DSM-III-R Revisions in the Dissociative Disorders: An Exploration of their Derivation and Rationale Richard.P. Kluft, M.D. Marlene Steinberg, M.D. Robert L. Spitzer, M.D. ABSTRACT The authors describe and explore changes in the dissociative disorders …
With DSM-III-based PTSD (APA, 1980 ), there was finally a diagnosis that recognized the lasting pathological effects of traumatic stress. DSM-III also found a place for code 308.33, delayed catastrophic stress disorder following an asymptomatic interval (“incubation period”). This phenomenon was seen by many clinicians.
DSM-III-R disorders were more prevalent than had been expected. About 48% of the sample reported at least one lifetime disorder, and 30% of respondents reported at least one disorder in the 12 months preceding the interview. The most common disorders were major depression and alcohol dependence, followed by social and simple phobias.
the convention adopted in DSM-III and maintained in DSM-IV, is considered. This classification is based on clinical phenomenology with specific emphasis on disorders characterized by fear or anxiety reactions to environmental stimuli or circumstances. Second, disorders from the perspective of neurocircuitry are discussed.
DSM-5 Diagnostic Criteria for Binge Eating Disorder Eating, in a discrete period of time (for example, within any two-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.Oct 19, 2021
These include six specific diagnoses: (1) Pica, (2) Rumination Disorder (RD), (3) Avoidant/Restrictive Food Intake Disorder (ARFID), (4) Anorexia Nervosa (AN), (5) Bulimia Nervosa (BN), and (6) Binge Eating Disorder (BED).Feb 22, 2014
Russell Marx. It's official! Binge Eating Disorder (BED) is now an actual eating disorder diagnosis in the DSM-5 which was released by the American Psychiatric Association in May 2013. DSM stands for Diagnostic and Statistical Manual of Mental Disorders.
According to the DSM-5, the category of other specified feeding or eating disorder (OSFED) is applicable to individuals who are experiencing significant distress due to symptoms that are similar to disorders such as anorexia, bulimia, and binge-eating disorder, but who do not meet the full criteria for a diagnosis of ...Dec 17, 2021
Binge eating disorder is the most common eating disorder in the U.S., according to the National Eating Disorders Association. It's characterized by episodes of eating large amounts of food, often quickly and to the point of discomfort.Jan 9, 2018
These eating disorders are diagnosable eating disorders that do not meet the specific requirement for anorexia nervosa, binge eating disorder, bulimia nervosa, pica, avoidant/restrictive food intake disorder (ARFID) and rumination disorder.
Diagnosis. According to the DSM-5, diagnostic criteria for anorexia includes: Intense fear of gaining weight: People with anorexia typically fear weight gain and dread becoming "fat." This fear often manifests itself through depriving the body of food.Feb 27, 2022
Anorexia Nervosa In the update, DSM-V qualifies diagnosis if the person has reached a “significantly low weight,” giving treatment professionals the autonomy to specify the severity of the disorder. 2. Menstruation: Previously, women had to have three or more skipped periods to be diagnosed with anorexia nervosa.Sep 26, 2020
DSM-III was crafted in the post-Vietnam era, a time when the USA contained yet another wave of young men who had been exposed to the trauma of combat. Veterans Affairs and military psychiatrists had no official diagnosis to give them, as long as DSM-II was the official diagnostic manual.
The DSM-III requirement of a physiological criterion being present for a dependence diagnosis was controversial, but the debate continues. Perhaps the physiological criteria have been emphasized because they resemble a biological marker for the disease (Cottler and Compton, 1993 ). Among substance users, tolerance and withdrawal appear rare, whereas 86–99 percent of persons with dependence on alcohol, amphetamines, cannabis, cocaine, opiates, sedatives or nicotine report tolerance, withdrawal, or both ( Cottler et al., 1995a). In fact, it has been reported that the withdrawal criterion fails to distinguish persons with harmful substance use from other persons, particularly among adolescents ( Langenbucher et al., 2000 ). Less than one-third of adolescents in SUD treatment experience withdrawal ( Stewart and Brown, 1995; Winters and Stinchfield, 1995; Langenbucher et al., 2000; Mikulich et al., 2001 ).
