DSM 5 was published in May 2013. Psychiatric diagnosis such as depression, bipolar disorder, schizophrenia, asperger's syndrome and many others were revised and changed. This is a summary of some of the major changes and the debate raised about its validity.

1. DSM 5 - What has
changed in the Bible
Dictionary?
Dr Scott Eaton, MBChB, MRCPsych, FRANZCP
Sternberg Clinic, Bendigo
Sternberg S

2. History
First published 1952 to have a unified
classification system.
1980 DSM 3 Dropped psychodynamic for the
empirical
Axial system introduced

3. Process
Started in 1999 with DSM 5 research planning
conference
Six working groups: Nomenclature ,
Neuroscience and Genetics, Developmental
issues and Diagnosis, Personality Disorder,
Mental Disorders and Disability, and Cross-
cultural Issues
Developed Peer reviewed White papers.
Followed by recommendations by research
oriented panels.

4. 2007 Task Force to develop DSM 5
scientists from psychiatry and other
disciplines, clinical care providers, and
consumer and family advocates.
Scientists working on the revision of the DSM
have experience in research, clinical care,
biology, genetics, statistics, epidemiology,
public health, and consumer advocacy
DSM 5 Field Trials - reliability of diagnoses

5. Major Changes
Diagnostic reorganisation
removal infant/child disorders
Axis II

6. Neurodevelopmental
Disorders
Intellectual Disability - Mental retardation
Assess cognitive AND functional capacity
Severity dependent on FUNCTION
Communication Disorders (language, speech,
fluency, social communication)
Autism Spectrum Disorder - Autism,
Asperger’s, Childhood disintegrative disorder,
Pervasive developmental disorder

7. ADHD: Put in neurodevelpmental disorder
category
No change to symptom checklist and remain
in subgroups - inattention and hyperactive
Symptoms can occur later in life - before 12
rather than 7
Adults only require 5 not 6 symptoms

8. Schizophrenia
removal of special attribution symptoms -
bizarre deusions and Schneiderian
hallucinations
Must have 1 of delusions, hallucinations or
disorganised speech
Subtypes have been removed
Schizoaffective disorder requires major mood
disorder throughout much of the episode

9. Delusional disorder - demarcation from BDD
and OCD
Catatonia - same criteria throughout -
previously different for some disorders!

10. Bipolar Disorders
Manic/Hypomanic symptoms emphasis on
changes in ACTIVITY ENERGY MOOD
“with mixed features” - previously stricter
criteria - needed full diagnosis of both
episodes. Now only need feature(s)
“Other specified” - flexibility (attenuated) of
diagnosis with qualifiers
“anxious distress” qualifier

11. Depressive disorders
Disruptive mood dysregulation disorder - <18,
irritable, frequent behavioural dyscontrol
Premenstral dysphoric disorder
Persistent depressive disorder - Dysthymia
Chronic Depressive Disorder
Major Depression - no change. “Mixed” - 3
manic sx. Bereavement exclusion.

12. Anxiety Disorders
OCD related disorders NOT
Trauma related disorders NOT

13. Phobias - anxiety out of proportion with the
threat
Panic attacks - expected/unexpected, qualifier
Separation Anxiety Disorder
Selective mutism
6 month duration

14. Obsessive Compulsive
Reorganisation
specifiers - insight, delusional, tic-related
BDD
Hoarding Disorder - persistent difficulty discarding or
parting with possessions due to a perceived need to save the items
and distress associated with discarding them
Trichotillomania
Excoriating disorder
Medically/substance induced OCD

15. Trauma
Acute stress - direct/witnessed/indirect and
less emphasis on dissociative sx
Adjustment - traumatic/non-traumatic
PTSD - exposure to traumatic/catastrophic , 4
clusters - reexperiencing, avoindance,
numbing, arousal
Reactive Attachment D - separated from
disinhibited social engagement disorder

16. Dissociative Disorders
depersonalization added to derealization
disorder
fugue added to dissociative amnesia
Dissociative identity disorder

17. Somatic Symptom and
related disorders
Maladaptive thoughts, emotions and
behaviours with somatic symptoms
may or may not have medical condition
removed the high symptom criteria

18. medically unexplained symptoms - less
emphasis
Hypochondriasis now illness anxiety disorder
Pain disorder-recognition of psychological
factors in all pain, “specifier” status
Conversion disorder - do not need to
demonstrate psychological factors initially

19. Eating Disorder
avoidant/restrictive food intake disorder -
catchall
Anorexia Nervosa - amenorrhoea
Bulaemia lower threshold - 1xweekly

20. Gender Dysphoria
Gender incongruence
rather than cross gender identification
remove references to sex

21. Gambling to addictive disorders
mild neurocognitive disorder

22. DEBATE
Lack of transparency initially - issues of non-
disclosure clause, greater public input,
development process - ongoing scrutiny
Higher level of contributors (70%) with
affiliation to pharma - disclosure of interest
required
Borderline Personality Disorder

23. British Psychological Society
It criticized proposed diagnoses as "clearly based largely on social norms, with
'symptoms' that all rely on subjective judgements... not value-free, but rather reflect[ing]
current normative social expectations", noting doubts over the reliability, validity, and
value of existing criteria.
suggested a change from using "diagnostic frameworks" to a description based on
an individual's specific experienced problems, and that mental disorders are better
explored as part of a spectrum shared with normality.

24. NIMH
Research Domain Criteria - matrix
Constructs - concepts regarding brain
organization and function
domains of activity - brain circuits
units of analysis - genes, molecules, cells,
circuits, physiology, behaviour, self-report

26. The scientific foundation of psychiatric medicine has grown by leaps
and bounds in the last fifty years. The emergence of
psychopharmacology, neuroimaging, molecular genetics and biology,
and the disciplines of neuroscience and cognitive psychology have
launched our field into the mainstream of medicine and on a course for
future growth and success. Though not everyone, including ourselves,
is satisfied with the rate of our field’s progress, no one can argue with
one simple fact; if you or a loved one suffers from a mental illness, your
ability to receive effective treatment, recover and lead a productive life
is better now than ever in human history.