dsm-5 dsm-5 the diagnostic and statistical manual of mental disorders, fifth edition (dsm-5), is the 2013 update to the diagnostic and statistical manual of mental disorders, the taxonomic and diagnostic tool published by the american psychiatric association (apa). in the united states, the dsm serves as the principal authority for psychiatric diagnoses. treatment recommendations, as well as payment by health care providers, are often determined by dsm classifications, so the appearance of a new version has practical importance. however, not all providers rely on the dsm-5 for planning treatment as the icd's mental disorder diagnoses are used around the world and scientific studies often measure changes in symptom scale scores rather than changes in dsm-5 criteria to determine the real-world effects of mental health interventions. the dsm-5 is the only dsm to use an arabic numeral instead of a roman numeral in its title, as well as the only living document version of a dsm. further information: diagnostic and statistical manual of mental disorders dsm-5 authoramerican psychiatric associationcountryunited stateslanguageenglishseriesdiagnostic and statistical manual of mental disorderssubjectclassification and diagnosis of mental disorderspublishedmay 18, 2013media typeprint (hardcover, softcover); e-bookpages947isbn978-0-89042-554-1oclc830807378dewey decimal616.89'075lc classrc455.2.c4preceded bydsm-iv-tr textdsm-5 online the dsm-5 is not a major revision of the dsm-iv-tr but there are significant differences. changes in the dsm-5 include the reconceptualization of asperger syndrome from a distinct disorder to an autism spectrum disorder; the elimination of subtypes of schizophrenia; the deletion of the "bereavement exclusion" for depressive disorders; the renaming and reconceptualization of gender identity disorder to gender dysphoria; the inclusion of binge eating disorder as a discrete eating disorder; the renaming and reconceptualization of paraphilias, now called paraphilic disorders; the removal of the five-axis system; and the splitting of disorders not otherwise specified into other specified disorders and unspecified disorders. many authorities criticized the fifth edition both before and after it was published. critics assert, for example, that many dsm-5 revisions or additions lack empirical support; inter-rater reliability is low for many disorders; several sections contain poorly written, confusing, or contradictory information; and the psychiatric drug industry may have unduly influenced the manual's content, given many dsm-5 workgroup participants had ties to pharmaceutical companies. the apa itself has published that the inter-rater reliability is low for many disorders, including major depressive disorder and generalized anxiety disorder. changes from dsm-iv the dsm-5 is divided into three sections, using roman numerals to designate each section. section i section i describes dsm-5 chapter organization, its change from the multiaxial system, and section iii's dimensional assessments. the dsm-5 dissolved the chapter that includes "disorders usually first diagnosed in infancy, childhood, or adolescence" opting to list them in other chapters. a note under anxiety disorders says that the "sequential order" of at least some dsm-5 chapters has significance that reflects the relationships between diagnoses. the introductory section describes the process of dsm revision, including field trials, public and professional review, and expert review. it states its goal is to harmonize with the international statistical classification of diseases and related health problems (icd) systems and share organizational structures as much as is feasible. concern about the categorical system of diagnosis is expressed, but the conclusion is the reality that alternative definitions for most disorders are scientifically premature. dsm-5 replaces the not otherwise specified (nos) categories with two options: other specified disorder and unspecified disorder to increase the utility to the clinician. the first allows the clinician to specify the reason that the criteria for a specific disorder are not met; the second allows the clinician the option to forgo specification. dsm-5 has discarded the multiaxial system of diagnosis (formerly axis i, axis ii, axis iii), listing all disorders in section ii. it has replaced axis iv with significant psychosocial and contextual features and dropped axis v (global assessment of functioning, known as gaf). the world health organization's disability assessment schedule is added to section iii (emerging measures and models) under assessment measures, as a suggested, but not required, method to assess functioning. neurodevelopmental disorders "mental retardation" was renamed "intellectual disability (intellectual developmental disorder)". speech or language disorders are now