DSM-5: Fact Sheet

DSM-5 or the Diagnostic and Statistical Manual of Mental Disorders is a resource guide for mental health professionals. DSM-5 is the fifth edition in the series and was released in 2013.

For those who may not be familiar with it, we will discuss what DSM-5 does, how it is organized, its history and development, why psychiatrists use this manual to diagnose patients, and what can be diagnosed by using this manual.

We will also talk about how DSM-5 defines “mental disorder,” which sections are included in it as well as major psychiatric disorders that can be identified through its use. Finally, we will share some concluding thoughts on our discussion of the DSM-5.

What Is DSM-5?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA). DSM-IV was the fourth edition, released in 1994. The fifth edition, DSM-V, was released in May 2013.

It is a manual that provides a classification system for mental disorders. It also includes diagnostic criteria for such disorders, along with research information.

What Is DSM-V Used For?

The DSM-V is a classification system for mental disorders that provides clinicians and researchers with a set of diagnostic criteria for each disorder. It also includes information on prevalence, course, and symptoms. The manual is used to help identify mental disorders, understand their etiology and pathophysiology, and develop treatment plans.

What Can The DSM-V Diagnose?

The DSM can diagnose mental disorders. It provides a classification system for such disorders and lists the diagnostic criteria for them. It is used by clinicians to diagnose mental health conditions in the United States.

The DSM-V includes the five categories: disorders usually first diagnosed in infancy, childhood, or adolescence; mental disorders due to general medical conditions; substance use disorders; schizophrenia and other psychotic disorder; mood, anxiety, and related disorder.

What Is The Definition Of Mental Disorder In DSM-V?

Mental disorder is defined as “a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.”

In other words, it is a syndrome (or group of symptoms) that reflects an underlying dysfunction in the processes related to mental function.

Who Can Use The DSM-V?

The DSM-V can be used by psychiatrists, psychologists, psychiatric nurses, and other mental health professionals.

DSM-5 Index

The DSM-V is organized into three main sections, which are “Structure and content”, “Diagnostic criteria sets” and “Associated features and disorders”.

Structure And Content

Five Categories In DSM-5

There are five categories in DSM-V:

1. Neurodevelopmental Disorders
2. Schizophrenia Spectrum and Other Psychotic Disorders
3. Bipolar and Related Disorders
4. Depressive Disorders
5. Anxiety Disorders

Sections Of DSM-5

The sections are as follows:

Section I

Section I includes:

• The introduction and instructions for use,
• Glossary,
• Coding conventions, and
• Other information about the manual

It also contains the diagnostic criteria for all of the mental disorders in DSM-V.

Section II

Section II includes information on:

• Neurodevelopmental disorders, including attention-deficit/hyperactivity disorder,
• Autistic spectrum disorder, and
• Intellectual disability

Section III

Section III includes information on:

• Psychotic disorders, including schizophrenia spectrum and other psychotic disorders,
• Delusional disorders, and
• Hallucinogenic persisting perception disorder

Section IV

Section IV includes information on:

• Bipolar and related disorders,
• Depressive disorders,
• Anxiety disorders,
• Somatic symptom and related disorders (somatic symptom disorder; illness anxiety disorder; hypochondriasis),
• Personality disorders,
• Autism spectrum disorder with a known cause in childhood or adolescence (such as Rett syndrome) – but only if the symptoms are severe enough to warrant a diagnosis – and
• Sexual dysfunctions, paraphilias, and gender identity disorders.

Section V

Section V is an appendix that includes information on dimensional assessment measures for use in DSM-V.

Diagnostic Criteria Set

The following list contains some of the criteria sets for each disorder:

Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is diagnosed using three symptom domains, including:

• Deficits in social communication and interaction;
• Deficits in restricted or repetitive behaviors, interests, activities, or routines; and
• Excessive adherence to nonfunctional routines

NOTE: ASD symptoms are often present before age three.

Depressive disorders

Depressive disorders are diagnosed using four symptom domains, including:

• Appetizing loss of interest or pleasure in daily activities
• Significant weight or appetite disturbance, either by subjective report or objective observation
• Sleep disturbances (insomnia, hypersomnia)
• Psychomotor agitation

NOTE: The depressed mood or loss of interest in usual activities for more than two weeks. The depressed mood must be present most days of the week.

Anxiety disorders

These disorders are diagnosed using three categories:

• Anxiety about two of the following five domains: performance in social or occupational activities, schoolwork, daily routine tasks, physical health, appearance
• Muscle tension
• Autonomic arousal (e.g., heart rate increase)
• Excessive worry about several events or activities
• Persistent irrational fear that is not specific to one event or object
• Frequent intense panic attacks.

