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Mental disorders manual undergoes reorganization

The American Psychiatric Association has announced the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which includes the first revision since 1994 of the classifications and criteria of mental disorders.

The changes reflect nearly two decades of scientific advances and clinical experience, according to an APA news release. DSM-5 is the guidebook used by clinicians and researchers to diagnose and classify mental disorders in the United States and around the world.

“The changes to the manual will help clinicians more precisely identify mental disorders and improve diagnosis while maintaining the continuity of care,” David J. Kupfer, MD, chairman of the DSM-5 Task Force, said in the news release. “We expect these changes to help clinicians better serve patients and to deepen our understanding of these disorders based on new research.”

Many of the changes in DSM-5 were adjustments made to better characterize disorder symptoms in terms of appearance, duration or severity. Certain conditions were combined because of the recognized overlap between some categories or, as with autism spectrum disorder, because the relationships among categories clearly placed them along a single continuum.

In Section III, a supplemental section that is new to the manual, several conditions are introduced that warrant more research before they might be considered as formal disorders for the main book. Two such conditions, suicidal behavioral disorder and nonsuicidal self injury, reflect DSM-5’s increased recognition of suicidal ideation and its related issues. Their inclusion in Section III should help to determine whether they have clinical utility and their diagnostic criteria can be used reliably.

The revised chapter organization of DSM-5 signals how disorders may relate to each other based on underlying vulnerabilities or symptom characteristics. It also breaks out some disorders because of greater understanding of their basic causes.

As an example, the previous single chapter on “Anxiety disorders, including obsessive compulsive disorder and posttraumatic stress disorder” is three sequential chapters detailing anxiety disorders, obsessive-compulsive and related disorders, and trauma- and stressor-related disorders. This move both emphasizes the distinctiveness of the categories covered while signaling their interconnectedness.

Throughout the manual, disorders are framed in the context of age, gender and cultural expectations. Disorders are organized along a developmental lifespan within each chapter; conditions first evident in childhood and adolescence are no longer set apart but integrated throughout the manual.

Although DSM-5 includes several new categories — such as binge eating disorder, disruptive mood dysregulation disorder and hoarding disorder — the new manual will have approximately the same number of disorders as DSM-IV.

The product of the most comprehensive and transparent development process in APA history, the new book represents the strongest science and the contributions of more than 1,500 U.S. and international experts from a diversity of mental health and medical fields, according to the news release.

“When the APA set out to revise DSM, we wanted to facilitate the broadest participation possible to ensure we captured a diversity of opinions,” said Dilip Jeste, MD, president of APA. “We also wanted to strengthen the final manual for clinicians, patients and researchers. We have achieved both goals and expect DSM to have immediate utility for clinicians and benefit for patients.”

The APA is looking to make future revision processes more responsive to breakthroughs in research with incremental updates until a new edition is required. Since the research base of mental disorders is evolving at different rates for different disorders, diagnostic guidelines will not be tied to a static publication date but rather to scientific advances.

Get more information on changes to DSM-5 and how to purchase the manual and other products from the DSM-5 Collection: www.psychiatry.org/dsm5.

By | 2013-05-19T00:00:00-04:00 May 19th, 2013|Categories: National|0 Comments

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