DSM-5 Gets APA's Official Stamp of Approval

Caroline Cassels

December 02, 2012

The final diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been approved by the leadership of the American Psychiatric Association (APA).

In an official communiqué released December 1 at 3:31 pm Eastern Time, the APA announced that its Board of Trustees approved the manual's proposed criterial.

"The Board of Trustees' approval of the criteria is a vote of confidence for the DSM-5," APA president Dilip Jeste, MD, said in a prepared statement.

"We developed DSM-5 by utilizing the best experts in the field and extensive reviews of the scientific literature and original research, and we have produced a manual that best represents the current science and will be useful to clinicians and the patients they serve," Dr. Jeste added.

According to the APA, the latest edition of the manual will include "approximately the same number of disorders as the DSM-IV."

"We have sought to be very conservation in our approach to revising DSM-5. Our work has been at more accurately defining mental disorders that have a real impact on people's lives, not expanding the scope of psychiatry."

"I'm thrilled to have the Board of Trustees' support for the revision and for us to move forward toward publication," said David J. Kupfur, MD, chair of the DSM-5 Task Force.

In its release the APA announced that the latest edition of the manual will include a restructuring of its 20 chapters "based on disorders' apparent relatedness to one another, as reflected by similarities in disorders' underlying vulnerabilities and symptom characteristics."

The new manual will remove the current mutiaxial system in favor of nonaxial documentation of diagnosis, which will combine the former Axes I, II, and III with separate notations for psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V).

Criteria for autism spectrum disorder will now incorporate several diagnoses from DSM 4, including autistic disorder, Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder (not otherwise specified), into the diagnosis of autism spectrum disorder for DSM-5 to help more accurately and consistently diagnose children with autism.

Binge eating disorder will be moved from DSM-4's Appendix B: Criteria Sets and Axes Provided for Further Study to DSM-5 Section 2. The change is intended to better represent the symptoms and behaviors of people with this condition.

Disruptive mood dysregulation disorder will be included in DSM-5 to diagnose children who exhibit persistent irritability and frequent episodes of behavior outbursts 3 or more times a week for more than a year. The diagnosis is intended to address concerns about potential overdiagnosis and overtreatment of bipolar disorder in children.

Excoriation, also known as skin picking disorder, is new to DSM-5 and will be included in the Obsessive-Compulsive and Related Disorders chapter.

Hoarding disorder is also new to DSM-5. According to the APA, "its addition to DSM is supported by extensive scientific research on this disorder. This disorder will help characterize people with persistent difficulty discarding or parting with possessions, regardless of their actual value. The behavior usually has harmful effects — emotional, physical, social, financial and even legal — for a hoarder and family members."

Pedophilic disorder criteria will remain unchanged from DSM-4, but the disorder name will be revised from "pedophilia" to "pedophilic disorder."

Further, according to the APA the DSM-5 will maintain the categorical model and criteria for the 10 personality disorders included in DSM-4and will include the new trait-specific methodology "to encourage further study how this could be used to diagnose personality disorders in clinical practice."

Posttraumatic stress disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related Disorders. DSM-5 pays more attention to the behavioral symptoms that accompany PTSD and proposes 4 distinct diagnostic clusters instead of 3. PTSD will also be more developmentally sensitive for children and adolescents.

The APA will also remove the bereavement exclusion. In the DSM-4 this criterion applied to people experiencing depressive symptoms lasting less than 2 months after the death of a loved one.

The new manual will distinguish the differences between grief and depression and recognize that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one.

The new manual will also broaden the criteria for learning disorders to represent distinct disorders that interfere with language acquisition and the use of use of oral language, reading, writing, or mathematics or a combination of these.

Finally, the DSM-5 will combine the categories of substance abuse and substance dependence. The APA notes that previous substance abuse criteria required only 1 symptom whereas the DSM-5's mild substance use disorder requires 2 to 3 symptoms.