The SIDP-IV represents the latest version of the first interview to assess the spectrum of DSM personality disorders. Although originally developed to be administered in a topical format to assess DSM personality disorders the SIDP-IV now provides alternative formats for assessing specific disorders without administering the entire SIDP-IV and for assessing ICD diagnoses. Reliability data are encouraging for some disorders. However, these data are limited to selected disorders using the SIDP and reliability data have not been presented for specific disorders using the SIDP-R ( Pilkonis et al., 1995 ). No reliability data are available for the SIDP-IV. Little data are available concerning the long-term test–retest reliability of the SIDP. The SIDP-IV does not come with a screening questionnaire to assist in identifying personality disorders that might be a focus of the interview.
The first edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was published in 1952. It was the first official nomenclature to provide a glossary of the diagnostic categories it listed.
Panic is an inherent feature of a proportion of cases of severe depressiv e illness and there are features of panic disorder that can also satisfy DSM-III criteria for major depression. It is therefore to be expected that one or both should be found in first-degree relatives.
The most common disorders were major depression and alcohol dependence , followed by social and simple phobias. As a group, substance use and anxiety disorders were more prevalent than affective disorders, with approximately one in four respondents meeting criteria for a substance use disorder in their lifetime, one in four for an anxiety disorder, and one in five respondents for an affective disorder (Table 61-4 ).
Avoidant disorder, defined, as extreme withdrawal from and/or avoidance of, contact with unfamiliar people. In order to meet diagnostic criteria for avoidant disorder, a child must manifest anxiety regarding new people and situations that is sufficiently severe to interfere with social functioning, while at the same time demonstrating a desire and a capacity for warm and close relationships with familiar people (such as family members).
After PTSD first officially appeared in the third edition of the DSM (1980) as an Anxiety Disorder (and in the ICD- 9 as an Adjustment Reaction Disorder), it was revised to provide a more detailed specification of the diagnostic criteria in the revision of the DSM published in 1987 ( DSM-III-R ).
The Structured Clinical Interview for DSM-IV (SCID-I) is a semistructured interview designed to assist in determining DSM-IV Axis I diagnoses ( First, Gibbon, Spitzer, & Williams, 1996 ). Construction of the interview began in 1983 following the introduction of the DSM-III, which introduced operationalized, specific behavioral criteria. At this time existing clinical structured diagnostic interviews became limited in that they did not conform to the DSM-III criteria (e.g., the SADS and PSE). Although the Diagnostic Interview Schedule (DIS) was developed to yield DSM-III diagnoses, the DIS was designed to be used by lay interviewers in epidemiological studies. It was argued by Spitzer (1983) that the most valid diagnostic assessment required the skills of a clinician so that the interviewer could rephrase questions, ask further questions for clarification, challenge inconsistencies, and use clinical judgment in ultimately assigning a diagnosis. Thus, the SCID was initially developed as a structured, yet flexible, clinical interview for DSM-III, and subsequently DSM-III-R, diagnoses ( Spitzer, Williams, Gibbon, & First, 1992 ).
Comorbidity between anxiety disorders and other DSM-III-R or - IV disorders are even more common in adolescents than in adults [50 ]. Anxiety disorders are associated with all of the other major classes of disorders including depression, disruptive behaviors, eating disorders, and substance use. In the Virginia Twin Study of Adolescent Behavioral Development (VTSABD), there was a significant degree of overlap within the subtypes of anxiety disorders as well as with depression, which was stronger in girls than in boys. However, there was little overlap between anxiety disorders and behavior disorders [ 39 ]. In older adolescents, anxiety disorders are more strongly associated with regular substance use, including cigarettes, alcohol, and illicit substances, in girls than in boys [ 68 ]. A review of comorbidity of anxiety and depression by Brady and Kendall [ 69] suggests that anxiety and depression may be part of a developmental sequence in which anxiety is expressed earlier in life than is depression. Thus, although comorbidity between anxiety and both depression and substance problems is quite common in children and adolescents of both genders, further research on the mechanisms for links between specific disorders both across and within genders is necessary.
