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Welcome to the World of the DSM-5

What is the DSM?

History

"The Diagnostic and Statistical Manual of Mental Disorders is a handbook used by health care professionals. It includes descriptions, symptoms, and other criteria for diagnosing mental disorders" (American Psychiatric Association). It provides common language for professionals and consistent and reliable diagnoses.

History

DSM-IV

DSM-II

Pre-World War II

  • The DSM contained the word "reaction" and indicated a psychobiological view that mental disorders represented reactions of the personality to psychological, social, and biological factors
  • The DSM II was similar to the DSM, but it excluded the word "reaction"
  • The DSM IV added, deleted, and reorganized disorders
  • It also changed the diagnostic criteria sets and the descriptive text
  • A lot of effort was put into reviewing literature to create a strong empirical base
  • It was published in 1994
  • The beginnings of the DSM started with the 1840's census recording of "idiocy/insanity"
  • By the 1880's, seven categories of mental health were distinguished
  • In 1917, the American Medico-Psychological Association and the National Commission on Mental Hygiene developed a plan to gather uniform health statistics across mental hospitals

DSM

DSM-III & DSM-III-R

  • Post WWII, the U.S. Army developed a broader classification system to help their servicemen and veterans receive better outpatient services
  • The World Health Organization (WHO) included a section for mental disorders for the first time in their International Classification of Diseases (ICD) in their sixth edition
  • In 1952, the APA developed a variation of the ICD-6 known as the first DSM. It included a glossary of descriptions of the diagnostic categories and was the first official manual of mental disorders to focus on clinical use
  • The DSM III introduced explicit diagnostic criteria, a multiaxial diagnostic assessment system, and a neutral approach to the causes of mental disorders.
  • It was developed through work on constructing and validating diagnostic criteria and developing psychiatric interviews
  • It was published in 1980

  • In the DSM III, there were inconsistencies in the manual and the diagnostic criteria was not clear
  • A new revision was published in 1986

Revisions from the DSM-IV to the DSM-V

  • Published in May of 2013
  • The multiaxial system was removed
  • More emphasis added on culture
  • Major revisions to diagnostic critera:

1. Combining and splitting

2. Specifiers and subtypes

3. New disorders

4. Removals

5. Name/Language changes

A Few Changes

Diagnoses

  • delayed ejaculation
  • erectile disorder
  • female orgasmic disorder
  • female sexual interest/arousal disorder
  • genito-pelvic pain/penetration disorder
  • male hypoactive sexual desire disorder
  • premature (early) ejaculation
  • substance/medication induced sexual dysfunction
  • other specified sexual dysfunction
  • unspecified sexual dysfunction

Sexual Dysfunctions

What's new?

What's new?

  • Sexual dysfunction is now defined as "a clinincally significant disturbance in a person's ability to respond sexually or to experience sexual pleasure" (DSM-5).
  • All sexual dysfunctions except substance/medication-induced sexual dysfunction require a minimum duration of six months and more precise severity criteria.
  • Subtypes: lifelong vs aquired, general vs situational
  • Associated features: partner factors, relationship factors, individual vulnerability factors, religious or cultural factors, and medical factors

The big diagnostic changes

The big diagnostic changes:

  • female arousal disorder has been combined with female hypoactive desire disorder into one: female sexual interest/arousal disorder
  • vaginismus and dyspaeunia have been merged into genito-pelvic pain/penetration disorder
  • Sexual aversion disorder has been removed due to lack of supporting research
  • Hypoactive sexual desire disorder has been renamed to male hypoactive sexual desire disorder.
  • Male orgasmic disorder has been renamed to delayed ejaculation.

Gender Dysphoria

What's Gender Dsyphoria?

"Gender dysphoria refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. Although not all individuals

will experience distress as a result of such incongruence, many are distressed if the desired physical interventions by means of hormones and/or surgery are not available. The current term is more descriptive than the previous DSM-IV term gender identity disorder

and focuses on dysphoria as the clinical problem, not identity per se" (DSM V).

