DIAGNOSTIC AND STATISTICAL

MANUAL IV, V, AND V & TR

What is DSM?

Diagnostic and Statistical Manual of Disorders is the latest edition of American Psychiatric
Association’s professional reference on book on mental health and brain-related condition.

What is the purpose of DMS?

The first step in treating any health conditon- physical or mental- is accurately diagnosing the
conditon. Thst’s where the DSM-5 comes in. It provides clear, highly detailed definitions of
mental health and brain-related conditions.

How was DMS content created?

To create the DSM-5, the APA gathered more than 160 mental healthcare professionals from
around the world, including psychiatrist, psychologists, and experts from many other professional
fields.
What topics does the DSM-5 cover?

- The DSM-5 mainly focuses on mental health conditions. However, because mental health and brain
function are inseparable, the DSM-5 also covers condition and concerns related to how the brain works.

Is DSM-5 still used?

- Yes, but there are two variants of this book. The APA published the DSM-5 in 2013. In 2022, the APA
published a test version the DSM-5-TR.

These are the sequence of when the different versions of DSM books were published over the year.

DSM- I : 1952

DSM- II: 1968

DSM- III: 1980

DSM- IV: 1994

DSM-IV: TR (Text Revision): 2000

DSM- V: 2013

DSM V: TR (Text Revision): 2022

TYPE AND CONDITION FOUND IN DSM- V
NEURODEVELOPMENTAL DISORDERS
AUTISM SPECTRUM DISORDER
What is Autism?

-Autism spectrum disorder (ASD) was previously known as autism or pervasive

developmental disorder. It's a lifelong condition.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized

by the following:

● Difficulties in social communication differences, including verbal and

nonverbal communication.
● Deficits in social interactions.
● Restricted, repetitive patterns of behavior, interests or activities and
sensory problems

Many of those with ASD can have delayed or absence of language development,
intellectual disabilities, poor motor coordination and attention weaknesses.
Criterias
-While ASD is believed to be a disorder of very early brain development, the behavioral signs
of autism characteristics surface between age 1 and ½ years of age and 3 years of age.
Symptoms
The signs include the following:
● Your child doesn’t respond to their name being called at all or responds inconsistently.
● Your child doesn’t smile widely or make warm, joyful expressions by the age of 6 months.
● Your child doesn’t engage in smiling, making sounds and making faces with you or other
people by the age of 9 months.
● Your child doesn’t babble by 12 months.
● No back-and-forth gestures such as showing, pointing, reaching or waving by 12 months.
● No words by 16 months.
● No meaningful, two-word phrases (not including imitating or repeating) by 24 months.
● Any loss of speech, babbling or social skills at any age.
Diagnosed
There are no laboratory tests to determine ASD. However, certain healthcare providers receive specific
training and can do screenings and evaluations if needed and who might ask parents or teachers to
record observations. These providers might include specialized physicians, psychologists and speech-
language pathologists.
Treatment
ASD is most often a life-long condition. Both children and adults with autism benefit from behavioral
interventions or therapies that can teach new skills to address the core deficits of autism and to reduce
the core symptoms. Every child and adult with autism is unique. For this reason, the treatment plan is
individualized to meet specific needs. It is best to begin interventions as soon as possible, so the benefits
of therapy can continue on throughout the course of life.
Many people with ASD often have additional medical conditions, such as gastrointestinal and feeding
issues, seizures and sleep disturbances. Treatment can involve behavioral therapy, medications or both.
Early intensive behavioral treatments involves the entire family and possibly a team of professionals. As
your child ages and develops, treatment may be modified to cater to their specific needs.
During adolescence, children benefit from transition services that promote skills of independence
essential in adulthood. The focus at that point is on employment opportunities and job skill training.
BIPOLAR AND RELATED DISORDERS
BIPOLAR I AND BIPOLAR II DISORDERS
What is Bipolar?

Bipolar disorder is a chronic mood disorder that causes intense shifts in mood, energy
levels and behavior. Manic and hypomanic episodes are the main sign of the condition, and
most people with bipolar disorder also have depressive episodes. The condition is
manageable with medications, talk therapy, lifestyle changes and other treatments.

Manic Episode

A key feature of bipolar I disorder is manic episodes. To meet the criteria for bipolar I
disorder, you must have had at least one manic episode in your life for at least a week
with or without ever experiencing a depressive episode.

