The DSM-IV-TR had a diagnosis of mood disorder NOS. The DSM-5 did away with this, and then it was brought back in the DSM-5-TR but renamed unspecified mood disorder. It’s basically a placeholder diagnosis for when it’s not initially clear what the true diagnosis is.
Here we outline the main changes in DSM‐5‐TR, subdivided into four categories: addition of diagnostic entities and symptom codes; changes in diagnostic criteria or specifier definitions; updated terminology; and comprehensive text updates.
Other changes in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) include eliminating the multi-axial system; removing the Global Assessment of Functioning (GAF score); reorganizing the classification of the disorders; and changing how disorders that result from a general medical condition are conceptualized.
In March of this year, the American Psychiatric Association came out with the DSM-5-TR, the text revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Text revisions have changes that are less significant than the changes between editions, and the DSM-IV was also followed by the DSM-IV-TR.
DSM-IV and DSM-5 categorize disorders into “classes” with the intent of grouping similar disorders (particularly those that are suspected to share etiological mechanisms or have similar symptoms) to help clinician and researchers use of the manual.
No significant changes have been made to the elimination disorders diagnostic class from DSM-IV to DSM-5. The disorders in this chapter were previously classified under disorders usually first diagnosed in infancy, childhood, or adolescence in DSM-IV and exist now as an independent classification in DSM-5.
The DSM-5 was introduced after a lengthy revision period and is associated with multiple differences compared with the DSM-IV, with the introduction of several new diagnostic chapters, refinement of diagnoses for several disorders and in many cases consolidation of two or more previous disorders in DSM-IV into one ...
DSM-5-TR is a text revision of DSM-5 and includes revised text and new references, clarifications to diagnostic criteria, and updates to ICD-10-CM codes since DSM-5 was published in 2013. It features a new disorder, prolonged grief disorder, as well as ICD-10-CM codes for suicidal behavior and nonsuicidal self-injury.
DSM-5 Controversies: Autism, ODD, Bipolar There was a big public outcry when four separate autistic disorders that had been listed in the fourth edition of the DSM, including Asperger's syndrome, were combined into a single illness, autism spectrum disorder, for the DSM-5.
One of the key changes from DSM-IV to DSM-5 is the elimination of the multi-axial system. DSM-IV approached psychiatric assessment and organization of biopsychosocial information using a multi-axial formulation (American Psychiatric Association, 2013b).
What is a major difference between the DSM-IV-TR and the research-based section of the DSM-5? The DSM-IV-TR cluster categorization system has been deleted. Bethany often has emotional outbursts for no apparent reason. What personality disorder is Bethany likely to have?
Here we outline the main changes in DSM-5-TR, subdivided into four categories: addition of diagnostic entities and symptom codes; changes in diagnostic criteria or specifier definitions; updated terminology; and comprehensive text updates.
DSM-IV-TR provides diagnostic criterion sets to help guide a clinician toward a correct diagnosis and an additional section devoted to differential diagnosis when persons meet diagnostic criteria for more than one disorder.
Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental Disorders / Full nameAmerican Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (Text Revision): DSM-IV-TR (ed 4).
There are two main interrelated criticisms of DSM-5: an unhealthy influence of the pharmaceutical industry on the revision process. an increasing tendency to “medicalise” patterns of behaviour and mood that are not considered to be particularly extreme.
The chapter on obsessive-compulsive and related disorders , which is new in DSM-5, reflects the in-creasing evidence that these disorders are related to one another in terms of a range of diagnostic validators, as well as the clinical utility of grouping these disorders in the same chapter. New disorders include hoarding disorder, excoriation (skin-picking) disorder, substance-/medication-induced obses-sive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition. The DSM-IV diagnosis of trichotillomania is now termed trichotillomania (hair-pull-ing disorder) and has been moved from a DSM-IV classification of impulse-control disorders not else-where classified to obsessive-compulsive and related disorders in DSM-5.
Autism spectrum disorder is a new DSM-5 name that reflects a scientific consensus that four previously separate disorders are actually a single condition with different levels of symptom severity in two core domains. ASD now encompasses the previous DSM-IV autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. ASD is characterized by 1) deficits in social communication and social interaction and 2) restricted repetitive behaviors, interests, and activities (RRBs). Because both components are required for diagnosis of ASD, social communication disorder is diagnosed if no RRBs are present.
Suicidality represents a critical concern in psychiatry. Thus, the clinician is given guidance on assess-ment of suicidal thinking, plans, and the presence of other risk factors in order to make a determination of the prominence of suicide prevention in treatment planning for a given individual. A new specifier to indicate the presence of mixed symptoms has been added across both the bipolar and the depressive disorders, allowing for the possibility of manic features in individuals with a diagnosis of unipolar de-pression. A substantial body of research conducted over the last two decades points to the importance of anxiety as relevant to prognosis and treatment decision making. The “with anxious distress” specifier gives the clinician an opportunity to rate the severity of anxious distress in all individuals with bipolar or depressive disorders.
