Taking a Look at the DSM V

1. Taking a Look at the DSM V Kimmie Jordan, Ms, CPRP, LADAC PSRANM 21st Annual Conference “The Art of Recovery”

2. Overall Changes • Organizational changes • Division into Three Sections • Chapter Order • Order of disorders are based on relatedness to each other • Alignment with Internal Classification of Diseases (ICD-11) • Removal of 5 Axis System • Changes to Specific Disorders

3. Organization of the DSM V • Three Sections: • Section I • DSM V Basics • Introduction • Instructions for Use • Section II • Diagnostic Criteria and Codes • Section III • Emerging Measures and Models • Assessment Measures • Cultural Formulation • Conditions for Future Study

4. Removal of Axis V System • Axis I, II, and III information combined unilaterally • Concerns: Codes will need to be listed with diagnosis written as some disorders have the same numerical code. • Axis IV information with be noted separately using V or Z codes from ICD • Axis V ?????? • World Health Organization Disability Assessment Schedule (WHODAS 2.0) Best current alternative, but APA is not recommending until there is more research to validate use

5. Removal of Axis V System • Implications for PSR and other programs based on Global Assessment of Functioning (GAF) scores • ????????? • Possible use of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to determine level of functioning • 36 item Self-administered or Clinician administered assessment tool • Also comes in short 12 item forms • Assesses ability to perform activities in 6 areas: Understanding and communicating, getting around, self –care, getting along with people, life activities, and participation in society • Can be used with any medial disorder and can track changes over time • http://www.who.int/classifications/icf/whodasii/en/index.html

6. Changes to Specific Disorders in PSR • Schizophrenia Spectrum and Other Psychotic Disorders • Includes Schizophrenia, other psychotic disorders, and schizotypal (personality) disorder • Defined by abnormalities in 5 domains: • Delusions • Hallucinations • Disorganized thinking (or speech) • Grossly disorganized or abnormal movements (including catatonia • Negative symptoms

7. Changes to Specific Disorders in PSR • Schizophrenia Spectrum and Other Psychotic Disorders • Schizophrenia 295.90 • DSM IV Subtypes Paranoid, Disorganized, catatonic, undifferentiated and residual are eliminated • Severity rating: Mild, Moderate, and Severe are added using Psychosis Symptom Severity Assessment.

8. Changes to Specific Disorders in PSR • Bipolar and Related Disorders • Additional focus on changes in activity and energy

9. Changes to Specific Disorders in PSR • Depressive Disorders • New Disorders • Disruptive mood dysregulation disorders • Added to address over diagnosis in children • Premenstrual dysphoric disorders • Dysthymia is now persistent depressive disorder • Bereavement Exclusion removed • Duration is 1-2 years • Can be trigger for major depression

10. Changes to Specific Disorders in PSR • Anxiety Disorders • Obsessive-Compulsive Disorders, Posttraumatic Stress disorder and Acute stress disorder moved to new chapters • Agoraphobia, Specific Phobia, Social Anxiety disorder (Social Phobia) replaces the individual recognizing that anxiety is excessive with the anxiety being out of proportion to the actual threat • Panic Attack disorder changes types of attacks to unexpected and expected and can be a specified to all Disorders

11. Changes to Specific Disorders in PSR • Anxiety Disorders • Panic Disorder and agoraphobia are now two separate diagnosis • Social Phobia is now Social Anxiety disorder (Social Phobia) and specifier of generalized is replaced with performance only • Separation Anxiety Disorder is now classified as an anxiety disorder.

12. Changes to Specific Disorders in PSR • Obsessive Compulsive and Related Disorders • New Disorders • Hoarding Disorder • Excoriation (skin-picking) disorder • Substance-/Medication-induced obsessive-compulsive disorder, obsessive-compulsive and related disorder due to another medical condition. • Trichotillomania (hair-pulling disorder) • Specifier with poor insight changed to good, fair, or poor insight and absent insight/delusional OCD beliefs

13. Changes to Specific Disorders in PSR • Trauma and Stress Related Disorders • Acute Stress disorder explicit if event was experienced, witnessed, or expensed indirectly • Posttraumatic Stress Disorder • More explicit as to how event was experienced • 3 symptom clusters (Reexperiencing, avoidance/Numbing, and arousal) –now 4 symptom clusters (Intrusion symptoms, Avoidance symptoms, Negative alterations in cognitions and mood, alteration in arousal and reactivity

14. Changes to Specific Disorders in PSR • Substance-Related and Addictive Disorder • Removal of abuse and addiction • Removal of recurrent legal problems • Addition of craving or strong urge to use • 2-3 Criteria for Mild, 4-5 for moderate, 6 or more severe • Removal of polysubstance Dependence • New Specifiers: In a controlled environment, on maintenance therapy • Addition of Gambling Disorder

15. Online Assessment Measures • Assessment measures to assist in clinical diagnosis, identify other areas to look at, and guide treatment. • Level 1 Cross-Cutting Symptom Measures • Level 2 Cross-Cutting Symptom Measures • http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures#Level2 • Depression, Anger, Mania, Anxiety, Somatic Symptom, Sleep Disturbance, Repetitive Thoughts and Behaviors, and Substance Use • Disorder-Specific Severity Measures • http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures#Disorder • Depression, Separation Anxiety Disorder, Specific Phobia, Social Anxiety Disorder (Social Phobia), Panic Disorder, Agoraphobia, Generalized Anxiety Disorder, Posttraumatic Stress Symptoms, Acute Stress Symptoms, and Dissociative Symptoms

16. Mental Health Rehabilitation ServicesKimmie Jordan MS, CPRP, LADAC 1215 New York Ave, Alamogordo, NM 88310 575-649-8518 WWW.MentalHealthRehabServices.com