1. HIGHLIGHTS of CHANGES: DSM-IV-TR to DSM-5
Venkata Kolli
Creighton-Nebraska Psychiatry Residency Program

3. DSM- A long road! Medical 203 (1943) DSM I : 1952: 130 pages long
DSM II: 1968:1974 (7th printing) homosexuality was removed as a disorder by voting!
DSM III: 1980: “multiaxial”
DSM IIIR: 1987.
DSM IV: 1994.
DSM IV-TR:2000.

4. DSM I-DSM 5

5. Why is the roman numeral discarded? DSM –IV to DSM-5
‪school.discoveryeducation.com 

6. DSM-5, book divided into 3 sections
1. Section I: Basics
2. Section II: Diagnostic Criteria and Codes
3. Section III: Emerging Measures and Models

7. DSM –IV TR DSM -5 Axis –I Psychiatric disorders Axis –II Diagnosis
Personality disorder & MR
Axis III
Medical problems
Psychosocial & contextual factors
Axis IV
World Health Organization Disability Assessment Schedule (WHODAS 2.0)
Axis V (GAF)

8. Neurodevelopmental disorders
Autism Spectrum Disorder
ADHD
Intellectual Disability
Communication Disorders
Specific Learning Disorders
Motor Disorders
Other Neurodevelopmental disorders

9. Pervasive Developmental Disorder Autism Spectrum Disorder
DSM -5
Autistic Disorder
Autism Spectrum Disorder
Childhood Disintegrative disorder
Asperger's Disorder
Pervasive Developmental Disorder NOS
Can still be diagnosed as ASD but with specifier ‘with known genetic or medical condition’
Rett’s Disorder

10. Autism Spectrum Disorder
DSM –IV TR
DSM-5
Formerly (DSM-IV-TR): Required Deficits in 3 Areas:
Social Interaction
Communication
Restricted, Repetitive and Stereotyped Behavior
DSM–V: Characterized by Deficits in 2 CORE Domains:
Social Communication and Interaction
Restricted & Repetitive Behavior, Interests, and Activities
Deficits in communication are related to social interaction deficits.
DSM-5 fixes this double counting.

11. Autism Spectrum Disorders
Social Communication and Interaction
Social-Emotional Reciprocity
Non-verbal Communication
Developing, Maintaining, & Understanding relationships
Level 3 is most severe, Level 1 Mild

12. Autism Spectrum Disorders
Restricted & Repetitive Behavior, Interests, and Activities
Stereotyped Movements, Use of Objects, or Speech
Insistence on Sameness, Inflexibility, Ritual Behaviors
Highly Restricted/Fixated Abnormal Interests
Hyper- or Hypo-Reactivity to Sensory Input
Level 3 is most severe

13. Autism Spectrum Disorders
Present in Early Development
Symptoms Cause Significant Impairment in Social, Occupational Functioning
Symptoms Not Better Explained by Intellectual Disability or Developmental Delay

14. Intellectual Disability (Intellectual Developmental Disorder)
Formerly Mental retardation
Previously part of Axis II of DSM- IV TR
DSM-5 focus is on adaptive functioning along with standardized testing
In DSM IV Levels of Retardation based on IQ Scores:
Mild (IQ = 50/55 to 70),
Moderate (IQ=35/40 to 50/55),
Severe (IQ= 20/25 to 35/40),
Profound (IQ= <20/25)
Severity Unspecified (Unmeasurable)

15. Intellectual Disability (Intellectual Developmental Disorder)
Deficits in: a) Intellectual and
b) Adaptive Functioning
c) Onset in Developmental Period
Specifiers: Severity - Based on Conceptual, Social, Practical Functioning & Supports Needed:
Mild
Moderate
Severe
Profound

16. Changes related to Attention Deficit Hyperactivity Disorder
Symptoms present prior to age 12 (opposed to 7 in DSM –IV TR)
Can now have a diagnosis of ADHD & Autism Spectrum Disorder
Adults with ADHD: Symptom cutoffs for diagnosis is 5 criteria (instead of 6 for those <16 years old)

17. Schizophrenia Spectrum and Other Psychotic Disorders

18. Schizophrenia symptoms
Positive symptoms
Negative symptoms
Hallucinations
Eg. Second person, Third person
(Schneiderian symptom)
Delusions
Disorganization
Bizzare
Eg. Aleins controlling thoughts
Nonbizzare
Eg. Someone following

19. No special attributes
Elimination of the special attribution of bizarre delusions and Schneiderian first- rank auditory hallucinations (e.g., two or more voices conversing).
No bizzare Vs non-bizzare significance

20. Psychotic disorders time frames Unchanged from DSM-IV
Brief psychotic disorder
<1 month
Schizophreniform disorder
1-6 months
Schizophrenia
> 6 months
Duration of disturbance

21. Schizophrenia: Criteria A symptoms
Hallucinations
At least one of these symptoms should be present
Delusions
Disorganized speech
Grossly disorganized or catatonic behavior
At least two symptoms must be present for the majority duration
Negative symptoms

22. No more Schizophrenia subtypes
No more subtypes
paranoid
disorganized
catatonic
undifferentiated
Residual
Specifier can be used
three catatonic symptoms (out of 12)

23. Other Psychotic disorders
Schizoaffective disorder:
Psychosis + Mood symptoms
Major mood episode should be present for majority of the disorders total duration after criteria A(psychotic symptoms) is met.
Delusional disorder no longer has the requirement that the delusions must be nonbizarre

24. Psychotic disorders Part of Section III
Attenuated Psychosis Syndrome
Schizophrenia
Early intervention improves prognosis in psychotic disorders.