The SCID is a well-established structured interview for determining DSM-III-R and DSM-IV diagnoses. Users may find the inclusion of diagnostic algorithms within the SCID and the use of skip-outs to result in a time-efficient interview. Reliability data from multiple sites indicate that the SCID can provide reliable DSM-IV diagnoses. Additionally, the SCID has some of the most extensive training materials and support available for any structured interview. The interview, user's guide, and all training materials have been completely updated for DSM-IV.
Overall, the results indicate that the use of a structured interview can produce moderately to highly reliable diagnoses using the DSM-III-R system for childhood anxiety disorders , and that utilizing different sources of information is important in reaching an accurate final consensus diagnosis.
Any categorical clustering contains decisions that weigh certain factors more than others in determining inclusion and exclusion from that category. There is also inevitable arbitrariness in the conversion of variables on a continuum, such as the number and severity of anxiety, depressive, dissociative, and other symptoms, to categories. Pathological responses to stress and trauma have commonalities with anxiety disorders, including phobias (fearfulness, hyperarousal, avoidance) and OCD (intrusive thoughts), and panic disorder (hyperarousal), but also with depression (rumination, dysphoria) and DD (amnesia, depersonalization, derealization). What AD, ASD, PTSD, and most cases of DD have in common is a history of stress and/or trauma exposure.
ADs are generally milder, more vaguely defined maladaptive responses to stressors that are broader in range than the A criterion of ASD and PTSD, from relatively mild to severe. The symptoms are likewise less specifically delineated, and include: (1) malfunctioning at work, at school, in relationships, or in other areas of living; and (2) the magnitude of distress and/or functional impairment is, not infrequently, excessive and out of proportion to the degree of the stress. Unlike PTSD and ASD, there is less emphasis on the nature and severity of the stress(ors) which do not have to reach the traumatic level, than on maladaptation and distress. AD subtypes have generally been understood as subsyndromal mood, anxiety, and conduct disorders. In that regard, they have provided a residual diagnosis for individuals whose distress and/or functional capacity warrants clinical attention although they do not exceed a diagnostic threshold for a more discrete or major psychiatric disorder. In DSM-5, ADs have been reconceptualized as stress response syndromes. Within that context, they provide a diagnostic option for people whose problems are clearly related to a
The revisions of the DSM from the 3rd Edition forward have been mainly concerned with diagnostic reliability —the degree to which different diagnosticians agree on a diagnosis. Henrik Walter argued that psychiatry as a science can only advance if diagnosis is reliable. If clinicians and researchers frequently disagree about the diagnosis of a patient, then research into the causes and effective treatments of those disorders cannot advance. Hence, diagnostic reliability was a major concern of DSM-III. When the diagnostic reliability problem was thought to be solved, subsequent editions of the DSM were concerned mainly with "tweaking" the diagnostic criteria. Unfortunately, neither the issue of reliability or validity was settled.
The DSM-IV is a categorical classification system. The categories are prototypes, and a patient with a close approximation to the prototype is said to have that disorder. DSM-IV states, "there is no assumption each category of mental disorder is a completely discrete entity with absolute boundaries" but isolated, low-grade, and non-criterion (unlisted for a given disorder) symptoms are not given importance. Qualifiers are sometimes used: for example, to specify mild, moderate, or severe forms of a disorder. For nearly half the disorders, symptoms must be sufficient to cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning", although DSM-IV-TR removed the distress criterion from tic disorders and several of the paraphilias due to their egosyntonic nature. Each category of disorder has a numeric code taken from the ICD coding system, used for health service (including insurance) administrative purposes.
