A Workshop Training

:on

The DSM-5
Presented
By
A practitioner Psychologist
Khalid Hawli
 Ice Breaker/Introduction
• Introduce your self

• Your current position/occupation

• Your educational background

• Mention why you’re here participating in the

training course?
Ground Rules
✓ Punctuality
✓ Be active
✓ Put your cell phone on silent position
✓ Practice mutual RESPECT
✓ Feel free to ask

✓ It’s OK to have fun

Objectives and Expectations

At the end of this course the participants will be

able to:
▪ Identify and get familiar with the big categories of
DSM-5
▪ Understand the diagnostic criteria of some mental
disorders
▪ Find out the major differences between DSMIV-TR and
DSM5
Pre-course Test (5 mins)
• What are the differences between the DSM and
ICD?
• Define the Nero-developmental disorders and
mention just 3 main types?
• Mention 3 types of major psychotic disorders?
• What is a new name for Dysthymia?
• Mentioned the clusters of personality disorders?
 The Mental Health professional Team
Medical team
▪ Psychiatrist
▪ Registrar
▪ Physician/MD
▪ Medical officer
Clinical Psychology team

• Psychometrician
▪ Psychotherapist
▪ Therapeutic Counselor

Nursing team
▪ Psychiatric Nurse

Social work team

▪ Psychiatric Social Worker
Disciplines Overlapping
Abnormal Psy
Psychopatholog
y
Nosology/
Psychiatric
classifications

Psychopharmac
Psychometrics
ology

Psychotherapy
)Theories(
Brief History of Psychiatric Nosology

2 Major classifications of MD

▪ ICD produced by WHO

▪ DSM produced APA

▪ In 1844
▪  13 superintendents and organizer of insane asylums and hospitals form
     the ( Association of Medical Superintendents of American Institutions for
Insane)        (AMSAII)
▪ In 1892
▪ Allow assistant physicians working in mental hospital to become members
▪ American Medico­Psychological Association
▪ In 1921

▪  The name was changed to American Psychiatric Association  APA
 …Cont

✓ DSM-I (1952)
✓ DSM-II (1968)
✓ DSM-III (1980)
✓ DSM-IV (1994)
✓ DSM-IV TR (2000)
✓ DSM-5 (2013)
 …Cont
• DSM-5 (no Romans numeral)
Organized into three sections with 20 chapters
• Section I
Introduction (it states its goal to harmonized with the ICD
system
• Section II

Diagnostic criteria
• Section III
Appendix
Neuro-developmental Disorders

Intellectual Disabilities
✓ Intellectual developmental disorder
✓ Global Developmental Delay
✓ Unspecified intellectual disability

Communication Disorder

✓ Language Disorder
✓ Speech Sound Disorder
✓ Childhood-onset Fluency Disorder
✓ Social (Pragmatic) communication Disorder
✓ Unspecified communication Disorder
 ….Cont

Autism Spectrum Disorder (ASD)

✓ Autism Spectrum Disorder

Attention Deficit/Hyperactivity Disorder

✓ Attention Deficit/Hyperactivity Disorder

✓ Other Specified Attention Deficit/Hyperactivity Disorder
✓ Unspecified Attention Deficit/Hyperactivity Disorder
 ….Cont

Specific Learning Disorder

✓ Specific Learning Disorder

Motor Disorders
✓ Developmental Coordination Disorder
✓ Stereotypic Movement Disorder

Tic Disorders
✓ Tourette’s Disorder
✓ Persistent (chronic) Motor or Vocal Tic Disorder
✓ Provisional Tic Disorder
✓ Other Specific Tic Disorder
✓ Unspecified Tic Disorder
 ….Cont

