DSM-5 No Roman numerals Changes/Updates - 5.1, 5.2 … Print and electronic versions

1. DSM-5 No Roman numerals Changes/Updates - 5.1, 5.2 … Print and electronic versions Severity scales -more specific Suicide risk will be discussed with many diagnoses Cultural context emphasized- section 3 - chapter on cultural formulation; structured interview Implementation date unclear- ICD 10 DSM-5 websites: www.dsm5.org and www.psychiatry.org/dsm5

2. NOS Eliminated • Other specified disorder • Other unspecified disorder • Provisional diagnoses – time limited

3. Multiaxial System Eliminated • Axis I-V eliminated • GAF eliminated • Psychosocial and environmental problems eliminated • Contributing medical conditions eliminated • V Codes still available • Decision trees in an appendix eliminated • Lots of specifiers are available • Online assessment measures at www.psychiatry.org/dsm5 )

4. Diagnostic Groupings • 1. Neurodevelopmental Disorders • 2. Schizophrenia Spectrum and Other Psychotic Disorders • 3. Bipolar and Related Disorders • 4. Depressive Disorders • 5. Anxiety Disorders • 6. Obsessive-Compulsive and Related Disorders • 7. Trauma and Stressor-Related Disorders • 8. Disruptive, Impulse Control, and Conduct Disorders • 9. Personality Disorders

5. Neurodevelopmental Disorders • Category includes: • Intellectual Disability • Communication Disorders • Autism Spectrum Disorder • ADHD • Specific Learning Disorder • Motor Disorders

6. Intellectual Disability • IQ not the sole diagnostic criteria • IQ typically below 70 • Severity is based upon adaptive functioning and IQ score • Replaces Mental retardation - DSM-IV • Borderline Intellectual Functioning is a V code • Assess functional ability in 3domains: • Conceptual-language, reading, writing, math, reasoning, knowledge, memory • Social-empathy, social judgment, interpersonal communication skills, friendships • Practical-personal care, job responsibilities, money management, recreation, organizing school and work activities

7. Communication Disorders • Language Disorder • Difficulties in acquisition and use of language • Speech Sound Disorder (was Phonological Disorder) • Childhood-Onset Fluency Disorder (was Stuttering) • Social (Pragmatic) Communication Disorder (new) • Persistent difficulties in the social use of verbal and nonverbal communication • Autism

8. Autism Spectrum Disorders (ASD) • Asperger’s, Childhood Disintegrative Disorder, Rett’s Disorder, and Pervasive Developmental Disorder (PDD) NOS will be eliminated

9. Autism Spectrum Disorders • Three domains in DSM-IV - Two in DSM-5: • DSM-IV: 1. Qualitative impairment in social interaction 2. Qualitative impairments in communication 3. Restricted repetitive and stereotyped, patterns of behavior, interests, and activities (RRB’s) • DSM-5: 1. Social and communication deficits 2. Restricted repetitive behaviors, interests, and activities (RRB’s)

10. ADHD • Age of onset of symptoms will be raised from age 7 to age 12 • Must have several symptoms two or more settings • Can now have a comorbid diagnosis with autism • Fewer symptoms needed for adults (5 instead of 6 for both inattention and hyperactivity/impulsivity) • Greater emphasis on identifying adults (but onset must still be before age 12) • Symptom lists basically unchanged

11. Specific Learning Disorder • Specifiers: Reading (dyslexia) Mathematics (dyscalculia) Written Expression

12. Schizophrenia Spectrum andOther Psychotic Disorders • Schizotypal Personality Disorder (also listed under personality disorders) • Delusional Disorder • Brief Psychotic Disorder • SchizophreniformDisorder • Schizophrenia • Schizoaffective Disorder

13. Schizophrenia Spectrum andOther Psychotic Disorders • The 5 subtypes of schizophrenia have been dropped. • Paranoid • Disorganized • Catatonic • Undifferentiated • Residual

14. Bipolar and Related Disorders • Bipolar I Disorder • Presence or history of one or more manic episodes, may also have episodes of depression or hypomania • Bipolar II Disorder • Presence or history of one or more major depressive episodes • Presence or history of at least one hypomanic episode • There has never been a manic episode • Cyclothymic Disorder

15. Depressive Disorders • Category includes: • Disruptive Mood Dysregulation Disorder (new) • Major Depressive Disorder • Persistent Depressive Disorder (was Dysthymia) • Premenstrual DysphoricDisorder (new)

