Differences between DSM - IV and DSM 5

DSM IV & DSM 5Classification of Mental Disorders

By:Mr. Sathish Rajamani

HOD – Psychiatric NursingVNC - Panipat

DSM – IV TR

• Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision

• Published by American Psychiatric Association

• Covers all mental disorders of adults and chilfren.

• The DSM uses a multiaxial or multidimensional approach to diagnose.

• Five Axis of Mental Disorders are listed below.Axis I: Clinical SyndromesAxis II: Developmental Disorders and Personality DisordersAxis III: Physical ConditionsAxis IV: Severity of Psychosocial StressorsAxis V: Highest Level of Functioning

Axis I: Clinical Syndromes

• 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

• Axis IV is fairly easy to understand: essentially, it is for recording life events - e.g. marriage, new job, death of a loved one - that may affect a patient's mental health diagnosis and treatment.

• For example, someone with an Axis I diagnosis of depression who had recently lost their job would have "job loss" or "unemployment" recorded on Axis IV.

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

• Published in 2015 by American Psychiatric Association.

• It is intended to assist researchers, healthcare providers, insurance providers, regulatory institutions, and other parties in the medical field in guiding treatment of mental health issues.

7 Biggest Changes from DSM-IV to 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.

7 Biggest Changes from DSM-IV to DSM-5

2. The Autism SpectrumIn 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, Asperger’s, childhood disintegrative disorder, and pervasive developmental disorder are no longer in use.

7 Biggest Changes from DSM-IV to DSM-5

3. Elimination of Childhood Bipolar DisorderIn 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 Dysregulation Disorder (DMDD).

7 Biggest Changes from DSM-IV to DSM-5

4. Revisions to ADHD DiagnosisThe new DSM-5 broadens the ADHD diagnosis, allowing for adult-onset and relaxing the strictness of the criteria to more accurately reflect new research 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.

7 Biggest Changes from DSM-IV to DSM-5

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

7 Biggest Changes from DSM-IV to DSM-5

6.   Reclassification of DementiaIn 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 Biggest Changes from DSM-IV to DSM-5

7.   Intellectual DisabilityTo 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 more strongly focus on adaptive functioning, rather than IQ score.