Changes in DSM 5

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2013-06-28 看过
For those working in the field of mental health (particularly in North America), DSM has been long considered as the Holy Bible. It is almost impossible to imagine a book like this could shape the whole industry, from individual therapists to pharmaceutic conglomerates, hospitals to insurance companies, research institutes to governments. In short, it defines what should be identified mental disorders and what type of mental disorders should be given. It follows a symptomatic approach so that disorders are defined by the symptoms rather than the pathology, which is entirely arbitrary and unscientific. This is exactly why DSM has suffered tremendous controversies over the years.

Nonetheless, the exciting (perhaps annoying at the same time) news is that DSM 5 is now released, which costs 130-200 dollars on the market. The implications are huge: hospitals need to change the diagnoses, insurance company need to amend their policies, therapists and physicians need to revise and relearn the new typology and diagnostic criteria, assessment tools need to be updated, etc.

So what are the changes in the new DSM?

I have only briefly skimmed through parts of the book: Neurodevelopmental, Bipolar, Depressive, Anxiety, Obsessive-Compulsive, Trauma, and Eating Disorders. So this review only serves as a short summary. I do have a more detail review, and I would love to send it to you if needed.

General Impression:
1. DSM 5 follows a new format: diagnostic criteria first, and then texts.
2. There are more specifiers in all disorders: now you could specify the severity, features, duration with more options.
3. Some disorders have been integrated, some separated: Obsessive-Compulsive and Trauma are now separate categories from Anxiety, Depressive has been taken out from Bipolar, Feeding and Eating have been combined.
4. The new DSM uses a life-span approach: instead of putting all pediatric mental disorders in one chapter, now you could find them in separate categories.
5. Differential Diagnoses are easier to read: each diagnosis is now subtitled.
6. There is merely any change in Personality Disorders: all previous diagnoses are retained and it does not change to a dimensional approach, still categorical.
7. Instead of having NOS (Not Otherwise Specified), there are Other-Specified and Unspecified ones.

Bipolar and Depression:
1. Otherwise-Specified Bipolar Disorders: significantly better and more organized than the previous ones.
2. Dysthymia is now named Persistent Depressive Disorder.
3. There is a new depressive disorder called “Premenstrual Dysphoric Disorder”. I doubt if this is gender biased.
4. Better specifiers: depression with anxious distress--this is awesome.

Neurodevelopmental:
1. No more Asperger Syndrome, only Autism Spectrum Disorder.
2. Now we can diagnose adults with ADHD.

Anxiety:
No change.

Obsessive-Compulsive:
1. Hoarding, Trichotillomania, Excoriation, Body Dysmorphic are now part of this category.
2. A new criterion: repeated attempts to decrease or stop compulsive behaviors.

Trauma:
1. Children can now be diagnosed with PTSD--awesome.
2. Adjustment Disorder, Acute Stress Disorder are now in this category.
3. Four dimensions in PTSD instead of three: intrusion, avoidance, cognition/mood, and arousal.

Eating:
1. Feeding disorder is now in this category, including Pica.
2. New disorders: Rumination Disorder, Avoidant/Restrictive Food Intake Disorder (a bizarre syndrome), Binge Eating Disorder.
3. Better EDNOS.
4. Lower threshold for diagnosing Bulimia Nervosa and BED: binge eat one per week rather than twice per week.

Not sure if this is better, but diagnosing mental disorders is always a tricky business.
Diagnosis serves one purpose--better treatment and prognosis.
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