Bipolar disorder

Bipolar disorder is diagnosed using four symptom domains:

• A distinct period of elevated, expansive, or irritable mood lasting at least one week (and any three from)
• Inflated self-esteem;
• Decreased need for sleep; or
• More talkative than usual; or
• Pressured to keep talking; or
• Flight of ideas or subjective experience that thoughts are racing

Along with these criteria, DSM5 also considers a manic episode. A manic episode must include symptoms such as:

• Elevated mood,
• Inflated self-esteem,
• Decreased need for sleep,
• More talkative than usual,
• Racing thoughts, and
• Distractibility

Schizophrenia spectrum and other psychotic disorders

The schizophrenia spectrum and other psychotic disorders are diagnosed using five symptom domains:

• Two from hallucinations, delusions, or disorganized speech
• One of the following: catatonia; lack of motivation; poverty of content in speech

NOTE: Hallucinations must be sensory, such as hearing voices when there is no one around.

Personality disorders

Personality disorders are diagnosed using nine criteria sets, which cover a range of different personality characteristics.

• Significant impairments in self (identity, self-direction) and interpersonal (empathy, intimacy) functioning
• The enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture or is associated with distress or disability…
• The enduring pattern is inflexible and pervasive across a broad range of personal and social situations
• The pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning
• The pattern is stable and of long duration
• The individual’s symptoms are not better explained by another mental disorder

Somatic symptom disorder

Somatic symptom disorder is diagnosed when the individual has one or more somatic symptoms that cause distress and impairment in social, occupational, educational activities.

Illness anxiety disorder

Illness anxiety disorder is diagnosed when the individual has excessive and persistent worry about having or developing a serious illness.

Hypochondriasis

Hypochondriasis is diagnosed when the individual has excessive and persistent worries about having a serious physical illness, despite medical reassurance to the contrary.

Sexual dysfunctions

Sexual dysfunctions are diagnosed using four symptom domains, including difficulty experiencing orgasm, erectile dysfunction in men, and lack of sexual interest or pleasure.

Paraphilia disorders

Paraphilias are diagnosed when the individual has:

• Recurrent fantasies,
• Urges, or behaviors involving nonhuman objects;
• Activities with children, adults, or other unwilling partners;
• Hurting self or others during sex acts;
• Using pain to create a response from another person during sex

Gender identity disorders

Gender identity disorders are diagnosed when an individual expresses:

• A strong desire to be the other gender,
• Identifies with another gender, or
• Have their genitals surgically altered

Associated features and disorders

The following list of conditions have been associated with mental disorders but are not part of the diagnostic criteria for any specific disorder:

• Intellectual disability
• Attention-deficit/hyperactivity disorder
• Conduct disorder
• Oppositional defiant disorder
• Delinquency
• Substance abuse or dependence
• Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder)
• Self-injurious behaviors (for example, self-cutting or burning)

Categories And Subcategories Of Disorders

The diagnostic criteria for mental disorders in the manual are organized into different categories and subcategories:

Schizophrenia Spectrum Disorders

• Schizoaffective disorder;
• Schizophrenia;
• Schizophreniform disorder;
• Schizotypal personality disorder

Delusional Disorders

• Delusional disorder;
• Shared psychotic disorder

Affective Disorders

• Major depressive episode;
• Bipolar disorders I and II;
• Cyclothymic disorder,
• Mood episodes in borderline personality disorder

Anxiety Disorders

• Panic disorder;
• Obsessive-compulsive disorder;
• Posttraumatic stress disorder

Somatic Symptom and Related Disorders

• Somatic symptom disorder;
• Illness anxiety disorder;
• Hypochondriasis

Eating Disorders

• Anorexia nervosa;
• Bulimia nervosa

Substance-Related and Addictive Disorders

• Alcohol dependence;
• Cocaine dependence

Neurodevelopmental Disorders

• Attention-deficit/hyperactivity disorder;
• Autistic spectrum disorder

Personality Disorders

• Borderline personality disorder;
• Paranoid personality disorder;
• Schizoid personality disorder;
• Histrionic personality disorder;
• Narcissistic personality disorder

Sexual Dysfunctions

• Erectile dysfunction;
• Premature ejaculation;
• Female sexual interest/arousal disorder;
• Genito-pelvic pain/penetration disorder;
• Vaginismus

Paraphilias

• Exhibitionism;
• Fetishism;
• Transvestic fetishism;
• Pedophilia;
• Sexual masochism;
• Sexual sadism

Gender Identity Disorders

• Gender dysphoria of childhood;
• Transgenderism,
• Intersex conditions and
• Gender incongruence

Updates Made To DSM-5 Criteria

Several changes have been made to the DSM-V, which is the latest edition of the Diagnostic and Statistical Manual of Mental Disorders. The most notable change is that the manual will now cover more mental disorders, including both children and adults.

