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:
and

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 )

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 3 domains:
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 and Other Psychotic Disorders
Schizotypal Personality Disorder (also listed under personality disorders)
Delusional Disorder
Brief Psychotic Disorder
Schizophreniform Disorder
Schizophrenia
Schizoaffective Disorder

13. Schizophrenia Spectrum and Other 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 Dysphoric Disorder (new)

16. Depressive Disorders
• Core criteria are little changed from DSM-IV • Prevalence: • 12-month=7% • 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 Dysregulation Disorder
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 Dysregulation Disorder
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 % 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 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, and Conduct 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
Specifier for 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)