The Diagnostic and Statistical Manual of Mental Disorders (DSM) is ...

Hockenbury & hockenbury Psychology, 6e: dsm-5 update supplement

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a comprehensive encyclopedia of psychological disorders first published by the American Psychiatric Association in 1952. The DSM is used as a classification system in order to provide a common language for psychiatrists, psychologists, and other health-care professionals. It’s also used by insurance companies and legal authorities. The fifth and most recent edition, popularly called DSM-5, was published in May 2013. With each new edition, disorders are eliminated, relabeled, or added. Often, these changes reflect the progress of scientific research. In other cases, such as the 1973 removal of homosexuality from the DSM, they reflect changes in social and cultural understanding. This table shows a chapter-by-chapter list of the DSM-5 changes that affect content in your textbook. Chapter



Chapter 7: Thinking, Language, and Intelligence

Chapter 10: Gender and Sexuality

Chapter 14: Psychological Disorders

Affected Terms



DSM–5 Change



Comment

Asperger’s syndrome and autism (pp. 275-276; 302-303)

Both are now included in autism spectrum disorder.

Asperger’s syndrome and autism are no longer separate, distinct disorders, and are differentiated only in terms of their symptom severity. Individuals diagnosed with autism spectrum disorder display the two core symptoms of (1) deficits in social communication and social interaction and (2) restricted, repetitive behaviors, interests, and activities. People with autism spectrum disorder are diagnosed according to three levels of symptom severity: Level 1, “requiring support”; Level 2, “requiring substantial support”; or Level 3, “requiring very substantial support.”

Mental retardation (p. 302)

Now called intellectual disability

“Intellectual disability” is the currently accepted term; severity is now determined by adaptive functioning rather than primarily by IQ score.

Gender identity disorder (p. 417)

Now called gender dysphoria

Both terms refer to psychological problems caused by feelings of intense discomfort (“dysphoria”) caused by a discrepancy or mismatch between the gender one was assigned at birth and the gender that one expresses or experiences. However, the change in terminology is meant to emphasize that it is the discomfort, and not the discrepancy, that is considered to be a psychological disorder.

Sexual aversion disorder (p. 432)

Dropped from DSM-5

Disorder was dropped due to lack of research supporting its prevalence.

Vaginismus and dyspareunia (p. 432)

Combined into a new disorder, genito-pelvic pain/penetration disorder

Both conditions frequently occurred together and were hard to distinguish.

Infancy, childhood, or adolescent disorders (p. 566, Table 14.1)

Now called neuro-developmental disorders

More accurately describes these disorders as disorders of neural development.

Autistic disorder (p. 566, Table 14.1)

Now called autism spectrum disorder

Individuals diagnosed with autism spectrum disorder display the two core symptoms of (1) deficits in social communication and social interaction and (2) restricted, repetitive behaviors, interests, and activities. People with autism spectrum disorder are diagnosed according to three levels of symptom severity: Level 1, “requiring support”; Level 2, “requiring substantial support”; or Level 3, “requiring very substantial support.”

Somatoform disorders (p. 566, Table 14.1)

Now called somatic symptom and related disorders

“Somatoform disorders” was confusing; renamed for clarity.

Hypochondriasis (p. 566, Table 14.1)

Dropped from DSM-5

Hypochondriasis eliminated partly because of its negative connotations. Excessive worry over one’s health is now split into two separate disorders: somatic symptom disorder, in which physical symptoms are

Chapter



Affected Terms



DSM–5 Change



Chapter 14: Psychological Disorders (continued)

Comment present but their significance is exaggerated; and illness anxiety disorder, in which individuals worry excessively about being ill despite an absence of physical symptoms. Both disorders involve an anxious preoccupation or worry about health concerns.

Sexual and gender identity disorders (p. 566, Table 14.1)

Split into three diagnostic classes: sexual dysfunctions, gender dysphoria, and paraphilic disorders

In DSM-5, this class has been split into three diagnostic classes: (1) sexual dysfunctions, which are clinically significant disturbances in a person’s ability to respond sexually or to experience sexual pleasure; (2) gender dysphoria, which refers to the distress (“dysphoria”) that may accompany the mismatch between one’s experienced or expressed gender and one’s assigned gender; and (3) paraphilic disorders, referring to intense and persistent sexual interest in inappropriate objects or people that causes distress or impairment to the individual or harm to others.

Fetishism (p. 566, Table 14.1)

Now called fetishistic disorder

Change made to emphasize that a fetish is only a disorder if it causes clinically significant personal distress or psychosocial role impairment.