25. Bipolar disorder ‪

26. Bipolar Disorders
Changes in activity & energy as well as mood needs to be present for a diagnosis of mania or hypomania.
NOS changed to ‘other specified bipolar and related disorder’

27. Mixed features specifier
Full criteria for one mood (depression, mania or hypomania)
Have 3 or more symptoms of the other mood pole.
Distractibility, irritability, insomnia & indecisiveness are not included.

28. Depressive disorder
Bereavement specifier removed from major depressive episode
Previously categorical exclusion 2 months following bereavement

29. Disruptive Mood Dysregulation Disorder (DMDD)
Exhibiting persistent irritability and severe behavioral outbursts 3 or more times per week for more than 1 year.
The mood in between temper outbursts is persistently negative (irritable, angry, or sad), are present in at least 2 settings.
Onset of illness has to be before age 10 years
Chronological or developmental age of at least 6 years

30. Premenstrual dysphoric disorder again a mood diagnosis!
Symptoms are present in the final week before onset of menses
Improves with menses
Minimal in the week following menses
‪womensmentalhealth.org

31. Anxiety disorders DSM changes
Anxiety disorders: Agoraphobia, Specific Phobia, and Social Anxiety Disorder (Social Phobia)
Obsessive-Compulsive and Related Disorders
Trauma- and Stressor-Related Disorders

32. Other changes
Previous versions: requirement that individuals over age 18 years recognize that their anxiety is excessive or unreasonable
Anxiety must be out of proportion to the actual danger or threat in the situation, after taking cultural contextual factors into account

33. Panic disorder & Agoraphobia
Panic disorder and agoraphobia are unlinked in DSM-5. ‪

34. New OCD disorders Trichotillomania ‪www.trekdek.com ‪
Trichotillomania

35. New disorders -OCD’s Hoarding disorder
Excoriation (skin-picking) disorder
Substance-/medication-induced obsessive- compulsive and related disorder
Obsessive-compulsive and related disorder due to another medical condition
Trichotillomania (Hair-Pulling Disorder): From impulse control disorder

36. Trauma- and Stressor-Related Disorders
‪ssgtleslie.wordpress.com

37. Post Traumatic Stress Disorder-DSM –IV TR
>3 months chronic
‘reaction with horror, helplessness or fear’
intrusive recollection
avoidant/numbing
hyper-arousal

38. Post Traumatic Stress Disorder-DSM –5
Is better defined e.g. sexual assault, recurrent exposure in police officers
Removed
>3 months chronic
‘reaction with horror, helplessness or fear’
4 symptom clusters
Intrusive recollection
Avoidance
Numbing
Hyper-arousal

39. Trauma- and Stressor-Related Disorders
PTSD will have 2 new sub types
1. PTSD in children less than 6 years
2. PTSD with Prominent dissociative symptoms
PTSD Debate in the military: Should PTSD be called Post Traumatic Stress injury?

40. Somatic Symptom and Related Disorders
Somatic symptom disorder covers previous somatization disorder DSM-IV disorder
DSM-IV disorder diagnosis required large collection of symptoms (4 pain, 2 GI, 1 sexual symptoms, 1 pseudo-neurological symptoms)
DSM-V diagnosis: Maladaptive thoughts, feelings, and behaviors are required.
Illness Anxiety disorder (Hypochondriasis):high health anxiety without somatic symptoms

41. Feeding & Eating disorders
Binge eating disorder: Binging but no compensatory purging
1.Eat more food in a short period
2. Once a week for 3 months
3. Guilt, embarrassment, or disgust
‪kidshealth.org 

42. Eating disorders
Bulimia nervosa: Binge/Purge behavior once a week, was twice a week in DSM-IV
Anorexia Nervosa:
Reduction in energy intake leading to significantly low weight
Fear of gaining weight
Body Image distortions
Amenorrhea for 3 months removed as a criteria ‪

43. Substance-Related and Addictive Disorders
Gambling Disorder: Gambling, activates the same brain reward system as other substance use disorders. ‪

44. Substance Use Disorders
Not separate the diagnoses of substance abuse and dependence
Cannabis withdrawal, Caffeine withdrawal are new
2-3 criteria: mild, 4-5 :moderate, 6 or more: severe ‪

45. Substance Use Disorder
Dailymail.co.uk

46. Personality disorders
No major changes
6 categories were proposed
Finally 10 categories were retained
Borderline personality disorder had the highest reliability

47. Conditions of Further Study
Relevant for younger populations
Attenuated psychosis syndrome
Internet gaming disorder
Neurobehavioral disorder with prenatal alcohol exposure
Suicidal behavior Disorder
Non suicidal self injury

48. References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing;2013.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Arlington, VA: American Psychiatric Publishing; 2000. df
Stetka BS, Correll, CU. A Guide to DSM-5. Medscape Psychiatry. May 21, Retrived: 27th Marchhttp://

49. Images
Dailymail.co.uk  
kidshealth.org 
ssgtleslie.wordpress.com
school.discoveryeducation.com 
helps/#sthash.981eD4Ns.dpuf
in-the-Classroom.jpg
ww.trekdek.com 
1/friday-eye-day.html ‪ ‪
5/utilizing-change/

50. Communication disorders
DSM-5 communication disorders include language disorder (which combines DSM-IV expressive and mixed receptive- expressive language disorders):
Speech sound disorder (a new name for phonological disorder)
Childhood-onset fluency disorder (a new name for stuttering)
Social (pragmatic) communication disorder, a new condition for persistent difficulties in the social uses of verbal and nonverbal communication.

51. Reactive attachment disorder
emotionally withdrawn/inhibited and indiscriminately social/disinhibited.
In DSM-5, these subtypes are defined as distinct disorders: reactive attachment disorder & disinhibited social engagement disorder.