Changes in DSM-5: An Overview

Sheila L. Videbeck, PhD, RN

Overview

• The focus of this overview is major changes

between DSM-IV-TR (2000) and DSM-5
(2013).
• Both organizational and conceptual changes in
diagnoses are included.
• Further, inclusive and detailed changes and
explanations for changes are available at
www.DSM5.org/HighlightsofChanges
Major DSM-5 Changes

• Elimination of the only age-based section:

Disorders Usually First Diagnosed in Infancy,
Childhood or Adolescence. Diagnoses from this
section have been distributed to other sections
based on disorder categories.
• Creation of new sections: Neurodevelopmental
Disorders; Obsessive-Compulsive and Related
Disorders; Trauma- and Stressor-Related
Disorders.
Major DSM-5 Changes (continued)

• Sections renamed to better reflect disorders in

the section
• Change in the name of diagnoses (with
minimal change in individual diagnosis)
• Change in conceptual approach to a set of
diagnoses, specifically Autism Spectrum
Disorder
• Changes in definition, criteria for diagnoses,
and/or specifiers of the disorder
Major DSM-5 Changes (continued)

• The term “General medical condition” has been

replaced throughout DSM-5 with “Another
medical condition”
• Diagnoses are no longer placed on the multi-
axial system of Axes I-V
• The Global Assessment of Functioning Scale
(GAF) has been eliminated
Disorders Usually First Diagnosed
in Infancy, Childhood, or
Adolescence
• This category has been eliminated
• Disorders formerly in the section have been
distributed in other sections
• Neurodevelopmental Disorders is a new
section that contains many of the diagnoses
from this old section
Intellectual Disability

• Mental Retardation diagnosis has been

replaced with Intellectual Disability
• Both cognitive capacity (IQ) and adaptive
functioning are assessed with severity based
on adaptive functioning rather than IQ
Communication Disorders is a
category in Neurodevelopmental
Disorders that includes:
1. Language Disorder (combines Expressive and
Mixed Receptive-Expressive Disorder)
2. Speech Sound Disorder (replaces
Phonological Disorder)
3. Childhood Onset Fluency Disorder (formerly
Stuttering)
4. Social Pragmatic Disorder (New)
Autism Spectrum Disorder
• A conceptual change defines Autism Spectrum
Disorder as a single condition with different
levels of symptom severity – 2 symptom
categories are: social communication &
interaction; and repetitive, behavior, interests,
& activities
• Encompasses previous diagnoses of Autistic
Disorder, Asperger’s Disorder, Childhood
Disintegrative Disorder, and Pervasive
Developmental Disorder NOS
Additional Neurodevelopmental
Disorder Diagnoses
• Attention Deficit/Hyperactivity Disorder
• Specific Learning Disorder (includes former
reading, math, written expression, and NOS
diagnoses)
• Motor Disorders (includes Developmental
Coordination Disorder, Stereotypic Movement
Disorder, Tourette’s Disorder, and other vocal
and motor tics, & unspecified disorders)
Schizophrenia Spectrum and other
Psychotic Disorders
• Elimination of paranoid, undifferentiated,
disorganized, and residual subtypes
• Delusional Disorder – can now include bizarre
delusion(s)
• Schizoaffective Disorder – major mood episode
must be present for a majority of the total
duration of disorder
Bipolar and Related Disorders
• Criteria for mania and hypomania now include
changes in activity and energy as well as mood
changes
• Changes in diagnosis of Bipolar Disorder in
children on slide #13
Depressive Disorders

• Disruptive Mood Dysregulation Disorder – for

children under age 18 who have persistent
irritability and frequent extreme out of control
behavior (to address concerns about potential
overdiagnosis of Bipolar Disorder)
• Persistent Depressive Disorder (replaces
Dysthymic Disorder)
• Bereavement no longer excluded from
depression diagnosis
Anxiety Disorders
• PTSD moved to new section called Trauma and
Stressor Related Disorders
• OCD moved to new section called Obsessive-
Compulsive and Related Disorders
• Social Anxiety Disorder (replaces Social
Phobia)
• Panic Disorder with Agoraphobia – now 2
diagnoses, no longer one diagnosis
• Separation Anxiety Disorder – moved from the
old First Diagnosed in Infancy…section
Obsessive-Compulsive and Related
Disorders
• Obsessive-Compulsive Disorder – moved from
Anxiety Disorder section
• New Diagnosis: Hoarding Disorder
• Body Dysmorphic Disorder – moved from old
Somatoform Disorder section
• Trichotillomania
• Skin-picking Disorder
• Substance-induced OCD and OCD due to
another medical condition
Trauma and Stressor-Related
Disorders
• Reactive Attachment Disorder – moved from
the old First Diagnosed in Infancy…section
• Disinhibited Social Engagement Disorder
• PTSD – moved from Anxiety Disorders section
• Acute Stress Disorder – moved from Anxiety
Disorder Section
• Adjustment Disorders – old section of
Adjustment Disorders eliminated
Dissociative Disorders

• Depersonalization/Derealization Disorder –
concepts of depersonalization and derealization
combined to replace former Depersonalization
Disorder
• Dissociative Fugue – now a specifier under
Dissociative Amnesia instead of a stand-alone
diagnosis
Somatic Symptom and Related
Disorders
• Formerly called Somatoform Disorders
• Somatic Symptom Disorder (replaces
Somatization Disorder)
• Illness Anxiety Disorder (replaces
Hypochondirasis)
• Conversion Disorder – also called Functional
Neurological Symptom Disorder
• Factitious Disorder: Imposed on self or
Imposed on other colloquially known as
Munchausen’s Syndrome and Munchausen’s by
proxy)
Feeding and Eating Disorders
• Adult diagnoses of Anorexia Nervosa and
Bulimia Nervosa are essentially unchanged
• New Diagnosis: Binge Eating Disorder
• New Diagnosis: Avoidant/Restrictive Food
Intake Disorder
• Pica and Rumination Disorder - moved from
former First Diagnosed in Infancy…section
Disruptive, Impulse-Control, and
Conduct Disorders
• Conduct Disorder and Oppositional Defiant
Disorder – moved from former First Diagnosed
in Infancy…section
• Intermittent Explosive Disorder, Kleptomania,
& Pyromania – moved from former Impulse-
Control Disorder section
Substance-Related and Addictive
Disorders
• Gambling – moved from former Impulse-
Control Disorder section
• No longer a separation of substance abuse and
dependence
• Categories reduced by combining
amphetamine and cocaine into stimulants;
phencyclidine included in hallucinogens; and
nicotine expanded to tobacco
Neurocognitive Disorders
• Formerly Delirium, Dementia, and Amnestic
and other Cognitive Disorders section
• Delirium remains in section
• Amnestic Disorder and Dementia are now in a
new category called Mild or Major
Neurocognitive Disorder specified according to
etiology (vascular, HIV Infection, Traumatic
Brain Injury, Alzheimer’s Parkinson’s
Huntington’s, Prion, other medical condition,
multiple etiologies), location (Frontotemporal),
or characteristics (with Lewy Bodies)
Personality Disorders

• Personality Disorder diagnoses remain

unchanged in Section II
• Another alternative approach is proposed in
Section III to be used for further study; it
contains changes proposed in drafts of DSM-5
which were not ultimately accepted
• The alternate section has 6 rather than 10
diagnoses with criteria focusing on
personality traits and personality functioning
Additional Changes

• For changes in criteria, definitions, or

specifiers that are routinely used by clinicians
making diagnoses, see the website
www.DSM5/HighlightsofChanges