The Making of the DSM-5
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Transcript of The Making of the DSM-5
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
DisorderSubstance 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
11Major 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