called communication disorders—which include language disorder (formerly expressive language disorder and mixed receptive-expressive language disorder), speech sound disorder (formerly phonological disorder), childhood-onset fluency disorder (stuttering), and a new condition characterized by impaired social verbal and nonverbal communication called social (pragmatic) communication disorder. autism spectrum disorder incorporates asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (pdd-nos)—see diagnosis of asperger syndrome § dsm-5 changes. a new sub-category, motor disorders, encompasses developmental coordination disorder, stereotypic movement disorder, and the tic disorders including tourette syndrome. attention deficit hyperactivity disorder (adhd). schizophrenia spectrum and other psychotic disorders all subtypes of schizophrenia were removed from the dsm-5 (paranoid, disorganized, catatonic, undifferentiated, and residual) in favor of a severity-based rating approach. a major mood episode is required for schizoaffective disorder (for a majority of the disorder's duration after criterion a is met). criteria for delusional disorder changed, and it is no longer separate from shared delusional disorder. catatonia in all contexts requires 3 of a total of 12 symptoms. catatonia may be a specifier for depressive, bipolar, and psychotic disorders; part of another medical condition; or of another specified diagnosis. bipolar and related disorders new specifier "with mixed features" can be applied to bipolar i disorder, bipolar ii disorder, bipolar disorder ned (not elsewhere defined, previously called "nos", not otherwise specified) and mdd. allows other specified bipolar and related disorder for particular conditions. anxiety symptoms are a specifier (called "anxious distress") added to bipolar disorder and to depressive disorders (but are not part of the bipolar diagnostic criteria). depressive disorders the bereavement exclusion in dsm-iv was removed from depressive disorders in dsm-5. new disruptive mood dysregulation disorder (dmdd) for children up to age 18 years. premenstrual dysphoric disorder moved from an appendix for further study, and became a disorder. specifiers were added for mixed symptoms and for anxiety, along with guidance to physicians for suicidality. the term dysthymia now also would be called persistent depressive disorder. anxiety disorders for the various forms of phobias and anxiety disorders, dsm-5 removes the requirement that the subject (formerly, over 18 years old) "must recognize that their fear and anxiety are excessive or unreasonable". also, the duration of at least 6 months now applies to everyone (not only to children). panic attack became a specifier for all dsm-5 disorders. panic disorder and agoraphobia became two separate disorders. specific types of phobias became specifiers but are otherwise unchanged. the generalized specifier for social anxiety disorder (formerly, social phobia) changed in favor of a performance only (i.e., public speaking or performance) specifier. separation anxiety disorder and selective mutism are now classified as anxiety disorders (rather than disorders of early onset). obsessive-compulsive and related disorders a new chapter on obsessive-compulsive and related disorders includes four new disorders: excoriation (skin-picking) disorder, hoarding disorder, substance-/medication-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition. trichotillomania (hair-pulling disorder) moved from "impulse-control disorders not elsewhere classified" in dsm-iv, to an obsessive-compulsive disorder in dsm-5. a specifier was expanded (and added to body dysmorphic disorder and hoarding disorder) to allow for good or fair insight, poor insight, and "absent insight/delusional" (i.e., complete conviction that obsessive-compulsive disorder beliefs are true). criteria were added to body dysmorphic disorder to describe repetitive behaviors or mental acts that may arise with perceived defects or flaws in physical appearance. the dsm-iv specifier "with obsessive-compulsive symptoms" moved from anxiety disorders to this new category for obsessive-compulsive and related disorders. there are two new diagnoses: other specified obsessive-compulsive and related disorder, which can include body-focused repetitive behavior disorder (behaviors like nail biting, lip biting, and cheek chewing, other than hair pulling and skin picking) or obsessional jealousy; and unspecified obsessive-compulsive and related disorder. trauma- and stressor-related disorders post traumatic stress disorder (ptsd) is now included in a new section titled "trauma- and stressor-related disorders." the ptsd diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of dsm-iv. separate criteria were added for children six years old or younger. for the diagnosis of acute stress disorder and ptsd, the