Update: DSM-V Major Changes

At the American Psychiatric Association’s annual meeting last week, a presentation covered some of the likely major changes that will be incorporated into the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, commonly referred to as the DSM by mental health professionals. The DSM provides professionals with the symptom checklists that allow for a mental disorder diagnosis to be made.

The most significant change proposed has to do with the inclusion of dimensional assessments for depression, anxiety, cognitive impairment and reality distortion that span across many major mental disorders. So a clinician might diagnose schizophrenia, but then also rate these four dimensions for the patient to characterize the schizophrenia in a more detailed and descriptive manner.

Despite the PR spin that “no limits” were placed on this revision of the DSM, the reality is that there will be very few significant changes from the existing edition of the DSM-IV. While virtually all disorders will be revised, the revisions will, for the most part, be incremental and small. Why? Because the APA recognizes that you can’t retrain 300,000 mental health professionals (not to mention the 500,000 general physicians) in the field to completely relearn their way of diagnosing common mental disorders such as depression, bipolar disorder, ADHD and schizophrenia. Changes are always incremental and tweak the existing system, nothing more.

Some disorders are on the chopping block, just as others were for the DSM-IV revision. This time around, schizoaffective disorder will likely be replaced by a general schizophrenia diagnosis that includes the previously mentioned dimensional assessments. This might be termed schizophrenia with a strong mood component. Gender identity disorder will likely be renamed and placed under a different category, to reflect the modern reality that it is rarely considered a sexual dysfunction.

There will likely be the addition of some new disorders as well, just as in the DSM-IV. Many, if not most, new disorders are placed into an appendix called “Criteria Sets and Axes Provided for Further Study.” These are not disorders that can be diagnosed, but the proposed criteria are used to help researchers communicate with one another. For instance, premenstrual dysphoric disorder (PMDD) is listed in the current DSM-IV as such a disorder, but is already commonly diagnosed by many professionals.

Amongst the new disorders proposed, hoarding may be added to the category of obsessive-compulsive illnesses as its own disorder. Another new disorder is apparently being proposed for children and teens:

And the group was leaning heavily toward proposing a new risk syndrome for individuals — especially young people — that research has suggested are strongly predisposed to schizophrenia and other psychotic conditions.

The DSM-V is scheduled for publication in 2012 and will be the result of 13 years’ worth of literature reviews, independent research, and countless meetings amongst the 160 professionals in the 13 working groups organized by the American Psychiatric Association. Next steps?

The 13 working groups in charge of DSM’s major subsections must still reach decisions on proposed language defining conditions and disorders. Field tests of revised diagnostic criteria are scheduled to begin this summer, with results ready for analysis in mid-2010.

Looking forward to its publication in 2012, but that’s still 3 years away. We still have a long wait ahead of us!

Read the full article: Major Changes Loom for Bible of Mental Health