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Key Changes to the DSM-5

Posted on May 27, 2013 by Ailee Slater ()  | Tags: ADHD, American Psychiatric Association, anorexia, Asperger's, autism, binge eating, bulimia, Diagnostic and Statistical Manual of Mental Disorders, DSM-5, DSM-IV, eatings disorders, mental health, mental illness, paraphilia, paraphiliac disorder

With over ten years of research and the work of thousands of psychiatrists, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has finally been completed. The publishing of this manual has been met with praise and criticism. Produced by the American Psychiatric Association (APA), the DSM-5 includes  many changes regarding how psychiatrists and other clinicians diagnose and treat patients with mental disorders.

A complete list of additions and alterations to the new manual can be found on the APA's DSM-5 website. Following are four of the more notable changes in the new manual.


In previous editions of the DSM, attention-deficit/hyperactivity disorder (ADHD) was a disease that could only be diagnosed in children. However, research has shown that the symptoms of ADHD often continue into adulthood, and that patients who do recover from childhood ADHD do so at different ages. Because there is no definitive age at which ADHD can be expected to disappear, the DSM-5 manual reflects the fact that the disorder may continue into adulthood. Clinicians will now have better information for identifying and treating adults with ADHD.

With this new diagnostic criteria, it is likely that many more adults will be classified as ADHD patients. To avoid misdiagnosis, the DSM-5 advises clinicians that a patient should not be identified as ADHD if their symptoms occur only during a psychotic episode, such as that brought on by schizophrenia. Similarly, if a patient is better classified as having an anxiety disorder, or is recovering from drug or alcohol withdrawal, that person should not be diagnosed with ADHD.

Paraphilic Disorders

A person with a paraphilic disorder will experience atypical sexual behavior that causes either great personal distress to the sufferer, or involves the physical or psychological distress of another person. In research leading up to the publication of the DSM-5, a Sexual and Gender Identity Disorders Work Group was employed by researchers, to make sure that unusual sexual behavior was not, by itself, made out to be a disease.

In the DSM-5, as opposed to older editions, there is a bigger distinction between an atypical sexual behavior, and a disease which may arise alongside that behavior. For example, in the DSM-IV, a patient could be diagnosed with Sexual Masochism. Now, that patient would be classified as having Sexual Masochism Disorder - there is a distinction between fantasizing about masochism, and experiencing psychological harm as a result of that fantasy.

Another change in the DSM-5 involves gender. Previously, only men could be diagnosed with transvestic disorder - a condition of experiencing distress due to a desire to dress up as the opposite sex. DSM-5 researchers have determined that women can now be diagnosed with transvestic disorder as well.

Under the DSM-5 definition of paraphilic disorders, there are eight conditions that a patient might have: exhibitionistic disorder, fetishistic disorder, frotteuristic disorder, pedophilic disorder, sexual masochism disorder, sexual sadism disorder, transvestic disorder and voyeuristic disorder.

Autism Spectrum Disorder

According to the American Psychiatric Association itself, one of the biggest changes in the DSM-5 is in the manual's advice on defining and diagnosing autism-type disorders. In the DSM-IV, a child with symptoms of autism could be diagnosed with one of four disorders: autistic disorder, Asperger's disorder, childhood disintegrative disorder, or what was known as "pervasive developmental disorder not otherwise specified."

In the DSM-5, there is just one possible diagnosis: Autism Spectrum Disorder. The APA says that this change was made because autism has long been recognized as a disease that affects different people with different intensities; it is a spectrum disorder. Now, as long as a patient falls somewhere on the spectrum of autism, they should be diagnosed with autism spectrum disorder.

This major change, effectively getting rid of Asperger's and other disorders, has been met with criticism. Some people in the Asperger's community feel that their identity is being taken away, because Asperger's has for so long been classified and treated differently than autism. Likewise, there is a concern that with one single definition for autism, fewer people will fit the diagnostic criteria, and some children may miss out on behavior therapy and other treatment.

On the other hand, there is evidence that having one umbrella disease will be helpful to sufferers of autism-type disorders. The new diagnosis better reflects what psychiatrists know about autism and Asperger's at the moment: that patients with one disorder may vary greatly amongst each other, and patients with different disorders may be very similar to one another. With autism spectrum disorder, these variations are recognized as deviations within the one major mental affliction. The APA also reports that according to their research, the change to autism spectrum disorder will not lead to fewer autism-type diagnoses.

Feeding and Eating Disorders

Previously, binge eating was not described as a mental disorder, but rather listed under the category of an "eating disorder not otherwise specified." With changes in the DSM-5, a patient may now be diagnosed with Binge Eating Disorder: defined as eating an abnormally large amount of food in a short period of time, and experiencing a lack of control with regard to food intake. A patient must feel distress about these eating habits, and the binge eating must occur once per week for at least three months, in order to get a binge eating disorder diagnosis.

Changes have also been made to the classifications of Anorexia Nervosa and Bulimia Nervosa. In the DSM-IV, absence of at least three menstrual cycles was one diagnostic criteria; however, DSM-5 researchers found this to be a faulty psychiatric tool, as men, younger women and women on birth control will not exhibit this feature of anorexia. As for bulimia, a patient now has only to exhibit symptoms of the disorder one time per week - previously, criteria was set at two times per week - in order to receive a diagnosis of bulimia nervosa.

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