stressor criteria (criterion a1 in dsm-iv) was modified to some extent. the requirement for specific subjective emotional reactions (criterion a2 in dsm-iv) was eliminated because it lacked empirical support for its utility and predictive validity. previously certain groups, such as military personnel involved in combat, law enforcement officers and other first responders, did not meet criterion a2 in dsm-iv because their training prepared them to not react emotionally to traumatic events. two new disorders that were formerly subtypes were named: reactive attachment disorder and disinhibited social engagement disorder. adjustment disorders were moved to this new section and reconceptualized as stress-response syndromes. dsm-iv subtypes for depressed mood, anxious symptoms, and disturbed conduct are unchanged. dissociative disorders depersonalization disorder is now called depersonalization/derealization disorder. dissociative fugue became a specifier for dissociative amnesia. the criteria for dissociative identity disorder were expanded to include "possession-form phenomena and functional neurological symptoms". it is made clear that "transitions in identity may be observable by others or self-reported". criterion b was also modified for people who experience gaps in recall of everyday events (not only trauma). somatic symptom and related disorders somatoform disorders are now called somatic symptom and related disorders. patients that present with chronic pain can now be diagnosed with the mental illness somatic symptom disorder with predominant pain; or psychological factors that affect other medical conditions; or with an adjustment disorder. somatization disorder and undifferentiated somatoform disorder were combined to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms. somatic symptom and related disorders are defined by positive symptoms, and the use of medically unexplained symptoms is minimized, except in the cases of conversion disorder and pseudocyesis (false pregnancy). a new diagnosis is psychological factors affecting other medical conditions. this was formerly found in the dsm-iv chapter "other conditions that may be a focus of clinical attention". criteria for conversion disorder (functional neurological symptom disorder) were changed. feeding and eating disorders criteria for pica and rumination disorder were changed and can now refer to people of any age. binge eating disorder graduated from dsm-iv's "appendix b -- criteria sets and axes provided for further study" into a proper diagnosis. requirements for bulimia nervosa and binge eating disorder were changed from "at least twice weekly for 6 months" to "at least once weekly over the last 3 months". the criteria for anorexia nervosa were changed; there is no longer a requirement of amenorrhea. "feeding disorder of infancy or early childhood", a rarely used diagnosis in dsm-iv, was renamed to avoidant/restrictive food intake disorder, and criteria were expanded. elimination disorders no significant changes. disorders in this chapter were previously classified under disorders usually first diagnosed in infancy, childhood, or adolescence in dsm-iv. now it is an independent classification in dsm 5. sleep–wake disorders "sleep disorders related to another mental disorder, and sleep disorders related to a general medical condition" were deleted. primary insomnia became insomnia disorder, and narcolepsy is separate from other hypersomnolence. there are now three breathing-related sleep disorders: obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation. circadian rhythm sleep–wake disorders were expanded to include advanced sleep phase syndrome, irregular sleep–wake type, and non-24-hour sleep–wake type. jet lag was removed. rapid eye movement sleep behavior disorder and restless legs syndrome are each a disorder, instead of both being listed under "dyssomnia not otherwise specified" in dsm-iv. sexual dysfunctions dsm-5 has sex-specific sexual dysfunctions. for females, sexual desire and arousal disorders are combined into female sexual interest/arousal disorder. sexual dysfunctions (except substance-/medication-induced sexual dysfunction) now require a duration of approximately 6 months and more exact severity criteria. a new diagnosis is genito-pelvic pain/penetration disorder which combines vaginismus and dyspareunia from dsm-iv. sexual aversion disorder was deleted. subtypes for all disorders include only "lifelong versus acquired" and "generalized versus situational" (one subtype was deleted from dsm-iv). two subtypes were deleted: "sexual dysfunction due to a general medical condition" and "due to psychological versus combined factors". gender dysphoria further information: gender dysphoria dsm-iv's gender identity disorder is similar to, but not the same as, gender dysphoria in dsm-5. separate criteria for children,