The first change is the elimination of the special attribution of bizarre delusions and Schneiderian first-rank auditory hallucinations (e.g., two or more voices conversing). In DSM-IV, only one such symptom was needed to meet the diagnostic requirement for Criterion A, instead of two of the other listed symptoms. This special attribution was removed due to the nonspecificity of Schneiderian symptoms and the poor reliability in distinguishing bizarre from nonbizarre delusions. Therefore, in DSM-5, two Criterion A symptoms are required for any diagnosis of schizophrenia. The second change is the addition of a requirement in Criterion A that the individual must have at least one of these three symptoms: delusions, hallucinations, and disorganized speech. At least one of these core “positive symptoms” is necessary for a reliable diagnosis of schizo-phrenia.
The DSM-5 communication disorders include language disorder (which combines DSM-IV expressive and mixed receptive-expressive language disorders), speech sound disorder (a new name for phono-logical disorder), and childhood-onset fluency disorder (a new name for stuttering). Also included is social (pragmatic) communication disorder, a new condition for persistent diculties in the social uses of verbal and nonverbal communication. Because social communication deficits are one component of autism spectrum disorder (ASD), it is important to note that social (pragmatic) communication disorder cannot be diagnosed in the presence of restricted repetitive behaviors, interests, and activities (the oth-er component of ASD). The symptoms of some patients diagnosed with DSM-IV pervasive developmen-tal disorder not otherwise specified may meet the DSM-5 criteria for social communication disorder.
The term mental retardation was used in DSM-IV. However, intellectual disability is the term that has come into common use over the past two decades among medical, educational, and other professionals, and by the lay public and advocacy groups. Moreover, a federal statue in the United States (Public Law 111-256, Rosa’s Law) replaces the term “mental retarda-tion with intellectual disability. Despite the name change, the deficits in cognitive capacity beginning in the developmental period, with the accompanying diagnostic criteria, are considered to constitute a mental disorder. The term intellectual developmental disorder was placed in parentheses to reflect the World Health Organization’s classification system, which lists “disorders” in the International Classifica-tion of Diseases (ICD; ICD-11 to be released in 2015) and bases all “disabilities” on the International Classification of Functioning, Disability, and Health (ICF). Because the ICD-11 will not be adopted for several years, intellectual disability was chosen as the current preferred term with the bridge term for the future in parentheses.
Because of the DSM-5 mandate for concurrent specification of coexisting conditions (medical and mental), sleep disorders related to another mental disorder and sleep disorder related to a general medical condition have been removed from DSM-5, and greater specification of coexisting conditions is provided for each sleep-wake disorder. This change underscores that the individual has a sleep disorder warranting independent clinical attention, in addition to any medical and mental disorders that are also present, and acknowledges the bidirectional and interactive effects between sleep disorders and coex-isting medical and mental disorders. This reconceptualization reflects a paradigm shift that is widely ac-cepted in the field of sleep disorders medicine. It moves away from making causal attributions between coexisting disorders. Any additional relevant information from the prior diagnostic categories of sleep disorder related to another mental disorder and sleep disorder related to another medical condition has been integrated into the other sleep-wake disorders where appropriate.
One of the key changes from DSM-IV to DSM-5 is the elimination of the multi-axial system. DSM-IV approached psychiatric assessment and organization of biopsychosocial information using a multi-axial formulation ( American Psychiatric Association, 2013b ). There were five different axes.
DSM-IV and DSM-5 categorize disorders into “classes” with the intent of grouping similar disorders (particularly those that are suspected to share etiological mechanisms or have similar symptoms) to help clinician and researchers use of the manual.
Dimensionality appears in some disorder spectra, in some disorders (scales for diagnostic criteria of intellectual disability, autism spectrum and schizophrenia), partially in others (domains are defined in neurocognitive disorders, but the structure is categorical), and in determining severity (not in all diagnoses).
The Autism spectrum disorder is a reclustering of DSM-IV-TR manifestations headed by the concept of Pervasive developmental disorders: Autistic disorder (autism), Rett's disorder, childhood disintegrative disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified.
To summarize, the former concept of dysthymia has little time left (which is why it appears in parentheses), and the point on which this new disorder turns is the chronicity of the depressive manifestation, which is why all the specifiers available, most of which are inapplicable to pure dysthymic syndrome, are added.
Childhood characteristics such as selective mutism or separation anxiety disorder are studied in the diagnostic class related to Anxiety disorders. In this one, it is clearly specified by its possible presence in adults, although in reality the DSM-IV-TR did not exclude its diagnosis (p. 123).
Needless to say, the DSM is not a psychopathology text, although, as it is a Manual that has to guide diagnosis (still clinical), treatment and research, it is quite relevant to underline the obvious: that the biologicist perspective ( Adam, 2013) conditions the subject of study.