Other Neuro-developmental Disorders

• Other specified Nero-developmental Disorder
• Unspecified Nero -developmental Disorder
• Bipolar and related Disorders
✓ Bipolar I Disorder
✓ Bipolar II Disorder
✓ Cyclothymic Disorder
✓ Other Specified Bipolar and Related Disorder
✓ Unspecified Bipolar and Related Disorder
 Depressive Disorders
✓ Disruptive Mood Dysregulation Disorder
✓ Major Depressive Disorder
✓ Persistent Depressive Disorder (Dysthymia)
✓ Premenstrual Dysphoric Disorder
✓ Substance/Medication-Induced Depressive
Disorder
✓ Depressive Disorder Due to Another Medical
Condition
✓ Other Specified Depressive Disorder
✓ Unspecified Depressive Disorder
 Anxiety Disorders
▪ Separation Anxiety Disorder
▪ Selective Mutism
▪ Specific Phobia
✓ Animal
✓ Natural environment
✓ Blood-injection-injury
✓ Fear of blood
✓ Fear of injections and transfusions
✓ Fear of other medical care
✓ Fear of injury
✓ Situational
✓ Other
▪ Social Anxiety Disorder (Social Phobia)
▪ Panic Disorder
▪ Agoraphobia
▪ Generalized Anxiety Disorder
▪ Substance/Medication-Induced Anxiety
Disorder
▪ Anxiety Disorder Due to Another Medical
Condition
▪ Other Specified Anxiety Disorder
▪ Unspecified Anxiety Disorder
• Obsessive-Compulsive and Related
Disorders
✓ Obsessive-Compulsive Disorder
✓ Body Dysmorphic Disorder
✓ Hoarding Disorder
✓ Trichotillomania (Hair-Pulling Disorder)
✓ Excoriation (Skin-Picking) Disorder
✓ Substance/Medication-Induced Obsessive-
Compulsive andRelated Disorder
• Trauma- and Stressor-Related Disorders
✓ Reactive Attachment Disorder
✓ Disinhibited Social Engagement Disorder
✓ Posttraumatic Stress Disorder
✓ Acute Stress Disorder
✓ Adjustment Disorders
• Dissociative Disorders
✓ Dissociative Identity Disorder
✓ Dissociative Amnesia
✓ Depersonalization/Derealization Disorder
• Somatic Symptom and Related Disorders
✓ Somatic Symptom Disorder
✓ Illness Anxiety Disorder
✓ Conversion Disorder (Functional Neurological
Symptom Disorder
✓ Psychological Factors Affecting Other Medical
Conditions
✓ Factitious Disorder
• Feeding and Eating Disorders
✓ Pica
✓ Rumination Disorder
✓ Anorexia Nervosa
✓ Bulimia Nervosa
✓ Binge Eating disorder
• Elimination Disorders
✓ Enuresis
✓ Encopresis
• Sleep-Wake Disorders
✓ Insomnia Disorder
✓ Hypersoninolence Disorder
✓ Narcolepsy
✓ Breathing-Related Sleep Disorders
✓ Obstructive Sleep Apnea Hypopnea
✓ Central Sleep Apnea
• Sexual Dysfunctions
✓ Delayed Ejaculation
✓ Erectile Disorder
✓ Female Orgasmic Disorder
✓ Female Sexual Interest/Arousal Disorder
✓ Genito-Pelvic Pain/Penetration Disorder
✓ Male Hypoactive Sexual Desire Disorder
✓ Premature (Early) Ejaculation
✓ Substance/Medication-Induced Sexual
Dysfunction
 • Substance-Related and Addictive
Disorders
1. Alcohol
2. Caffeine
3. Cannabis
4. Hallucinogens (Phencyclidine or similarity acting arylcyclohexylamines
and other hallucinogens such as LSD)
5. Inhalants
6. Opioids
7. Sedatives, hypnotics or anxiolytics
8. Stimulants (including amphetamine-type substance, cocaine and other
stimulants)
9. Tobacco
10. Other or unknown substances
• Neurocognitive Disorders (organic)
✓ Delirium
• Personality Disorders
• Cluster A Personality Disorders
✓ Paranoid Personality Disorder
✓ Schizoid Personality Disorder
✓ Schizotypal Personality Disorder
• Cluster B Personality Disorders
✓ Antisocial Personality Disorder
✓ Borderline Personality Disorder
✓ Histrionic Personality Disorder
✓ Narcissistic Personality Disorder
• Cluster C Personality Disorders
✓ Avoidant Personality Disorder
✓ Dependent Personality Disorder
✓ Obsessive-Compulsive Personality Disorder
Intellectual Disabilities