Mania is a condition in which you have a period of abnormally elevated or irritable

mood, as well as extreme changes in emotions, thoughts, energy, talkativeness and
activity level. This highly energized level of physical and mental activity and behavior is a
change from your usual self and is noticeable by others.
People with certain types of bipolar such as bipolar II disorder
experience hypomania, which is a less severe form of mania. It
doesn’t last as long as manic episodes and it doesn’t interfere
with daily functioning as much.
Depressive Episode
During a depressive episode, you experience a low or depressed
mood and/or loss of interest in most activities, as well as many
other symptoms of depression, such as:
● Tiredness.
● Changes in appetite.
● Feelings of worthlessness and hopelessness.
Symptoms

The defining sign of bipolar I disorder is a manic episode that lasts at least one week, while
people with bipolar II disorder or cyclothymia experience hypomanic episodes.

But many people with bipolar disorder experience both hypomanic/manic and depressive
episodes. These changing mood states don’t always follow a set pattern, and depression doesn’t
always follow manic phases. A person may also experience the same mood state several times —
with periods of euthymia in between — before experiencing the opposite mood.

Mood changes in bipolar disorder can happen over a period of weeks, months and sometimes
even years.

An important aspect of the mood changes is that they’re a departure from your regular self and
that the mood change is sustained for a long time. It may be many days or weeks in the case of
mania and many weeks or months in the case of depression.

The severity of the depressive and manic phases can differ from person to person and in the
same person at different times.
Signs and Symptoms of Manic Episodes
● Excessive happiness, hopefulness and excitement.
● Sudden and severe changes in mood, such as going from being joyful to being angry and hostile.
● Restlessness.
● Rapid speech and racing thoughts.
● Increased energy and less need for sleep.
● Increased impulsivity and poor judgment, such as suddenly quitting your job.
● Making grand and unattainable plans.
● Reckless and risk-taking behavior, such as drug and alcohol misuse and having unsafe or unprotected sex.
● Feeling like you’re unusually important, talented or powerful.
● Psychosis — experiencing hallucinations and delusions (in the most severe manic episodes).

Most of the time, people experiencing a manic episode are unaware of the negative consequences of their
actions. With bipolar disorder, suicide is an ever-present danger — some people become suicidal in manic
episodes, not just depressive episodes.
If a person is having an intense manic episode, especially if they’re experiencing hallucinations and delusions,
they may need to be hospitalized to protect themselves and others from possible harm.

Diagnosis

Treatment
Signs and Symptoms of depressive episodes

The symptoms of depressive episodes in bipolar disorder are the same as those of major
depression. They include:

● Overwhelming sadness.
● Low energy and fatigue.
● Lack of motivation.
● Feelings of hopelessness or worthlessness.
● Loss of enjoyment of things that were once pleasurable for you.
● Difficulty concentrating and making decisions.
● Uncontrollable crying.
● Irritability.
● Increased need for sleep.
● Insomnia or excessive sleep.
● A change in appetite, causing weight loss or gain.
● Thoughts of death or suicide (suicidal ideation).
Diagnosed

To diagnose bipolar disorder, your healthcare provider may use many tools, including:

● A physical exam.
● A thorough medical history, which will include asking about your symptoms,
lifetime history, experiences and family history.
● Medical tests, such as blood tests, to rule out other conditions that could be
causing your symptoms, such as hyperthyroidism.
● A mental health evaluation. Your healthcare provider may perform the
evaluation, or they may refer you to a mental health specialist, such as a
psychologist or psychiatrist.

To be diagnosed with bipolar disorder, you must have experienced at least one
episode of mania or hypomania. Mental health providers use the Diagnostic and
Statistical Manual of Mental Disorders (DSM) to diagnose the type of bipolar disorder a
person may be experiencing.
to determine what type of bipolar disorder you may have, your mental health provider assesses the pattern of
symptoms and how much they affect your life during the most severe episodes.

People with bipolar disorder are more likely to also have the following mental health conditions:

● Anxiety.
● Attention-deficit /hyperactivity disorder (ADHD).
● Post-traumatic stress disorder (PTSD).
● Substance use disorders/dual diagnosis.

Because of this, as well as the fact that memory is often impaired during mania so people can’t remember
experiencing it, it can be difficult for healthcare providers to properly diagnose people with bipolar disorder.

People with bipolar disorder who are experiencing a severe manic episode with hallucinations may be
incorrectly diagnosed with schizophrenia. Bipolar disorder can also be misdiagnosed as borderline
personality disorder (BPD).

Because of this, it’s important to be honest and thorough when explaining all of your symptoms and
experiences when talking with your healthcare provider. It can also be helpful to include a loved one who may
be able to provide additional details about your mental health history in your discussions with your provider.
Treatment

Treatment can help many people, including those with the most severe forms of
bipolar disorder. An effective treatment plan usually includes a combination of the
following therapies:

● Psychotherapy (talk therapy).

