Presented by David J. Kupfer, MDChair of the DSM-5 Task Force

CARNEGIE LIBRARY OF PITTSBURGHSATURDAY, OCTOBER 26 , 2013

The Making of the DSM-5

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Why we need DSM

Provides a common language to use to understand and communicate about mental disorders

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Goal of DSM-5 Revisions

• Diagnostic criteria were revised and new diagnoses were added in light of scientific and clinical advances

• In the process we reduced the number of mental disorders from DSM-IV

A clinical guidebook that more precisely defines disorders and better characterizes groups of people who are seeking treatment, ultimately improving care patients and families receive

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DSM-5 Key Dates

DSM-5’s 14-year revision process involved more than 1,500 mental health and medical experts from around the world1999-2007Pre-

Planning White Papers

and Conferenc

es

2006-2008

DSM-5 Task Force Work Group

members appointed

2008-2010

Review of DSM

criteria

2010Launch

DSM5.org/ first

comment period; Field Trials

2011Second

comment period

2012Third

comment period; Review; DSM-5 criteria

approved

May 18, 2013

DSM-5 published

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Overarching Changes

Used the strongest scientific evidence to support changes to diagnostic criteria

Revised chapter order based on underlying vulnerabilities and symptom characteristics

Organized manual in sequence with developmental lifespan

Decreased the number of “Not Otherwise Specified” diagnoses through greater criteria specificity

Aligned manual with international classifications

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Disorder Specific Changes

Autism Spectrum Disorder

Attention-Deficit/Hyperactivity

Disorder

Disruptive Mood Dysregulation

Disorder

Major Depressive Disorder /

Bereavement Exclusion

Mild Neurocognitive

Disorder

Substance Use Disorders

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Autism Spectrum Disorder

Revised diagnosis represents more medically and scientifically accurate and useful way of diagnosing individuals with autism-related disorders

Single umbrella disorder will improve diagnosis of ASD without limiting the sensitivity of criteria or changing number of children being diagnosed

Individuals with ASD must show symptoms from early childhood, even if those symptoms are not recognized until later

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Attention-Deficit/Hyperactivity Disorder

Several of the individual’s ADHD symptoms must be present prior to age 12 years (compared to 7 in DSM-IV)

New criteria addresses adults affected by ADHD to ensure they get the care they need

No exclusion criteria for people with autism spectrum disorder

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Disruptive Mood Dysregulation Disorder

DMDD is characterized by severe and recurrent temper outbursts that are grossly out of proportion in intensity or duration of the situation- Occur three more times each week for one year or

more (on average)

Children with DMDD display persistently irritable or angry mood, most of the day and nearly every day

Onset of symptoms must be before age 10- Diagnosis should not be made for the first time

before age 6 or after age 18

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Major Depressive Disorder / Bereavement Exclusion

Exclusion is replaced by notes in the criteria and text that caution clinicians to differentiate between normal grieving associated with a significant loss and a diagnosis of a mental disorder- Removing exclusion helps prevent major depression from being overlooked

- Criteria for major depressive disorder now clarifies that the normal and expected response to a significant loss may resemble a depressive episode

Bereavement exclusion in DSM-IV suggested that grief somehow protected someone from major depression or only lasted two months

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Hoarding

Listed as a distinct disorder within the Obsessive-Compulsive and Related Disorders chapter Many severe cases of hoarding are not accompanied by

obsessive or compulsive behavior, warranting listing as a distinct disorder

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Mild Neurocognitive Disorder

Mild neurocognitive disorder goes beyond normal issues of aging- Describes level of cognitive decline, including

changes that impact cognitive functioning

Early identification of neurocognitive decline may enable use of treatments not effective at more severe levels of impairment and may prevent or slow progression

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Substance Use Disorders

Combines DSM-IV categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe

Each specific substance is addressed as a separate disorder (same overarching criteria)

Mild substance use disorder in DSM-5 requires two to three symptoms from list of 11, as opposed to one in DSM-IV

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Section III

Section III introduces emerging measures and models to assist clinicians in their evaluation of patients

Outlines conditions in need further study before inclusion in Section II of the manual

Addresses how cultural

influences can impact

diagnosis and treatment

Includes assessment tools and

cross-cutting symptom measures

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Future Forward

The best clinical tool available for diagnosing mental disorders Clinical utility of the manual is unparalleled

DSM-5 was revised to be a “living document” Manual will continue to update its criteria to reflect

the most up to date science