16. Depressive Disorders • Core criteria are little changed from DSM-IV • Prevalence: • 12-month=7% • 18-29 year olds 3x risk of people over 60 • Females 1.5-3x greater risk than males • Anxious Distress specifier(negatively impacts prognosis) • Keyed up/tense • Unusually restless • Decreased concentration • Fear of something awful happening • Fear of losing control

17. Persistent Depressive Disorder(Dysthymia) • Symptoms are a consolidation of chronic major depression and dysthymia • Early or late onset (age 21 is dividing line) • Prevalence 1%

18. Suicide • Primary cause of psychiatric malpractice suits but discussed rarely in DSM-IV • U.S. Preventive Services Task Force has determined that risk scales are not predictive of who will commit suicide • Active suicidal ideation (SI) is no more predictive than passive SI • When assessing risk look at: • Long-term factors • Recent factors (past 3 months) • Current factors (past week)

19. Disruptive Mood DysregulationDisorder • New diagnosis • Similar to Bipolar Disorder with extreme temper and rage, also similar to Oppositional Defiant Disorder, but more severe • Prevalence 2-5%

20. Disruptive Mood DysregulationDisorder • Severe recurrent temper outbursts • Verbal or behavioral • Inconsistent with developmental level • Mood between outbursts is persistently irritable or angry • Present in at least 2 settings, severe in at least one • Don’t diagnose before age 6 or after age18 • Frequency of at least 3 times weekly • Duration 12 months, no more than 3 months symptom-free

21. Premenstrual Dysphoric Disorder • Symptoms usually begin during the week before the menstrual cycle starts and terminate with the onset of menses • About 1.8-5.8% prevalence • Must happen in at least two cycles

22. Anxiety Disorders • PTSD and OCD no longer in this category • Category includes: • Separation Anxiety Disorder (can diagnose with adult onset) • Selective Mutism • Specific Phobia • Social Anxiety Disorder (Social Phobia) • Panic Disorder • Panic Attack (now just a specifier) • Agoraphobia (now a stand-alone diagnosis, doesn’t need to be linked with Panic Disorder) • Generalized Anxiety Disorder

23. Trauma and Stressor-Related Disorders • Category includes: • Reactive Attachment Disorder • Disinhibited Social Engagement Disorder • PTSD • Acute Stress Disorder • Adjustment Disorders

24. Reactive Attachment Disorders • Disorders develop out of insufficient care, comfort, and affection or neglect and deprivation, • Reactive Attachment Disorder • The child rarely seeks comfort when distressed and shows emotional distress when others attempt to provide comfort • Minimal social and emotional responsiveness • Limited positive affect • Unexplained irritability, sadness, or fearfulness • This is rare, affecting about 10% of severely neglected children

25. Disinhibited Social EngagementDisorder • Disinhibited Social Engagement Disorder • The child is overly familiar with strangers and does not hesitate to leave familiar caregivers • The child has loose boundaries with people, little reticence with strangers • Doesn’t check back with caregiver after venturing away • This is rare, about 20% of severely neglected children

26. PTSD DSM-IV • 3 symptom clusters – Re-experiencing – Avoidance and numbing – Arousal DSM-5 • 4 symptom clusters – Re-experiencing and intrusive symptoms – Avoidance – Arousal and reactivity – Negative alterations in cognitions and mood

27. Trauma and Stressor-Related • Adjustment Disorders • Begins within 3 months, lasts no longer than 6 months after the stressor has ceased • Most symptoms are similar to DSM-IV • Prevalence in outpatient mental health is 5-20% • Acute Stress Disorder • With Acute Stress Disorder early intervention can help prevent PTSD • Only half of people with ASD develop PTSD. It’s not predictive.

28. Disruptive, Impulse-Control, andConduct Disorders • Trichotillomania and Gambling moved • Category includes: • Oppositional Defiant Disorder • Intermittent Explosive Disorder (must be at least 18) • Conduct Disorder • Pyromania • Kleptomania • Antisocial Personality Disorder (dually listed here and in personality disorders section)

29. Limited Prosocial Emotions Specifier • Specifierfor use with Conduct Disorder • Lack of remorse or guilt • Unconcerned about performance • Shallow or deficient affect • Callous, lack of empathy • Less sensitive to punishment cues • Thrill-seeking, less inhibited • More proactive and reactive aggression • Traits can diminish when quality of parenting improves

30. Personality Disorders • Cluster A (odd and eccentric): • Paranoid • Schizoid • Schizotypal • Cluster B (dramatic, emotional, erratic): • Antisocial • Borderline • Histrionic • Narcissistic • Cluster C (anxious and fearful): • Avoidant • Dependent • Obsessive-Compulsive (personality disorder, not OCD)