● Medications.
● Self-management strategies, like education and identifying the early symptoms
of an episode or possible triggers of episodes.
● Helpful lifestyle habits, such as exercise, yoga and meditation. These can
support, but not replace, treatment.
● Other therapies, such as electroconvulsive therapy (ECT) in cases that are poorly
responsive to medication or where rapid control of symptoms is necessary to
prevent harm.
Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can
sometimes take several months to years before you and your healthcare provider find
a comprehensive treatment plan that works best for you. Although this can be
discouraging, it’s important to continue treatment.

Episodes of mania and depression typically come back over time. Between episodes,
many people with bipolar disorder don’t have mood changes, but some people may
have lingering symptoms. Long-term, continuous treatment can help manage these
symptoms.
DEPRESSIVE DISORDER
MAJOR DEPRESSIVE DISORDER
What is Major Depressive Disorder?

Depression is a mood disorder that causes a persistent feeling of sadness and loss of
interest in things and activities you once enjoyed. It can also cause difficulty with
thinking, memory, eating and sleeping.

There are several types of depressive disorders. Clinical depression, or major

depressive disorder, is often just called “depression.” It’s the most severe type of
depression.

Without treatment, depression can get worse and last longer. In severe cases, it can
lead to self-harm or death by suicide. The good news is that treatments can be very
effective in improving symptoms.
Symptoms

The symptoms of depression can vary slightly depending on the type and can range
from mild to severe. In general, symptoms include:

● Feeling very sad, hopeless or worried. Children and adolescents with depression
may be irritable rather than sad.
● Not enjoying things that used to bring joy.
● Being easily irritated or frustrated.
● Eating too much or too little, which may result in weight gain or weight loss.
● Trouble sleeping (insomnia) or sleeping too much (hypersomnia).
● Having low energy or fatigue.
● Having a difficult time concentrating, making decisions or remembering things.
● Experiencing physical issues like headache, stomachache or sexual dysfunction.
● Having thoughts of self-harm or suicide.
Diagnose

Healthcare providers diagnose depression based on a thorough understanding of your

symptoms, medical history and mental health history. They may diagnose you with a
specific type of depression, such as seasonal affective disorder or postpartum
depression, based on the context of your symptoms.

To receive a diagnosis of depression, you must have five depression symptoms every
day, nearly all day, for at least two weeks.

Your provider may order medical tests, such as blood tests, to see if any underlying
medical conditions are causing your depressive symptoms.
Treatment

Depression is one of the most treatable mental health conditions. Approximately 80% to
90% of people with depression who seek treatment eventually respond well to treatment.

● Psychotherapy: Psychotherapy (talk therapy) involves talking with a mental health

professional. Your therapist helps you identify and change unhealthy emotions,
thoughts and behaviors. There are many types of psychotherapy —
cognitive behavioral therapy (CBT) is the most common. Sometimes, brief therapy
is all you need. Other people continue therapy for several months or years.
● Medication: Prescription medicine called antidepressants can help change the
brain chemistry that causes depression. There are several different types of
antidepressants, and it may take time to figure out the one that’s best for you. Some
antidepressants have side effects, which often improve with time. If they don’t, talk
to your healthcare provider. A different medication may work better for you.
There are also things you can do at home to help improve depression symptoms,
including:

● Getting regular exercise.

● Getting quality sleep (not too little or too much).
● Eating a healthy diet.
● Avoiding alcohol, which is a depressant.
● Spending time with people you care about.
DISRUPTIVE, IMPULSE-CONTROL AND
CONDUCT DISORDER
KLEPTOMANIA
What is Major Kleptomania Disorder?

Kleptomania is a mental health condition where a person feels an overpowering,

irresistible urge to steal things. People who have this disorder know that stealing is
wrong and could get them into trouble, but they can’t stop themselves.

People who have kleptomania don’t steal because of a lack of willpower, self-control or
a character flaw. Instead, this is a medical condition where a person doesn’t have the
ability to resist the impulse to steal. It’s common for people with kleptomania to feel
guilt, shame or stress about stealing. Many try to compensate for this by returning items,
donating them to charity, or going back and paying for the items after the fact.
Symptoms

The main symptom of kleptomania is that a person acts on an irresistible urge or need to
steal items or objects. That often involves one or more of the following:

● The items aren’t stolen out of necessity or for their value.

