DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has significant practical importance. The DSM-5 was published on May 18, 2013, superseding the DSM-IV-TR, which was published in 2000. The development of the new edition began with a conference in 1999 and proceeded with the formation of a Task Force in 2007, which developed and field-tested a variety of new classifications. In most respects, the DSM-5 is not greatly modified from the DSM-IV-TR; however, some significant differences exist between them. Notable changes in the DSM-5 include the reconceptualization of Asperger syndrome from a distinct disorder to an autism spectrum disorder; the elimination of subtypes of schizophrenia; the deletion of the 'bereavement exclusion' for depressive disorders; the renaming of gender identity disorder to gender dysphoria, along with a revised treatment plan; the inclusion of binge eating disorder as a discrete eating disorder; the renaming and reconceptualization of paraphilias to paraphilic disorders; the removal of the axis system; and the splitting of disorders not otherwise specified into other specified disorders and unspecified disorders. In addition, the DSM-5 is the first DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the first 'living document' version of a DSM. Various authorities criticized the fifth edition both before and after it was formally published. Critics assert, for example, that many DSM-5 revisions or additions lack empirical support; inter-rater reliability is low for many disorders; several sections contain poorly written, confusing, or contradictory information; and the psychiatric drug industry unduly influenced the manual's content. Many of the members of work groups for the DSM-5 had conflicting interests, including ties to pharmaceutical companies. Various scientists have argued that the DSM-5 forces clinicians to make distinctions that are not supported by solid evidence, distinctions that have major treatment implications, including drug prescriptions and the availability of health insurance coverage. General criticism of the DSM-5 ultimately resulted in a petition, signed by many mental health organizations, which called for outside review of the DSM-5. This part of the article summarizes changes from the DSM-IV to the DSM-5. The DSM-5 is divided into three Sections, using Roman numerals to designate each Section. The same organizational structure is used in this overview, e.g., Section I (immediately below) summarizes relevant changes discussed in the DSM-5, Section I. Note that if a specific disorder (or set of disorders) cannot be seen, e.g., enuresis and other elimination disorders, mentioned in Section II: diagnostic criteria and codes (below), it means that the diagnostic criteria for those disorders did not change significantly from DSM-IV to DSM-5. Section I describes DSM-5 chapter organization, its change from the multiaxial system, and Section III's dimensional assessments. The DSM-5 deleted the chapter that includes 'disorders usually first diagnosed in infancy, childhood, or adolescence' opting to list them in other chapters. A note under Anxiety Disorders says that the 'sequential order' of at least some DSM-5 chapters has significance that reflects the relationships between diagnoses.