The DSM-V will include a new chapter on neurodevelopmental conditions to help clinicians better understand the relationship between some childhood psychiatric problems and brain development. Several changes have been made to specific diagnoses, such as autism spectrum disorder which has been renamed ‘autism spectrum disorder’ and ‘pedophilic disorder’.

The DSM-V was released in 2013 and made updates to criteria for several mental disorders. These include:

Schizophrenia

The new edition removes the requirement that two or more symptoms must be present for at least a month and instead stipulates that one symptom must be present for at least six months to make a diagnosis.

Autistic spectrum disorder

There are no longer two subtypes of autism. The former Asperger’s syndrome is now included in the same diagnosis as autism, which is known simply as ‘autism spectrum disorder’.

Intellectual disability

This has been renamed to intellectual developmental disorders and includes a range of conditions that result in significantly impaired cognitive function.

Depressive disorders

There will be a new category of ‘depressive episode’, which represents a clinical presentation that is defined by the presence of depressed mood or lack of interest in enjoyable activities lasting at least two weeks and includes bereavement as one cause.

Major depressive disorder

The DSM-IV criteria for major depressive disorder have been revised to improve the diagnostic specificity and to maintain consistency with the World Health Organization’s International Classification of Diseases (ICD-11), which is currently in development (in 2013).

Schedule for non-affective psychotic disorders

This category has been updated, having previously included ‘schizophreniform disorder’ and ‘schizoaffective disorder’. Schizophrenia will now be a separate disorder, and will include ‘prodromal schizophrenia’.

Anxiety disorders

Separation anxiety has been added to the DSM-V as a diagnosis. The new edition also includes specific criteria for posttraumatic stress disorder (PTSD) in children and adolescents aged six years or older. PTSD symptoms may be expressed differently in younger children.

Bipolar and related disorders

The DSM-V has refined the diagnostic criteria for bipolar disorder, which is now known as ‘bipolar I disorder’. Cyclothymia (a mild form of bipolar disorder) is no longer a separate diagnosis.

Attention deficit hyperactivity disorder (ADHD)

The new edition will cover both children and adults, whereas the DSM-IV only covers the diagnosis in children. However, some of its criteria have been removed to reflect research that has found they were not always helpful when diagnosing ADHD among adults.

Binge eating disorder

Previously listed under “eating disorders not otherwise specified”, binge-eating disorder (BED) will now be included as a stand-alone diagnosis.

Pedophilic disorder

DSM-V will introduce a new diagnosis of ‘pedophilic disorder’. This will be used to describe individuals who have recurrent, intense sexually arousing fantasies, urges, or behaviors involving sexual activity with prepubescent children (generally age 13 years or younger).

Gender dysphoria

The term ‘gender identity disorder’ is replaced by ‘gender dysphoria. This diagnosis will be used for individuals who experience significant distress because their biological sex does not match the gender they identify with.

Posttraumatic stress disorder (PTSD)

PTSD symptoms may be expressed differently in younger children and the new DSM includes criteria specifically for these cases of this condition.

Autistic spectrum disorder

This has been renamed ‘autism spectrum disorder’.

NOTE: The DSM-V, released in May 2013 is available in both print and electronic formats. Clinicians, researchers, and patients are encouraged to visit the website for updates on when the new edition will become available.

History And Development Of DSM-V

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual published by the American Psychiatric Association that provides a classification system for mental disorders. The first edition, DSM-I, was published in 1952 and contained 106 diagnoses. The most recent edition, DSM-V, was published in 2013 and contained elaborate diagnoses of mental disorders.

The diagnostic manual has historically been seen as an authoritative reference within the field of psychiatry, although this belief has come into question in recent years. It remains one of the most important classification systems to date and continues to be used by clinicians and researchers throughout the world today. According to some estimates, the DSM-IV is used in over 80% of clinical decisions made within psychiatry.

Experts’ Opinion On DSM-5

“While the DSM-IV had its critics, it is generally seen as a reliable and valid resource. However, there have been some concerns about how the DSM-V will fare.

One of the major changes in DSM-V is that Asperger’s Syndrome will be folded into Autism Spectrum Disorder. Some experts worry that this change may lead to more people being diagnosed with Autism Spectrum Disorder and that the criteria for diagnosis may be too broad.

There have also been concerns about the new category of ‘Behavioral Addictions.’ This category includes conditions such as gambling addiction and sex addiction. Some experts worry that this will lead to over-diagnosis and treatment of normal behaviors as addictions.”

Conclusion

The DSM-V is the latest edition of the Diagnostic and Statistical Manual of Mental Disorders. It provides a classification system for mental disorders and lists the diagnostic criteria for them. It also includes research information on mental disorders. The DSM-V can be used by psychiatrists to make a diagnosis.

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