● A person feels tension or anticipation before stealing, followed by pleasure, relief
or other positive emotions immediately afterward.
● Once the positive emotions fade, most people with kleptomania feel guilt, shame
or regret.
● Some people throw stolen items away, give them to others or donate them to
charity. Less commonly, a person will hoard stolen items, secretly return them or
return and pay for them.
● Stealing isn’t planned, and a person with kleptomania does it alone. Most people
who are married with kleptomania keep it a secret from their spouse
Treated
There’s no standard way to treat kleptomania, and there’s limited research on which
treatments work best. That’s partly because people with kleptomania rarely seek care
on their own, which means it’s harder to research possible treatments.
The most likely treatments fall into two main categories:
● Medication. Opioid antagonists (which block the effects of opioid medications)
are one of the first-line treatment options. There’s research supporting their
effectiveness. These medications block the positive emotions a person feels
when stealing, which could help a person resist the urge to steal. Other possible
medications include antidepressants, anti-seizure drugs or lithium.
● Psychotherapy. Also known as mental health therapy or behavioral therapy,
this usually involves helping a person understand why they do certain things
and then helping them develop ways to change or avoid those behaviors.
Psychotherapy for kleptomania can take many forms, such as
cognitive behavioral therapy (CBT), group therapy or even hypnosis.
Diagnosed

There aren’t any tests of any kind that can diagnose kleptomania. However, healthcare
providers may recommend tests to rule out other conditions. Your healthcare provider
is the best person to tell you if they recommend running tests for your specific case
and why.
ANXIETY DISORDER
PANIC DISORDER
What is Major Panic Disorder?

Panic disorder is an anxiety disorder that involves multiple unexpected panic attacks.
A main feature of panic disorder is that the attacks usually happen without warning
and aren’t due to another mental health or physical condition. There’s often not a
specific trigger for them.

Criterias

Symptoms

Treatment
Symptoms
A panic attack happens suddenly. Symptoms usually peak within 10 minutes after it starts and then disappear soon after.
Physical symptoms of a panic attack include:
● Chest pain.
● Racing heart.
● Difficulty breathing, such as hyperventilation.
● Trembling or shaking.
● Chills.
● Nausea.
● Sweating.
● Tingling or numbness in your fingers or toes.
You may feel:
● Intense terror.
● A choking or smothering sensation.
● Fear of losing control.
● Like you’re going to die.
● Derealization (feelings of unreality) or depersonalization (feeling detached from yourself).
Panic attacks are very unpleasant and can be frightening. If you’ve had symptoms of a panic attack, it’s important to see a
healthcare provider. They can give you an official diagnosis and ensure there’s no underlying physical cause.
Diagnosis

Medical or mental health providers can diagnose panic disorder based on criteria in
the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Your provider may
diagnose panic disorder when you have repeated, unexpected panic attacks as well as
one month or more of:

● Persistently worrying about having more panic attacks or their consequences.

● Changing your behaviors to avoid situations that you think may trigger an attack.

In addition, the attacks can’t be due to the direct effects of a substance or general
medical condition. And they can’t be better accounted for by another mental health
condition, like a phobia or PTSD.
Diagnosis
Psychotherapy, medications or a combination of both are very effective in treating panic attacks and panic
disorder. How long you’ll need treatment depends on the severity of the condition and how well you respond to
treatment.
Psychotherapy
Psychotherapy (talk therapy) is a term for a variety of treatment techniques that aim to help a person identify
and change unhealthy emotions, thoughts and behaviors.
Specific types of psychotherapy that can help with panic attacks and panic disorder include:
● Cognitive behavioral therapy (CBT): In this type of therapy, you discuss your thoughts and emotions with
a mental health professional, such as a licensed counselor or psychologist. This specialist helps identify
panic attack triggers so you can change your thinking, behaviors and reactions. As you start to respond
differently to triggers, the attacks may decrease and ultimately stop.
● Exposure therapy: This involves exposing you gradually and repeatedly — in your imagination and/or in
reality — to whatever triggers a panic attack. Over time, you learn to become comfortable with the
situation instead of it causing anxiety and panic. You’ll learn relaxation techniques, such as breathing
exercises, to manage your anxiety throughout the process.
Medications

Medications that can help treat panic attacks and panic disorder include:

● Antidepressants: Certain antidepressant medications can make panic attacks

less frequent or less severe. Healthcare providers may prescribe serotonin-
selective reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake
inhibitors (SNRIs). SSRIs include fluoxetine (Prozac®) and paroxetine (Paxil®).
SNRIs include duloxetine (Cymbalta®) and venlafaxine (Effexor®).
● Anti-anxiety medications: Providers most commonly prescribe
benzodiazepines to treat and prevent panic attacks. They help with anxiety but
have addiction potential, so it’s important to take them with caution. These
medications include alprazolam (Xanax®) and lorazepam (Ativan®).