Mental health professionals use the manual to determine and help communicate a patient's diagnosis after an evaluation. Hospitals, clinics, and insurance companies in the United States may require a DSM diagnosis for all patients. Health-care researchers use the DSM to categorize patients for research purposes.
The ICD has a broader scope than the DSM, covering overall health as well as mental health; chapter 5 of the ICD specifically covers mental and behavioural disorders.
In 1994, DSM-IV was published, listing 410 disorders in 886 pages. The task force was chaired by Allen Frances and was overseen by a steering committee of twenty-seven people, including four psychologists. The steering committee created thirteen work groups of five to sixteen members, each work group having about twenty advisers in addition. The work groups conducted a three-step process: first, each group conducted an extensive literature review of their diagnoses; then, they requested data from researchers, conducting analyses to determine which criteria required change, with instructions to be conservative; finally, they conducted multicenter field trials relating diagnoses to clinical practice. A major change from previous versions was the inclusion of a clinical-significance criterion to almost half of all the categories, which required symptoms causing "clinically significant distress or impairment in social, occupational, or other important areas of functioning". Some personality-disorder diagnoses were deleted or moved to the appendix.
The DSM evolved from systems for collecting census and psychiatric hospital statistics, as well as from a United States Army manual. Revisions since its first publication in 1952 have incrementally added to the total number of mental disorders, while removing those no longer considered to be mental disorders.
The revision took on a far wider mandate under the influence and control of Spitzer and his chosen committee members. One added goal was to improve the uniformity and validity of psychiatric diagnosis in the wake of a number of critiques, including the famous Rosenhan experiment. There was also felt a need to standardize diagnostic practices within the United States and with other countries, after research showed that psychiatric diagnoses differed between Europe and the United States. The establishment of consistent criteria was an attempt to facilitate the pharmaceutical regulatory process.
To test the predictive validity of 4 definitions of schizophrenia using 4 diagnostic classifications: Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-III-R); tenth and ninth revisions of the International Classification of Diseases ( ICD-10 and ICD-9 ); and a restrictive CATEGO S+.
99 patients (mean age 30 y, 66% men) making their first contact for an episode of psychosis between 1 August 1978 and 31 July 1980. 96% completed follow up.
All patients were interviewed by a psychiatrist using the Present State Examination and the Psychological Impairments Rating Scale. Other schedules covering psychiatric, personal, family, and social background and social disability were completed by a different interviewer with a close relative of the patient or other informant.
The ability of the 4 definitions to predict 13 year outcome using the Global Assessment of Functioning scales.
DSM-III-R and ICD-10 diagnoses of schizophrenia had high predictive validity for symptoms and disability and for 13 year outcome; both provided stable diagnoses. DSM-III-R proved to be considerably less sensitive than ICD-10.
Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-III-R) and tenth revision of the International Classification of Diseases (ICD-10) diagnoses of schizophrenia had high predictive validity and were superior to ICD-9 and CATEGO S+ diagnoses. ICD-10 had superior sensitivity to DSM-III-R.
The multi-axial system: -DSM-III , which was published in 1980, introduced a system of five axes or dimensions for assessing all aspects of a patient's mental and emotional health. The multi-axial system is designed to provide a more comprehensive picture of complex or concurrent mental disorders.
Mental retardation is characterized by intellectual impairment and deficits in other areas such as self-care and interpersonal skills. -Axis III: Medical Conditions: it includes physical and medical conditions that may influence or worsen Axis 1 and Axis II disorders. The five diagnostic axes (2):
Bio-Psycho-Social Model (1): -The biopsychosocial approach was originally proposed by a psychiatrist named George Engel in 1977 as a way around the disputes between psychoanalytically and biologically oriented psychiatrists that were splitting the field in the 1970s.
The biopsychosocial model states that health and illness are determined by a dynamic interaction between biological, psychological, and social factors. Key points: 1) biological influences on mental health and mental illness are varied, and include genetics, infections, physical trauma, nutrition, hormones, and toxins.