Key Changes

Key Changes

  • Gender Dysphoria is a new diagnostic class
  • This places more emphasis on the phenomenon of "gender incongruence" rather than the cross gender identification
  • This reflects the change from a dichotomy to a multicategory concept
  • Transition from Gender Identity Disorder to Gender Dysphoria
  • Language changes:
  • From term "sex" to "gender"
  • Changes child diagnostic criteria A1 "repeatedly stated desire" to "strong desire to be the other gender"
  • The removal of the sexual oritentation subtype due to the lack on clinical usefulness
  • There is an added emphasis on the presence of distress because it is not inherent
  • More emphasis on how cultural contexts can affect the client
  • More detailed and age appropriate criterion for Gender Dysphoria in children versus adolescents and adults
  • Timeline specifications

Examples

Current

The Crazy 8

  • voyeuristic disorder: spying on others in private activities
  • exhibitionistic disorder: exposing the genitals
  • frotteuristic disorder: touching or rubbing against a nonconsenting individual
  • sexual masochism disorder: undergoing humiliation, bondage, or suffering
  • sexual sadism disorder: inflicting humilation, bondage, or suffering
  • pedophilic disorder: sexual focus on children
  • fetishistic disorder: using nonliving objects or having a highly specific focus on nonsexual body parts
  • transvestic disorder: engaging in sexually arousing cross-dressing

Paraphilias

What's new?

  • specifiers "in a controlled environment" and "in remission" have been added for all disorders except pedophilic disorder.
  • A distinction has been made between paraphilia and paraphilic disorder: a paraphilia becomes a paraphilic disorder when it causes distress or harm to the individual or if it would cause harm or risk of harm to the individual or others.
  • In the DSM IV-TR, transvestic disorder was limited to straight men. The DSM-5 removes this restriction, allowing for diagnoses of women and gay men.

Multiple Choice

1. Which of the following is NOT an associated factors for sexual dysfunctions?

a. partner

b. relationship

c. religious

d. environmental

2. How many paraphilic disorders are listed in the DSM 5?

a. 5

b. 10

c. 8

d. 12

3. All paraphilias can have the specifier of "in a controlled environment" or "in remission" except which of the following?

a. sexual sadism disorder

b. frotteuristic disorder

c. pedophilic disorder

d. transvestic disorder

4. Which of the following is not a subtype for sexual dysfunctions?

a. general vs situational

b. lifelong vs acquired

c. partner vs individual

d. all of the above are subtypes.

5. Which of the following DSM models features a multiaxial system for the first time?

a. DSM-III

b. DSM-III-R

c. DSM-IV

d. DSM-V

6. The DSM-V was published in what year?

a. 1994

b. 2000

c. 2013

d. 2017

7. Gender Dysphoria was previously known as what in the DSM-IV?

a. Body Dysphoria

b. Gender Identity Disorder

c. Transvestic Dysphoria

d. Sexual Identity Disorder

8. Children, adolescents, and adults must show a marked incongruence between one’s experienced/expressed gender and assigned gender for how long to be diagnosed?

a. 3 months

b. 6 months

c. 12 months

d. 18 months

9. Diagnostic criteria state there must be evidence of what in addition to an incongruence between assigned gender and experience/expressed gender?

a. Distress

b. Intolerance

c. Disgust

d. Denial

10. Which of the following was most traumatic for us to find images to include in this presentation?

a. DSM History

b. sexual dysfunctions

c. gender dysphoria

d. paraphilia

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

American Psychiatric Association. (n.d.). DSM: History of the manual. Retrieved from

http://www.psychiatry.org/practice/dsm/dsm-history-of-the-manual

American Psychiatric Association. (n.d.). Cultural concepts in DSM-5. Retrieved from https://www.psychiatry.org/

American Psychiatric Association. (n.d.). Highlights of changes from DSM-IV-TR to DSM-5. Retrieved from https://www.psychiatry.org/

Graham, C. A. (2016). Reconceptualising women’s sexual desire and arousal in DSM- 5. Psychology & Sexuality, 7(1), 34-47.

doi:10.1080/19419899.2015.1024469

Kress, V. E., Minton, C. A. B., Adamson, N. A., Paylo, M. J., & Pope, V. (2017). The removal of the multiaxial system in the DSM-5: Implications

and practice suggestions for counselors. E-Journal of The Professional Counselor. Retrieved from http://tpcjournal.nbcc.org/the-

removal-of-the-multiaxial-system-in-the-dsm-5- implications-and-practice-suggestions-for-counselors/

Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World Psychiatry: Official Journal Of The World

Psychiatric Association (WPA), 12(2), 92-98. doi:10.1002/wps.20050

Zeglin, R. J. (2016). Sexual Disorders in the DSM-5: Implications for counselors. Journal Of Professional Counseling: Practice, Theory &

Research, 43(1), 17-31.

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