to the "bipolar and related disorders" or "depressive disorders" classes.
The DSM-5 also takes a lifespan perspective, recognizing the impact of age and development on the onset, manifestation, and treatment of mental disorders. This perspective considers the interplay between mental health and brain function, acknowledging that they are inseparable. Additionally, the DSM-5 includes diagnostic codes that correspond to the World Health Organization's International Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), facilitating cross-referencing for healthcare providers.
The creation of the DSM-5 involved gathering over 160 mental healthcare professionals worldwide, including psychiatrists, psychologists, and experts from various fields. Field trials and tests were conducted, and hundreds of other professionals contributed as advisers. The DSM-5-TR built upon this work, with more than 200 professionals directly contributing to the revised edition.
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Disorders requiring further study
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). It is the standard classification of mental disorders used by mental health professionals in the United States. The latest version, DSM-5-TR, was published in 2022 and includes the most current text updates based on scientific literature with contributions from more than 200 subject matter experts.
The DSM-5-TR includes a new diagnosis (prolonged grief disorder), modifications to the criteria for over 70 disorders, and updates to descriptive text for most disorders based on extensive literature reviews. The manual also includes a comprehensive review of the impact of racism and discrimination on the diagnosis and manifestations of mental disorders.
The content of the DSM is determined by hundreds of researchers, editors, and administrators who evaluate emerging psychopathology. Disorders that do not make it into the DSM as official disorders are often included in the category of "conditions for further study" and kept on a waiting list. These conditions rely on "proposed criteria [...] presented for conditions on which future research is encouraged." While they may become full-fledged disorders in future editions of the DSM, for now, they are in a separate category, outlining diagnostic features, prevalence, risk, and more.
The DSM-5 includes eight conditions requiring further study, including:
- Premenstrual dysphoric disorder: This condition was previously listed in an appendix for further study but has since become a recognized disorder.
- Binge eating disorder: This disorder has graduated from the "Appendix B -- Criteria Sets and Axes Provided for Further Study" in DSM-IV to a proper diagnosis in DSM-5.
- Catatonia: Catatonia may be a specifier for depressive, bipolar, and psychotic disorders, part of another medical condition, or of another specified diagnosis.
- Somatic symptom and related disorders: Somatization disorder and undifferentiated somatoform disorder were combined to form somatic symptom disorder, which no longer requires a specific number of somatic symptoms.
- Conversion disorder (functional neurological symptom disorder): The criteria for this disorder have been changed in DSM-5.
- Pica and rumination disorder: The criteria for these disorders have been changed in DSM-5, and they can now refer to people of any age.
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Cultural and gender-related considerations
The DSM-5 does consider cultural and gender-related factors in its diagnostic criteria. The manual explicitly states that ""gender non-conformity is not in itself a mental disorder". This marks a shift from previous editions, which categorised gender identity issues as sexual disorders. The DSM-5 also introduced a separate diagnosis of "gender dysphoria in children", recognising that gender dysphoria in minors may manifest differently and that children have less insight and ability to express their experiences.
The DSM-5 also acknowledges that gender identity and expression vary across time and culture. For example, in Samoa, the fa'afafine are a group of feminine males who are largely accepted and experience less distress than transgender women in Western cultures, suggesting that distress is heightened by cultural disapproval. The DSM-5's recognition of this dynamic is reflected in its criteria for Panic Anxiety, which considers how cultural context can influence symptoms.
However, critics argue that the DSM-5's approach to cultural considerations is inconsistent and that it continues to construct some symptoms of psychiatric distress as universal rather than culturally relative. For example, while the DSM-5's Cultural Formulation Interview is designed to account for cultural context in clinical practice, critics argue that the overall manual presents mixed messages, with its nuanced Cultural Formulation carrying less weight than the static Diagnostic Criteria and Codes.
In terms of gender considerations, the DSM-5's criteria for gender dysphoria focus on the distress caused by the mind and body being out of alignment and/or societal marginalisation. This shift from ""gender identity disorder" to "gender dysphoria" aimed to reduce stigma and pathologisation of identity. The diagnosis is not based on transgender identity itself but on the distress experienced, which may be related to societal marginalisation and cultural stigma.
The DSM-5 also includes the ""post-transition" specifier, indicating that an individual's gender transition is complete and that they may still require ongoing medical care. This addition reflects an attempt to preserve access to gender transition-related healthcare while minimising the potential for diagnostic categories to stigmatise.
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Diagnostic criteria
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is a handbook used by clinicians and psychiatrists to diagnose psychiatric disorders. It is the latest edition of the American Psychiatric Association's (APA) professional reference book on mental health and brain-related conditions. The APA does not publish editions of the DSM on a regular schedule but instead updates it as necessary.
The DSM-5-TR includes the most current text updates based on scientific literature, with contributions from more than 200 subject matter experts. It features revised criteria for more than 70 disorders, including a new diagnosis of prolonged grief disorder. The DSM-5-TR also includes a comprehensive review of the impact of racism and discrimination on the diagnosis and manifestations of mental disorders. It addresses racial and cultural biases by revising language surrounding gender dysphoria and race. For example, the term "Caucasian" was removed, and Latinx was used instead of Latino/Latina for gender inclusivity.
The DSM-5-TR also includes new codes that allow clinicians to document suicidal behaviour and nonsuicidal self-injury in patients without any other psychiatric diagnosis. The diagnostic criteria for autism spectrum disorder were also changed to indicate that all symptoms must be present for this diagnosis. The requisite age of symptom onset for ADHD was changed from 7 years old to 12 years old, and symptom thresholds were reduced for diagnosis as an adolescent or adult.
The DSM-5 differs from previous models of personality disorders in that it is based on a dimensional approach to personality pathology, whereas previous models were characterized by rigid diagnostic criteria for each individual personality disorder. The alternative model aims to better capture the complexity of personality pathology by assessing impairments in personality functioning and pathological personality traits.
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Field trials and tests
You may want to see also The Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM, is a reference book on mental health and brain-related conditions and disorders. It is published by the American Psychiatric Association (APA). The APA does not publish the DSM on a regular schedule. Instead, they update the DSM as necessary. The latest version, the DSM-5-TR, was published in 2022. The DSM is a tool and reference guide for mental health clinicians to diagnose, classify, and identify mental health conditions. It covers all categories of mental health disorders for both adults and children. The DSM is revised to clarify, add, or remove mental health diagnoses according to the latest research and clinical consensus. The APA gathers mental healthcare professionals from around the world, including psychiatrists, psychologists, and experts from other professional fields, to contribute to the creation of the DSM.The Power to Change the Constitution
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