✓ Intellectual developmental disorder

✓ Global Developmental Delay
✓ Unspecified intellectual disability
Introduction to Intellectual
Disabilities
• Intellectual Disabilities (IDs) once called mental
retardation, are characterized by below average
intelligence or mental ability and lack of skills
necessary for day to day living. People with
intellectual disabilities can and do learn new
skills, but they learn them more slowly.
• There are varying degrees of intellectual
disabilities, from mild to profound.
IQ (Intelligence Quotient)
• IQ is measured by an IQ test. The average IQ is
100, with the majority of people scoring
between 85 and 115.
• A person is considered intellectually disabled if
s/he has an IQ of less than 70 to 75
The Prevalence
• IDs are thought to affect about 1% of the
population.
• Of those affected, 85% have mild intellectual
disability.
• This means they just a little slower than average
to learn new info or skills.
• With the right support, most will be able to live
independently as adults.
Some signs and symptoms of IDs
• The signs and symptoms appear during infancy,
or they may not be noticeable until a child
reaches school age.
• Some of common signs and symptoms:
✓ Rolling over, sitting up, crawling or walking late
✓ Talking late or having trouble with talking
✓ Slow to master things like potty training, dressing, and feeding
himself
✓ Inability to connect actions with consequences
✓ Behavior problems such as explosive tantrums
✓ Difficulty with problem solving or logical thinking
 • In children with severe or profound intellectual
disabilities, there may be other health problems
as well.
• These problems may include:
✓ Seizure
✓ Vision problems
✓ Hearing problems
✓ Motor skills impairment
 Etiology (the causes of IDs)
• The most common causes of IDs:
✓ Genetics conditions
(Down syndrome- Fragile x syndrome)
✓ Problems during pregnancy
Things that can interfere fetal brain development
include alcohol or drug use, malnutrition,
certain infections or preeclampsia
✓ problems during childbirth
Deprived of oxygen or born extremely premature
✓ Illness or injury
Infections like: Meningitis, Whooping Cough, or
Measles
Severe head injuries, exposure to toxic substance
Severe neglect or Sever abuse
✓ None of above
2/3 of all children who have IDs the cause is
unknown
Intellectual Developmental Disorder. 1

• The developmental disorder is a disorder with onset during

the developmental period that include both:
❶ Intellectual functioning deficits ( IQ)
❷ Adaptive behavior functioning deficits (3 domains)
1. Conceptual,
2. Social and
3. Practical
DABS Diagnostic Adaptive Behavior Scale (4-21yr) from
AAIDD
American Association on Intellectual and Developmental
Disabilities
Examples of Intellectual Disabilities
Disorders

• Down Syndrome
• Fragile X Syndrome
• Fetal alcohol Spectrum Disorders
• Prader- Willi Syndrome
The diagnostic Criteria according to DSM-5

A- Deficit in intellectual functions such as:

• Reasoning
• Problem solving
• Planning
• Abstract thinking
• Judgment
• Academic learning
• Learning from experience

• Be confirmed by both:
✓ Clinical assessment
✓ IQ test
 …Cont

B- Deficits in Adaptive functioning

That result in failure to meet developmental and socio-cultural standard for personal
independence and social responsibility

Without ongoing support, the adaptive deficits limit functioning in one or more activities of
daily life such as:
• Communication
• Social participation
• Independence living
• Across multiple environment, such as
• Home
• School
• Work
• Community
C- The onset during the development period
Global Developmental Delay. 2

• This diagnosis is reserved for individual under the

age of 5yrs when the clinical severity level cannot
be reliably assessed during early childhood.
Unspecified intellectual Disability. 3

• This is reserved for individual over the age of 5yrs

but not able to apply to the child sensory or physical
impairments, as in blindness or prelingual deafness
Autism Spectrum Disorder
ASD
1- Deficits in

