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HIGHLIGHTS of CHANGES:
DSM-IV-TR to DSM-5
Venkata Kolli
Creighton-Nebraska Psychiatry Residency Program
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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.
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DSM I-DSM 5
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Whyis the roman

numeral discarded?
DSM IV to DSM-5
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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
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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

Axis V (GAF) Disability Assessment
Schedule (WHODAS 2.0)
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Neurodevelopmental disorders
Autism Spectrum Disorder
ADHD

Intellectual Disability
Communication Disorders
Specific Learning Disorders
Motor Disorders
Other Neurodevelopmental disorders
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Pervasive Developmental
Disorder DSM -5

Autistic Disorder

Childhood Disintegrative Autism Spectrum Disorder

disorder

Asperger's Disorder

Pervasive Developmental
Disorder NOS
Can still be diagnosed as ASD
but with specifier with known
Retts Disorder genetic or medical condition
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Autism Spectrum Disorder

DSM IV TR DSM-5
Formerly (DSM-IV-TR): DSMV: Characterized by
Required Deficits in 3 Areas: Deficits in 2 CORE Domains:
Social Interaction Social Communication and
Communication Interaction
Restricted, Repetitive and Restricted & Repetitive
Stereotyped Behavior Behavior, Interests, and
Activities

Deficits in communication are related to social interaction deficits.

DSM-5 fixes this double counting.
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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
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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
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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
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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)
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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
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Changes related to Attention
Deficit Hyperactivity Disorder
Symptoms present prior to age 12 (opposed to 7 in
DSM IV TR)

Cannow 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)
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Schizophrenia Spectrum and Other
Psychotic Disorders
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Schizophrenia symptoms

Positive symptoms Negative symptoms

Hallucinations Delusions Disorganization

Eg. Second
person, Third
person
(Schneiderian
symptom) Bizzare
Nonbizzare
Eg. Aleins
Eg. Someone
controlling
following
thoughts
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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
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Psychotic disorders time frames
Unchanged from DSM-IV

Brief psychotic Schizophreniform

Schizophrenia
disorder disorder
> 6 months
<1 month 1-6 months

Duration of disturbance
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Schizophrenia: Criteria A
symptoms
Hallucinations

Delusions At least one of these

symptoms should be present

Disorganized speech

Grossly disorganized or
catatonic behavior At least two symptoms
must be present for the
majority duration
Negative symptoms
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No more Schizophrenia subtypes

Schizophrenia

No more subtypes

undifferentiat
paranoid disorganized catatonic Residual
ed

Specifier can be
used
three catatonic
symptoms (out
of 12)
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Other Psychotic disorders

Schizoaffectivedisorder:
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
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Psychotic disorders

Part of
Section III

Attenuated Psychosis Syndrome Schizophrenia

Early intervention improves prognosis in psychotic disorders.

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Bipolar disorder
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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
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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.
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Depressive disorder

Bereavement specifier removed from

major depressive episode
Previouslycategorical exclusion 2 months
following bereavement
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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
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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
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Anxiety disorders DSM changes

Anxietydisorders: Agoraphobia, Specific

Phobia, and Social Anxiety Disorder (Social
Phobia)
Obsessive-Compulsive and Related
Disorders
Trauma- and Stressor-Related Disorders
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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
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Panic disorder & Agoraphobia

Panic
disorder and
agoraphobia are
unlinked in DSM-5.
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New OCD disorders

Trichotillomania
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New disorders -OCDs

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
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Trauma- and Stressor-Related
Disorders
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Post Traumatic Stress Disorder-
DSM IV TR
Trauma

>3 months
chronic
reaction with horror, helplessness or fear

intrusive avoidant/numbi
recollection ng hyper-arousal
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Post Traumatic Stress Disorder-
DSM 5
Trauma
Is better defined e.g. sexual assault, recurrent
exposure in police officers Removed

reaction with horror, helplessness or fear >3 months

chronic
4 symptom clusters

Intrusive
recollection Avoidance Numbing Hyper-arousal
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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?
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Somatic Symptom and Related
Disorders
Somatic symptom disorder covers previous
somatization disorder DSM-IV disorder
DSM-IVdisorder diagnosis required large collection
of symptoms (4 pain, 2 GI, 1 sexual symptoms, 1
pseudo-neurological symptoms)
DSM-Vdiagnosis: Maladaptive thoughts, feelings,
and behaviors are required.
IllnessAnxiety disorder (Hypochondriasis):high
health anxiety without somatic symptoms
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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

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Eating disorders

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

Gambling Disorder:
Gambling, activates the
same brain reward
system as other
substance use
disorders.
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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
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Substance Use Disorder
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Personality disorders

No major changes
6 categories were proposed
Finally 10 categories were retained
Borderline personality disorder had the
highest reliability
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Conditions of Further Study

Relevant for younger populations

1. Attenuated psychosis syndrome
2. Internet gaming disorder
3. Neurobehavioral disorder with prenatal
alcohol exposure
4. Suicidal behavior Disorder
5. Non suicidal self injury
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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.

http://www.dsm5.org/Documents/PTSD%20Fact%20Sheet.p
df

Stetka BS, Correll, CU. A Guide to DSM-5. Medscape

Psychiatry. May 21, 2013. Retrived: 27th
Marchhttp://www.medscape.com/viewarticle/803884_15
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Images

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http://www.lastlashblog.com/2010/1
www.brightsideofnews.com
1/friday-eye-day.html
www.glogster.com

www.dermatillomaniatreatment.com
kidshealth.org

ssgtleslie.wordpress.com www.trekdek.com
ssgtleslie.wordpress.com
www.pjvoice.com


school.discoveryeducation.com

www.uccs.edu -
http://www.koemba.com/forum/stressed-out-with-an-adhd-child-what-
helps/#sthash.981eD4Ns.dpuf

http://emilysrosenlcsw.com/wp-content/uploads/2014/01/Distracted-Student-
http://6foot4.net/articles/2013/03/0
in-the-Classroom.jpg 5/utilizing-change/
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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.
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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.