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Highlights of Changes from DSM-IV-TR to DSM-5 Dr Aghilian Psychatrist

Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Association • 1952: The DSM-I • 1968: The DSM-II • 1974: The DSM-II Reprint • 1984: The DSM-III • 1987: The DSM-III-R • 1994: The DSM-IV • 2000: The DSM-IV-TR • 2013: The DSM 5

Many mental health professionals use the manual to determine and help communicate a patient's diagnosis after an evaluation; hospitals, clinics, and insurance companies in the US also generally require a DSM diagnosis for all patients treated. The DSM can be used clinically in this way, and also to categorize patients using diagnostic criteria for research purposes.

International Statistical Classification of Diseases and Related Health Problems(ICD) A medical classification list by the World Health Organization (WHO). It codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses. Work on ICD-10 began in 1983 and was completed in 1992

ICD-10 I A00–B99 Certain infectious and parasitic diseases II C00–D48 Neoplasms III D50–D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism IV E00–E90 Endocrine, nutritional and metabolic diseases V F00–F99 Mental and behavioral disorders VI G00–G99 Diseases of the nervous system VII H00–H59 Diseases of the eye and adnexa VIII H60–H95 Diseases of the ear and mastoid process IX I00–I99 Diseases of the circulatory system X J00–J99 Diseases of the respiratory system XI K00–K93 Diseases of the digestive system XII L00–L99 Diseases of the skin and subcutaneous tissue XIII M00–M99 Diseases of the musculoskeletal system and connective tissue XIV N00–N99 Diseases of the genitourinary system XV O00–O99 Pregnancy, childbirth and the puerperium XVI P00–P96 Certain conditions originating in the perinatal period XVII Q00–Q99 Congenital malformations, deformations and chromosomal abnormalities XVIII R00–R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified XIX S00–T98 Injury, poisoning and certain other consequences of external causes XX V01–Y98 External causes of morbidity and mortality XXI Z00–Z99 Factors influencing health status and contact with health services XXII U00–U99 Codes for special purposes

ICD-10 V F00–F99 Mental and behavioral disorders I A00–B99 Certain infectious and parasitic diseases II C00–D48 Neoplasms III D50–D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism IV E00–E90 Endocrine, nutritional and metabolic diseases V F00–F99 Mental and behavioral disorders VI G00–G99 Diseases of the nervous system VII H00–H59 Diseases of the eye and adnexa VIII H60–H95 Diseases of the ear and mastoid process IX I00–I99 Diseases of the circulatory system X J00–J99 Diseases of the respiratory system XI K00–K93 Diseases of the digestive system XII L00–L99 Diseases of the skin and subcutaneous tissue XIII M00–M99 Diseases of the musculoskeletal system and connective tissue XIV N00–N99 Diseases of the genitourinary system XV O00–O99 Pregnancy, childbirth and the puerperium XVI P00–P96 Certain conditions originating in the perinatal period XVII Q00–Q99 Congenital malformations, deformations and chromosomal abnormalities XVIII R00–R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified XIX S00–T98 Injury, poisoning and certain other consequences of external causes XX V01–Y98 External causes of morbidity and mortality XXI Z00–Z99 Factors influencing health status and contact with health services XXII U00–U99 Codes for special purposes

DSM-5

Disorders usually first diagnosed in infancy, childhood, or adolescence Mental retardation Communication Disorders Pervasive Developmental Disorders Attention-Deficit/Hyperactivity Disorder Learning Disorder Feeding and eating disorders of infancy or early childhood Elimination disorders Oppositional Defiant Disorder Conduct Disorder Motor skills disorder Tic disorders Other disorders of infancy, childhood, or adolescence: Separation Anxiety Disorder Selective Mutism Reactive Attachment Disorder

Neurodevelopmental Disorders (Disorders usually first diagnosed in infancy, childhood, or adolescence) Intellectual Disability (Intellectual Developmental Disorder) Mental retardation Intellectual Disability Cognitive capacity (IQ) and adaptive functioning rather than IQ score Communication Disorders Expressive language disorders Language disorder Mixed receptive-expressive language disorders Language disorder Phonological disorder Speech sound disorder Stuttering Childhood-onset fluency disorder Social (pragmatic) communication disorder (verbal and nonverbal communication)

Autism Spectrum Disorder Pervasive Developmental Disorders Autism Rett's syndrome Asperger’s disorder, Childhood disintegrative disorder, Pervasive developmental disorder not otherwise specified

Attention-Deficit/Hyperactivity Disorder The onset criterion has been changed from age 7 years” to prior to age 12” Subtypes have been replaced with presentation specifiers that map directly to the prior subtypes A comorbid diagnosis with autism spectrum disorder is now allowed; A symptom threshold change has been made for adults(age 17 and older), with the cutoff for ADHD of 5 symptoms, instead of 6 required for younger persons Neurodevelopmental disorders chapter to reflect brain developmental correlates with ADHD

Specific Learning Disorder Combines the DSM-IV diagnoses of reading disorder, mathematics disorder, disorder of written expression, Motor Disorders Developmental coordination disorder, stereotypic movement disorder, Tourette’s disorder, persistent (chronic) motor or vocal tic disorder, provisional tic disorder, other specified tic disorder, and unspecified tic disorder

Change classification Separation Anxiety Disorder Anxiety Disorders Selective Mutism Anxiety Disorders (indicate that the diagnoses can be made for individuals of any age) Pica and Rumination Disorder Feeding and Eating Disorders (indicate that the diagnoses can be made for individuals of any age) Oppositional Defiant Disorder Disruptive, Impulse-Control, and Conduct Disorders Conduct Disorder Disruptive, Impulse-Control, and Conduct Disorders Reactive Attachment Disorder Trauma- and Stressor-Related Disorders

Anxiety Disorders No longer includes Obsessive-compulsive disorder Posttraumatic stress disorder

Obsessive-Compulsive and Related Disorders OCD Body Dysmorphic Disorder (Somatoform Disorders) Hoarding Disorder Trichotillomania (Hair-Pulling Disorder) (Impulse-control disorders) Excoriation (Skin-Picking) Disorder

Trauma- and Stressor-Related Disorders Acute Stress Disorder Adjustment Disorders Posttraumatic Stress Disorder Reactive Attachment Disorder

Major Depressive Disorder Bereavement Exclusion: The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months

Schizophrenia Bizarre delusions At least one of : Delusions, Hallucinations, Disorganized speech must be present The DSM-IV subtypes of schizophrenia (paranoid, disorganized, catatonic, undifferentiated, and residual types) are eliminated

Terminology The phrase “general medical condition” is replaced in DSM-5 with “another medical condition” where relevant across all disorders

The Multiaxial System DSM-5 has moved to a nonaxial documentation of diagnosis

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