PRACTICAL - 1

on
CHANGES MADE In THE
CLASSIFICAFATORY SYSTEM FROM
DSM – IV TO DSM - V

Sonal Kumari
MSc. (Clinical Psy) 2nd
Semester 2020-2022

Reg. #201909013
 PRACTICAL-1

CHANGES MADE In THE CLASSIFICAFATORY SYSTEM FROM DSM –

IV TO DSM - V

Definition of DSM: -

"Diagnostic and Statistical Manual of Mental Disorders" (DSM) is published by American

Psychiatry Association (APA).

DSM is the handbook widely used by clinicians and psychiatrists in the United States to
diagnose psychiatric illnesses. Published by the American Psychiatric Association (APA), the
DSM covers all categories of mental health disorders for both adults and children.

DSM IV-TR

The DSM-IV was originally published in 1994 and listed more than 250 mental disorders. An
updated version, called the DSM-IV-TR, was published in 2000. This version utilized a
multiaxial or multidimensional approach for diagnosing mental disorders.

It described disorders using five DSM "axes" or dimensions to ensure that all factors—
psychological, biological, and environmental—were considered when making a mental health
diagnosis.

The 5 AXIS OF DSM IV: -

AXIS I: Clinical Syndrome - This is the top-level diagnosis that usually represents the acute
symptoms that need treatment. E.g. major depressive episode, schizophrenic episode, panic
attack.

AXIS II: Developmental Disorders and Personality Disorders; -Axis II is the assessment of
personality disorders and intellectual disabilities. These disorders are usually life-long problems
that first arise in childhood, Axis II disorders are accompanied by considerable social stigma
because they are suffered by people who often fail to adapt well to society.

AXIS III: General Medical Conditions: -Axis III describes physical problems that may be
relevant to diagnosing and treating mental disorders. For example, a patient with an Axis I
diagnosis of mood disorder who also had glaucoma, would have the glaucoma recorded on Axis
IV; the pain and increasing blindness of glaucoma could be a relevant factor influencing
depression.

AXIS IV: Psychosocial and Environmental Problems: -Any social or environmental problems
that may impact Axis I or Axis II disorders were accounted for in this axis. These include such
things as unemployment, relocation, divorce, or the death of a loved one.

Axis V: Global Assessment of Functioning Scale; -A reflection of the evaluating clinician's

judgement of a patient's ability to function in daily life. The 100-point scale measures
psychological, social, and occupational functioning.

DSM 5

The newest version of the DSM, the DSM-5, was published in May of 2013.The new DSM-5
will consist of three sections. Section I provides instructions on how to use the manual. Section II
delineates the categorical diagnoses with a new organizational structure that eliminates the multi-
axial system and instead follows a life-span, developmental progression and organization.
Section III will include conditions suggested for further research, a dimensional alternative for
several diagnostic categories, as well as cultural and other contextual information.

Changes between DSM IV-TR and DSM 5: -

1. Modification of Artificial Categorization- No longer. With the release of the DSM-5, this
categorization has been simplified to clarify relationships between different disorders.

2. The Autism Spectrum- In the DSM-5, four separately classified issues—that are
unfortunately very common—have been unified under the header of autism spectrum disorder.
The previous categories of autism, Asperser’s, childhood disintegrative disorder, and pervasive
developmental disorder are no longer in use.

3. Elimination of Childhood Bipolar Disorder-In response to an observed trend of harmful

over diagnosis and over-treatment of childhood bipolar disorder, the DSM-5 removes childhood
bipolar disorder and replaces it with Disruptive Mood Deregulations Disorder (DMDD).

4. Revisions to ADHD Diagnosis-The new DSM-5 broaden the ADHD diagnosis, allowing for
adult-onset and relaxing the strictness of the criteria to reflect new research more accurately on
this disorder. Given that adults have more developed brains and generally greater impulse
control, adults can now be diagnosed with ADHD if they have fewer signs and symptoms than
children do.

5. Increasing Detail on PTSD Symptoms- Partly due to the wars in Iraq and Afghanistan,
medical researchers have gained a great deal more insight into PTSD in the last 15 years. The
DSM-5 reflects this increased understanding, adds nuance for children with PTSD, and describes
four main types of symptoms:

 Arousal
 Avoidance
 Flashbacks
 Negative impacts on thought patterns and mood

6. Reclassification of Dementia- In the DSM-5, both dementia and the category of

memory/learning difficulties called Amnestic disorders have been subsumed into a new category,
Neurocognitive Disorder.

7. Intellectual Disability- To reflect common language, the issues previously referred to as

“mental retardation” are now classified as “intellectual disability.” The diagnostic criteria for this
disorder have also been updated to focus on adaptive functioning more strongly, rather than IQ
score.

Conclusion: -

 Elimination of the Multi-Axial System and GAF Score

 One of the key changes from DSM-IV to DSM-5 is the elimination of the multi-axial
system. There were five different axes. The GAF scale was dropped from the DSM-5
because of its conceptual lack of clarity (i.e., including symptoms, suicide risk, and
disabilities in the descriptors) and questionable psychometric properties (American
Psychiatric Association, 2013b).

Disorder Reclassification

 DSM-IV and DSM-5 categorize disorders into “classes” with the intent of grouping
similar disorders (particularly those that are suspected to share etiological mechanisms or
 have similar symptoms) to help clinician and researchers use of the manual.

 From DSM-IV to DSM-5, there has been a reclassification of many disorders that reflects
a better understanding of the classifications of disorders from emerging research or
clinical knowledge. 

 In DSM-5, six classes were added and four were removed. As a result of these changes in
the overall classification system, numerous individual disorders were reclassified from
one class to another (e.g., from “mood disorders” to “bipolar and related disorders” or
“depressive disorders”).

 The reclassification of disorder classes will not have a direct effect on any SED
estimation; however, it does warrant consideration when documenting disorders that may
have changed classes.

 Of particular note for childhood mental disorders, the DSM-5 eliminated a class of
“disorders usually first diagnosed in infancy, childhood, or adolescence.

 DSM IV Is mostly used in foreign countries in the comparison of DSM-5.

REFERENCE:

 American Psychiatric Association (2000). Diagnostic and statistical manual of mental

disorders (4th ed., Text Revision). Washington, DC: Author.
 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.)