Gender identity disorder (p. 566, Table 14.1)

Now called gender dysphoria

Gender identity disorder, previously defined as the strong and persistent desire to be the other sex, has been replaced by gender dysphoria, now defined as distress that accompanies the discrepancy between one’s experienced and expressed gender and one’s assigned gender. The change in terminology is meant to emphasize that it is the discomfort, and not the discrepancy, that is considered to be a psychological disorder.

Impulse-control disorders (p. 566, Table 14.1)

These disorders are now included in a new diagnostic class called disruptive, impulse-control, and conduct disorders.

The definition is essentially the same but the classification has been expanded to include additional disorders.

Agoraphobia (p. 568)

Panic attacks are no longer a requirement for the diagnosis.

Because not all people with agoraphobia have panic attacks, criteria have been expanded to include fear of panic-like symptoms or of other incapacitating or embarrassing symptoms, such as fear of getting lost, fear of falling, or fear of incontinence.

Social phobia (p. 570) Posttraumatic stress disorder (PTSD) (pp. 571–572)

Renamed social anxiety disorder

Name changed for clarity.

Now included in new diagnostic class, trauma- and stressorrelated disorders

PTSD is no longer classified as an anxiety disorder. Instead, it falls under a new classification in DSM-5, called trauma- and stressor-related disorders. Although anxiety is still an important symptom in posttraumatic stress disorder, the new classification recognizes that some sufferers of trauma-related disorders experience symptoms other than fear and anxiety. Thus, to the three symptom clusters described in your text (frequent and intrusive recollections of the traumatic event, avoidance, and hyperarousal), DSM5 adds a fourth cluster: negative alterations in cognition and mood. Examples include angry outbursts, exaggerated negative beliefs about the self or the world, negative emotions, irritable behavior, reckless or self-destructive behavior, and so forth. Continued on the next page.

Chapter



Chapter 14: Psychological Disorders (continued)

Affected Terms



DSM–5 Change



Comment

Obsessive-compulsive disorder (pp. 544-545)

Now included in new diagnostic class, obsessive-compulsive and related disorders

Although anxiety is still an important symptom in obsessive-compulsive disorder, the disorder is no longer classified as an anxiety disorder. Instead, it’s included in a new DSM5 category called obsessive-compulsive and related disorders with other disorders involving compulsive behavior, such as hoarding, trichotillomania (hair-pulling), and excoriation (skin-pulling).

Mood disorders (pp. 575–581)

Now split into two diagnostic classes, depressive disorders and bipolar and related disorders

In previous editions of DSM, the classification mood disorders included both depression and bipolar disorder. In DSM-5, these disorders are split into two new diagnostic classes: depressive disorders, and bipolar and related disorders.

“The bereavement exclusion” (p. 577)

Bereavement is no longer excluded as a criterion for major depressive disorder

One key difference in DSM-5, and a controversial one, was the removal of what has been termed “the bereavement exclusion,” which we discuss on page 577 (paragraph 2). In DSM-IV-TR, despondency following the death of a loved one was not considered to be a case of major depression unless the ability to function was still severely impaired for 2 months or longer after the death. In DSM-5, recent bereavement no longer disqualifies someone for the diagnosis of major depression, although the point is made that it is important to distinguish true depression from normal grief symptoms.

Eating disorders (pp. 582–584)

Included in a new, expanded diagnostic class called feeding and eating disorders

Feeding and eating disorders is a new diagnostic class that includes anorexia nervosa, bulimia nervosa, a new disorder called binge-eating disorder, and feeding/ eating disorders of infancy and childhood, such as pica (eating nonfood substances).

Anorexia nervosa (p. 582)

Change in criteria: diagnosis requires only “significantly low weight” rather than “less than 85% of normal weight”; absence of menstrual cycles has been dropped.

Recognition that many women with anorexia nervosa did not experience a loss of menstrual periods, and that some people with symptoms of anorexia nervosa have an unhealthy body weight but do not meet the 85% criterion.

Schizophrenia (pp. 594–596, including Table 14.9)

The paranoid, catatonic, disorganized, and undifferentiated subtypes of schizophrenia have been dropped in DSM-5.

Instead of differentiating schizophrenia “subtypes” on the basis of distinct clusters of symptoms, clinicians now diagnose clients in terms of symptom severity. Note that the symptoms themselves are still present in schizophrenia, but they do not seem to be organized according to the subtypes described in earlier editions of DSM.

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