• Social communication
• Social interaction

2- Restricted, repetitive patterns of behavior

(RRBs)
Autism Spectrum Disorder
ASD
• Autism spectrum disorder (ASD) is one of Neuro-
developmental that occurring during the development
period.
• Now autism is known as a spectrum because there is
wide variation in the type and severity of symptoms
people experience.
• ASD occurs in all ethnic, racial, ecnomoic groups.
• Although ASD can be a lifelong disorder, treatments and
services can improve a person’s symptoms and ability to
function
Older terms of ASD
1. Asperser's syndrome ( the milder one)
A person with Asperser's may be very intelligent
and able to handle his/her daily life.
May really focused on topics that interest him/
her and discuss them nonstop. But he has a
much harder time socially.
2. Childhood disintegrative
This was the rarest and most severe part of the
spectrum . It described children who develop
normally and then quickly lose many social,
language, and mental skills, usually between
ages 2 and 4 often, these children also
developed a seizure disorder.
3. Rett syndrome
Is rare, severe neurological disorder that affect
mostly girls. It’s usually discovered in the first 2
years of life.
The syndrome showed small head (microcephaly)
Autism Spectrum Disorder
ASD

Diagnostic Criteria:
• A- Persistent deficits in social communication and social
interaction across multiple context, as manifested by the
following, currently or by history
• 1.  deficit in social­emotional reciprocity, ranging, for
example, from abnormal social approach and failure of
normal back­and forth conversation; to reduced sharing of
interest, emotions, or affect; to failure to initiate or respond
to social interactions
 ….Cont

• 2. deficits in nonverbal communicative behaviors used for social
interaction, ranging, for example, from poorly integrated verbal and
nonverbal communication, to abnormalities in eye contact and body
language or deficits in understanding and use of gesture, to a total lack
of facial expressions and nonverbal communication.

• 3. deficits in developing , maintaining, and understanding
relationships, ranging, for examples from adjusting behavior to
suit various social contexts; to difficulties in sharing imaginative
play or in making friends, to absence of interest in peers
• B- Restricted, repetitive patterns of behavior, interests or
activities as manifested by at least two of the following,
currently or by history:
• 1­ Stereotyped or repetitive motor movements, use of objects
or speech (e.g. simple motor stereotypies , lining up toys, or
flipping objects, echolalia, idiosyncratic phrases)
• 2- Insistence on sameness, inflexible to routines or ritualized
patterns of verbal or nonverbal behavior (e.g. extreme distress
at small changes, difficulties with transitions, rigid thinking
patterns, greeting rituals, need to take same route or eat same
food every day)
• 3- Highly restricted, fixed interests that are abnormal in intensity
or focus (e.g. strong attachment to or preoccupation with
unusual objects, excessively circumscribed or preservative
interests).
• 4­ Hyper­or hypo reactivity to sensory input or unusual interest in
sensory aspects of the environment (e.g. apparent indifference to
pain/temperature, adverse response to specific sound or textures,
excessive smelling or touching of objects, visual fascination with
lights or movement).
• C- Symptoms must be present in the early developmental
period
• D- Symptoms cause clinically signification impairment in
social, occupational or other impairment areas of current
functioning.
• E- These disturbances are not better explained by
intellctual disabilities,
Attention Deficit/Hyperactivity Disorder
ADHD

Persistent pattern of:

1- Inattention (6 out 9 symptoms

6/5 months)

2- Hyperactivity (6 out 9 symptoms

6/5 months)
• Attention deficit hyperactivity disorder (ADHD)
is a one of NDD that includes symptoms such as
inattentiveness, hyperactivity and
impulsiveness.

Symptoms of ADHD tend to be noticed at an

early age and may become more noticeable
when a child's circumstances change, such as
when they start school. Most cases are
diagnosed when children are 6 to 12 years old.
• The symptoms of ADHD usually improve with
age, but many adults who were diagnosed with
the condition at a young age continue to
experience problems.
• People with ADHD may also have additional
problems, such as sleep and anxiety disorders.
• Many children go through phases where they're
restless or inattentive. This is often completely
normal and does not necessarily mean they
have ADHD.
 Etiology
• What causes ADHD?
The exact cause of ADHD is unknown, but the
condition has been shown to run in families.
Research has also identified a number of
possible differences in the brains of people with
ADHD when compared with those without the
condition.

