What’s New in DSM-5

For Clinicians Working with Mandated

Populations

State Specialty Court Conference

DuAne L. Young • The Change Companies®

General Overview of the DSM

-5

• Concept of Axes is gone… no Axis I to V

• Personality Disorders remain but are no longer secondary (on par with Axis I)

• GAF scores are no longer assigned

General Overview of the DSM

-5

• Most common diagnoses have minimal changes regarding core symptoms

• Some disorders are in new sections

• Personality Disorders remain the same

General Overview of the DSM

-5

• Bipolar Disorders is now in a separate section – the criteria are essentially the same

• PTSD is now in a new section for Trauma and Stressor Related Disorders

• Obsessive/Compulsive Disorder is in a new section with other compulsive disorders

Allowing for Major Depressive Episode

to be diagnosed while experiencing

bereavement

“Hot” topics

Disruptive Mood Deregulation

Disorder – Essentially temper

tantrums with persistent anger or

irritability

“Hot” topics

Asperger’s Disorder now encompassed in Autism Spectrum

Disorders “Hot” topics

Dependence has a biological basis and is not just a more serious form

of abuse

Dependence produces distinct and striking problem prevalence

Dependence is a discrete syndrome of varying

severity

Dependence may be substance specific

The prognosis for dependence is

different than for abuse

Substance

Abuse

• Abuse may not have a biological component

• Problem areas for abuse tend to be more limited than with dependence

• Abuse is diagnostically distinct from dependence

Changes in diagnoses from dependence to abuse do not tend to occur – either continued dependence or recovery is more typical

Substance Use Disorders

• Replace abuse & dependence with “mild substance use disorder,, “moderate substance use disorder” & “severe substance use disorder”

• Combine 11 criteria into a single continuum of criteria

Substance Use Disorders

• Legal problems related to use are no longer part of the criteria… replaced with craving/compulsion to use

• Early remission now 3 months

• Craving only criterion that can be present in remission

DSM-5 Alcohol Use Disorder

1. Substance taken in larger amounts over a longer period than intended.

2. Persistent desire to cut down or control usage.

3. Significant time spent obtaining, using & recovering from substance use.

4. Use resulting in failure to fulfill major role obligations.

5. Continued use despite recurrent social or interpersonal problems.

6. Social, occupational or recreational activities given up or reduced.

7. Use in situations that are physically hazardous.

8. Continued use despite known recurrent physical or psychological problems likely caused by use.

DSM-5 Alcohol Use Disorder

9. Tolerance: Use more to get the same effect and/or effects diminished with same amount.

10. Withdrawal symptoms (Criteria A & B for withdrawal).

11. Craving or strong desire or urge to use.

DSM-5 Alcohol Use Disorder

Severity Scale0–1 criteria = No diagnosis

2–3 criteria = Mild substance use disorder

4–5 criteria = Moderate substance use disorder

6+ criteria = Severe substance use disorder

Continuum of use

No Diagnosis

Mild Substance

Use Disorder

ModerateSubstance

Use Disorder

Severe Substance

Use Disorder

Implications for our field

• What does removal of legal criteria mean for assessment & placement of mandated clients?

• How do the overall behavioral health changes impact placement?

• How will the majority of our clients fall within the continuum of use?

• Brief assessments • Comprehensive & co-occurring* Placement &

Planning * Workforce & SAP

Evaluations * Outcome

Evaluations

The Change Companies® Evince Clinical

Assessments

Thank You!

www.changecompanies.net