I am starting work at an agency that uses the DSM-V or 5 rather than the DSM-IV which I have been using at my previous agency. What should I know about the changes between the two versions?
The DSM-5 (it is “5” rather than “V”) was published in May 2013 but many agencies are not yet using it or are just beginning to transition to the new version. There are a number of structural changes in the organization of the DSM-5 and a number of revised or new diagnoses as well. The DSM-5 itself contains a summary of the changes in an appendix, which you may find helpful to review. In addition, I recommend that you look up the criteria for each diagnosis as you begin to use the DSM-5 to make sure you are applying it correctly. I have summarized the structural and diagnostic changes below.
The DSM-5 no longer uses a five axis diagnostic system as has been true in DSM-III and DSM-IV. Instead of five axes, you list the mental health and substance use disorders that apply in the order of their clinical relevance to your treatment, followed by listing the client’s medical conditions. Many of the psychosocial stressors that were previously listed on Axis IV are contained in an expanded section of “other conditions” called V codes or Z codes so they are included in your diagnostic list. The GAF is no longer used, but several assessment measures are included in the DSM-5 as alternatives to the GAF for assessing the client’s level of functioning.
Some diagnoses are combined on a continuum with codes for severity rather than having different diagnoses corresponding to different levels of severity. Autism spectrum disorder and substance use disorders are two commonly used diagnoses that have been changed in this way. The DSM-5 calls this a dimensional approach to diagnosis rather than a categorical or binary approach. Instead of “alcohol abuse” and “alcohol dependence” disorders, DSM-5 uses “alcohol use disorder” with a code for severity based on the number of criteria met by the client’s use.
The organization of diagnostic categories has been revised so that the categories are more clearly differentiated from each other. For example, all disorders formerly in the category of “disorders usually first diagnosed in infancy, childhood or adolescence” have been moved to the category of the diagnosis itself (e.g., attention deficit hyperactivity disorder moved to neurodevelopmental disorders). In addition, some categories have been divided into two smaller categories (e.g., bipolar and depressive disorders, anxiety and obsessive-compulsive & related disorders) or have been combined differently (e.g., trauma & stressor related disorders).
The category of “Other Conditions” has been greatly expanded to cover some of the conditions previously listed on Axis IV as well as other historical and current situational circumstances that may be relevant to the current treatment.
There are a number of new diagnoses in the DSM-5 as well as revised criteria for other diagnoses. Below is a partial list of new diagnoses:
- Disruptive mood dysregulation disorder (age of onset between 6 and 10 years of age)
- Persistent depressive disorder (combines dysthymia and major depressive disorder, chronic)
- Premenstrual dysphoric disorder (previously listed as a condition for further study)
- Hoarding disorder
- Excoriation disorder
- Disinhibited social engagement disorder (differentiated from reactive attachment disorder)
- Gambling disorder (previously listed as a condition for further study)
- All disorders in the category of “somatic symptom and related disorders” (renamed from “somatoform disorders” in DSM-IV)
This is a very brief summary of the changes between DSM-5 and DSM-IV. As mentioned above, you should look closely at the diagnostic criteria for each client’s diagnosis when you begin using the DSM-5 and also look at the listing of categories and diagnoses to see if there is a new diagnosis that fits your client’s symptoms more closely than a diagnosis which is familiar to you from the DSM-IV.
I hope you found this blog to be a helpful introduction to DSM-5. Please email me with comments, questions or suggestions for future blog topics.