Other factors suggested as potentially having a

role in ADHD include:
• being born prematurely (before the 37th week of
pregnancy)
having a low birthweight
smoking, or alcohol or drug abuse during
pregnancy
ADHD can occur in people of any intellectual
ability, although it's more common in people
with learning difficulties
 Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria
A. A persistent pattern of inattention and/or hyperactivity­
impulsivity that interferes with functioning or development, as
characterized by (1) and/or (2):
 1. Inattention: Six (or more) of the following symptoms have
persisted for at least 6 months to a degree that is
inconsistent with developmental level and that negatively
impacts directly on:
       social and academic/occupational activities:
• Note: The symptoms are not solely a manifestation of
oppositional behavior, defiance, hostility, or failure to
understand tasks or instructions.
• For older adolescents and adults (age 17 and older), at
least five symptoms are required.
a. Often fails to give close attention to details or makes careless
mistakes in schoolwork, at work, or during other activities (e.
g., overlooks or misses details, work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play
activities (e.g., has difficulty remaining focused during
lectures, conversations, or lengthy reading).
c. Often does not seem to listen when spoken to directly (e.g.,
mind seems elsewhere, even in the absence of any obvious
distraction).
d. Often does not follow through on instructions and fails to
finish schoolwork, chores, or duties in the workplace (e.g.,
starts tasks but quickly loses focus and is easily
sidetracked).
e. Often has difficulty organizing tasks and activities (e.g.,
difficulty managing sequential tasks; difficulty keeping
materials and belongings in order; messy, disorganized
work; has poor time management; fails to meet deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (e.g., schoolwork or
homework; for older adolescents and adults, preparing
reports, completing forms, reviewing lengthy papers).
g. Often loses things necessary for tasks or activities (e.g.,
school materials, pencils, books, tools, wallets, keys,
paperwork, eyeglasses, mobile telephones).
h. Is often easily distracted by extraneous stimuli (for older
adolescents and adults, may include unrelated thoughts).
i. Is often forgetful in daily activities (e.g., doing chores, running
errands; for older adolescents and adults, returning calls,
paying bills, keeping appointments).
 2­ Hyperactivity and impulsivity: Six (or more) of the following
symptoms have persisted for at least 6 months to a degree
that is inconsistent with developmental level and that
negatively impacts directly on social and academic/
occupational activities:
• Note: The symptoms are not solely a manifestation of
oppositional behavior, defiance, hostility, or a failure to
understand tasks or instructions. For older adolescents and
adults (age 17 and older), at least five symptoms are
required.
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is
expected (e.g., leaves his or her place in the classroom, in
the office or other workplace, or in other situations that
require remaining in place).
c. Often runs about or climbs in situations where it is
inappropriate.
(Note: In adolescents or adults, may be limited to feeling
restless.)
d. Often unable to play or engage in leisure activities quietly.
e. Is often “on the go,” acting as if “driven by a motor” (e.g., is
unable to be or uncomfortable
being still for extended time, as in restaurants, meetings; may be
experienced by others as being restless or difficult to keep up
with).
f. Often talks excessively.
g. Often blurts out an answer before a question has been
completed (e.g., completes
people’s sentences; cannot wait for turn in conversation).
h. Often has difficulty waiting his or her turn (e.g., while waiting
in line).
Often interrupts or intrudes on others (e.g., butts into
conversations, games, or
activities; may start using other people’s things without asking or
receiving permission;
for adolescents and adults, may intrude into or take over what
others
are doing).
B. Several inattentive or hyperactive­impulsive symptoms were present prior to
age
12 years.
C. Several inattentive or hyperactive­impulsive symptoms are present in two or
more settings
(e.g., at home, school, or work; with friends or relatives; in other activities).
D. There is clear evidence that the symptoms interfere with, or reduce the
quality of, social,
academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia
or another
psychotic disorder and are not better explained by another mental disorder (e.
g., mood
disorder, anxiety disorder, dissociative disorder, personality disorder,
substance intoxication
or withdrawal).