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DSM IV-TR vs DSM 5

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Philip Daniels

on 30 September 2013

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Transcript of DSM IV-TR vs DSM 5

Traveling the Universe of the:
DSM IV-TR vs DSM 5

As training Counselors...
We need to know:
Organization of DSM 5
Section I - DSM 5 Basics

Section II - Diagnostic Criteria and Codes

Section III - Emerging Measures and Models

Appendix
20 Disorder Chapters
Neurodevelopmental Disorders
Schizophrenia Spectrum & Other Psychotic Disorders
Bipolar & Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive & Related Disorders
Trauma- and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom Disorders
Feeding and Eating Disorders
Elimination Disorders
Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse Control & Conduct Disorders
Substance Use & Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Other Disorders

Disorders
Substance-Related & Addictive Disorders
Substance-Related Disorders:
Substance Use Disorders
Substance-Induced Disorders
Substance Intoxication & Withdrawal
Substance/Medication-Induced Mental Disorders
Neurocognitive Disorders
Delirium
Other Specified Delirium
Unspecified Delirium
Disclosure
There will be a time lag of when the DSM 5 will be fully implemented, however it can be used now
December 1, 2013 (Insurance Transition)
October 1, 2014 (adopt ICD-10)
This presentation is not to teach how to diagnose
This presentation is biased in the fact it is based on:
DSM IV-TR
DSM 5

Study up and be aware of the current & future changes in mental health diagnosing
with Philip Daniels
Section 1
Cautionary Statement for Forensic Use of DSM-5
Introduction
Use of the Manual
Section 2
20 Disorder Chapters
Section 3
Conditions for Further Study


Assessment Measures
Cultural Formulation
Alternative DSM-5 Model for Personality Disorders
Emerging Measures and Models
Diagnostic Criteria and Codes
DSM-5 Basics
History of the DSM
But....First!
Neurodevelopmental Disorders
Intellectual Disability
Communication Disorder
Autism Spectrum Disorder
Attention-Deficit/Hyperactivity Disorder
Specific Learning Disorder
Motor Disorder
Other Neurodevelopmental Disorders
Schizophrenia Spectrum
& Other Psychotic D/O
Schizotypal (Personality) D/O
Delusional D/O
Brief Psychotic D/O
Schizophreniform D/O
Schizophrenia
Schizoaffective D/O
Substance/Medication-Induced Psychotic D/O
Psychotic D/O Due to Another Medical Condition
Bipolar
& Related Disorder
Bipolar 1 D/O
Bipolar 2 D/O
Cyclothymic D/O
Substance/Medication-Induced Bipolar & Related D/O
Other Specified Bipolar and Related D/O
Unspecified Bipolar & Related D/O
Depressive Disorders
Disruptive Mood Dysregulation D/O (DMDD)
Major Depressive D/O, Single & Recurrent Episodes
Persistent Depressive D/O (Dysthymia)
Premenstrual Dysphoric D/O (PMDD)
Substance/Medication-Induced Depressive D/O
Other Specified Depressive D/O
Unspecified Depressive D/O
Anxiety Disorders
Separation Anxiety D/O
Selective Mutism
Specific Phobia
Social Anxiety D/O (Social Phobia)
Panic D/O
Panic Attack (Specifier)
Agoraphobia
Generalized Anxiety D/O
Substance/Medication-Induced Anxiety D/O
Anxiety D/O Due to Another Medical Condition
Other Specified Anxiety D/O
Unspecified Anxiety D/O
Obsessive-Compulsive
& Related Disorders
Obsessive - Compulsive D/O
Body Dysmorphic D/O
Hoarding D/O
Trichotillomania
Excoriation
Substance/Medication-Induced OCD
OCD Due to Another Medical Condition
Other Specified OCD & Related D/O
Unspecified OCD & Related D/O
Trauma- & Stressor-Related Disorders
Reactive Attachment D/O
Disinhibited Social Engagement D/O
Posttraumatic Stress D/O (PTSD)
Acute Stress D/O
Adjustment D/O
Other Specified Trauma- & Stessor-Related D/O
Unspecified Trauma- & Stressor-Related D/O
Dissociative Disorders
Dissociative Identity D/O
Dissociative Amnesia
Depersonalization/Derealization D/O
Other Specified Dissociative D/O
Unspecified Dissociative D/O
Somatic Symptom & Related Disorders
Somatic Symptom D/O
Illness Anxiety D/O
Conversion D/O (Functional Neurological Symptom D/O
Psychological Factors Affecting Other Medical Conditions
Factitious D/O
Other Specified S.S.R.D.
Unspecified S.S.R.D.
Feeding & Eating Disorders
Pica
Rumination D/O
Avoidant/Restrictive Food Intake D/O
Anorexia Nervosa
Bulimia Nervosa
Binge-Eathing D/O
Other Specified F&E D/O
Unspecified F&E D/O
Elimination Disorders
Enuresis
Encopresis
Other Specified Elimination D/O
Unspecified Elimination D/O
Sleep-Wake Disorders
Insomnia D/O
Hypersomnolence D/O
Narcolepsy
Sexual Dysfunctions
Delayed Ejaculation
Erectile D/O
Female Orgasmic D/O
Female Sexual Interest/Arousal D/O
Genito-Pelvic Pain/Penetration D/O
Male Hypoactive Sexual Desire Disorder
Premature Ejaculation
Substance/Medication-Induced Sexual Dysfunction
Other Specified Sexual Dysfunction
Unspecified Sexual Dysfunction
Gender Dysphoria
Gender Dysphoria
Other Specified Gender Dysphoria
Unspecified Gender Dysphoria
Disruptive,
Impulse-Control, & Conduct Disorders
Oppositional Defiant D/O
Intermittent Explosive D/O
Conduct D/O
Antisocial Personality D/O
Pyromania
Kleptomania
Other Specified D.I-C.CD
Unspecified D.I-C.CD
Catatonia
Breathing-Related Sleep Problems
Types of Substances
Alcohol
Caffeine
Cannabis
Halluciongen
Inhalant
Opioid
Sedative-, Hypnotic-, or Anxiolytic
Stimulant
Tobacco
Other (or Unknown) Substance
Specify with...
Use Disorder
Intoxication
Withdrawal
Other ... - Induced
Non-Substance (GAMBLING)
Major and Mild Neurocognitive Disorders
Types of Neurocognitive Disorders
Major Neurocognitive D/O
Mild Neurocognitive D/O
Alzheimer's Disease
Frontotemporal Neurocognitive Disorder
Lewy Bodies
Vascular Neurocognitive Disorder
Traumatic Brain Injury
Substance/Medication-Induced
HIV Infection
Prion Disease
Parkinson's Disease
Huntington's Disease
Another Medical Condition
Multiple Etiologies
Unspecified Neurocognitive Disorder
Due to:
Personality Disorders
General Personality Disorder
Cluster A
Cluster B
Cluster C
Paraphilic Disorders
Voyeuristic
Exhibitionistic
Frotteuristic
Transvestic
Sexual Masochism
Sexual Sadism
Pedophilic
Fetishistic
Transvestic
Other Specified Paraphilic D/O
Unspecified Paraphilic D/O
Cluster B
Antisocial
Borderline
Histrionic
Narcissistic
Cluster A
Paranoid
Schizoid
Schizotypal
Cluster C
Avoidant
Others Personality Disorders:

Personality Change Due to Another Medical Condition

Other Specified Personality Disorder

Unspecified Personality Disorder
1952
2013
2000
1994
1987
1980
1968
Obsessive-Compulsive
Dependent
Other
Mental Disorders
Other Specified Mental Disorder Due to Another Medical Condition
Unspecified Mental Disorder Due to Another Medical Condition
Other Specified Mental Disorder
Medication-Induced Movement Disorder and Other Adverse Effects of Medication
Other Conditions That May Be a Focus of Clinical Attention
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
What is Different?
DSM IV-TR
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, and Amnestic and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
Other Conditions That May Be a Focus of Clinical Attention
Appendix B
DSM 5
Neurodevelopmental Disorders
Schizophrenia Spectrum & Other Psychotic Disorders
Bipolar & Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive & Related Disorders
Trauma- and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom Disorders
Feeding and Eating Disorders
Elimination Disorders
Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse Control & Conduct Disorders
Substance Use & Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Other Disorders
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, and Amnestic and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
Other Conditions That May Be a Focus of Clinical Attention
Appendix B
Neurodevelopmental Disorders
Schizophrenia Spectrum & Other Psychotic Disorders
Bipolar & Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive & Related Disorders
Trauma- and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom Disorders
Feeding and Eating Disorders
Elimination Disorders
Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse Control & Conduct Disorders
Substance Use & Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Other Disorders
DSM IV-TR
DSM 5
Why a new Diagnosis?
Evidence-Based Criteria
Guiding Principles
Research evidence
Applying the Principles
Reviewing
Explaining
Categorizing
Evaluating
Assessing
Determining the diagnostic criteria
Transition of Insurance
Removal of GAF
Now get ready for it!!!
What's New?
Lifespan Development
DSM-5
DSM-IV-TR
Parasomnias
What are relevant implications
What's the same
What's new
Accurately & Consistent Diagnosis
No restraints should limit past
Routine clinical practices
Continuity
The World Health Organization Disability Assessment Schedule (WHODAS 2.0)
Cross-walk to ICD-10...Oct. 1, 2014
Removal of multi-axial system
Expanded V-code section
No longer General Medical Condition
Chapters based on advancement of understanding
3 additional disorder chapters
Other disorders reclassified
Broader chapter headings
Whats NEW?
Removal of Mental Retardation
Specific Learning Disorder
Autism Spectrum Disorder
Now Intellectual Disability
Whats NEW?
Two changes to Criteria A
Catatonia context
Delusional changes
Mood D/O + Szhizoaffective
Subtypes eliminated
What's NEW?
Changes in in activity, energy, & mood emphasized
"with mixed features" add
2 new other specified disorders
What's NEW?
New conceptualization of chronic forms of depression
DMDD
PMDD
What's NEW?
Excludes OCD
Excludes PTSD
Age 18 (Social Phobia)
"Performance only" specifier
Excludes Acute Stress Disorder
Unexpected vs expected Panic Attack
Separation Anxiety
Selective Mutism
Bereavement Exclusion
"with anxious distress" specifier
DSM-IV-TR
Definition of Mental Disorder
Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, biological dysfunctions in the individuals.
(APA, 2000)
(APA, 2000)
DSM-5
Definition of Mental Disorder
Socially deviant behavior and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognitive, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.
An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, in not a mental disorder.
Each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one.
(APA, 2013)
DSM-IV-TR
Definition of Mental Disorder
Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, biological dysfunctions in the individuals.
(APA, 2000)
Each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one.
DSM-5
Definition of Mental Disorder
Socially deviant behavior and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognitive, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.
An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, in not a mental disorder.
(APA, 2013)
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