Yesterday, the board of trustees of the American Psychiatric Association (APA) approved a set of updates, revisions and changes to the reference manual used to diagnose mental disorders. The revision of the manual, called the Diagnostic and Statistical Manual of Mental Disorders and abbreviated as the DSM, is the first significant update in nearly two decades.
Disorders that will be in the new DSM-5 — but only in Section 3, a category of disorders needing further research — include: Attenuated psychosis syndrome, Internet use gaming disorder, Non-suicidal self-injury, and Suicidal behavioral disorder. Section 3 disorders generally won’t be reimbursed by insurance companies for treatment, since they are still undergoing research and revision to their criteria.
So here’s a list of the major updates…
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Great summary John!
I am surprised and a little disturbed that parental alienation syndrome did not make it in at all, given the amount of good research out there and growing acknowledgement in legal citations. Here’s hoping for more sense in VTR.
Thanks for the great summary. I know we all will have to go to trainings to learn about the updates.
Too bad there is not a hypersexual disorder. Seems to be something that I see all of the time in my practice these days.
Is Excoriation the same as Dermatillomania?
Yes it is
Dermatillomania (also known as neurotic excoriation, pathologic skin picking (PSP), compulsive skin picking (CSP) or psychogenic excoriation) is an impulse control disorder characterized by the repeated urge to pick at one’s own skin, often to the extent that damage is caused.
How many of the people who played a role in the product will either be retiring within 3-5 years, and how many are already not practicing primary psychiatric care now? And how many pharmaceutical companies will be going to more PCP offices to sell their products to treat patients who never see a mental health care provider first?
Between the new CPT coding and DSM 5, mental health is in serious trouble. And like lemmings, no one is even looking forward and seeing the oncoming cliff. Wow, so sad patients are being marginalized and minimized by the very people who are supposed to be advocates and supporters.
Oh well.
Dr. John,
So with the new tantrum disorder and the reasoning for such, does this suggest that we have children being treated for a disorder (bi-polar) that actually does not exists?
And if so, for how long has this being going on do you suppose?
How can those who write the rules make amends for the misuse of psychotropic drugs on the children and the possible or probable damage these drugs have done?
I am not a clinician but a patient with several DSM-4 recognized disorders. I find it very troubling that Non-suicidal self-injury and Suicidal behavioral disorder have been reclassified under Section 3, as disorders needing more research (and not reimbursable). These are extremely serious disorders that can cause dysfunction and even death. Many of us experience them as separate and self-perpetuating disorders that don’t respond to current treatment even when provided. (It’s often not.) They are perhaps better thought of as a form of OCD (my personal opinion) but in any case they are clearly psychiatric in nature and potentially disabling and even fatal.
I just wonder if BPD or Borderline Personality Disorder is still included as a disease or if it is one requiring further investigation. Also, has it received a new name yet?
“The section on personality disorders was the main casualty. The [APA] board backed a recommendation to exclude it from the main text and instead publish it in a section describing diagnoses requiring further study.”
~Newscientist, Dec. 3, 2012
Unfortunately, I think you misunderstood what Newscientist was referring to — specifically, just the 5-trait system for diagnosing personality disorders was put into Section 3 — not all the personality disorders themselves.
Here’s the news release section on personality disorders:
What’s being included in Section 3 (the area where conditions are listed needing further research) is the trait-specific methodology — not the personality disorders themselves.
The 10 personality disorders remain in the DSM 5 unchanged. The working group wanted to completely revamp how personality disorders were conceptualized and diagnosed. That revamping is to undergo further research.
What about Borderline disorder?
My heart is broken that Sensory Prossessing Disorder did not make the list. We live with knowing this exists in my 4 1/2 year old boy every day. I’ll keep fighting the fight to educate people on this disorder. It’s real and it really exists in our children.
I agree with you WillsMom. I am sure you have heard of orphan drugs; Sensory Processing Disorder is a diagnosis that is stuck in the birth canal. I had hoped it would be seen as a psychiatric diagnosis; it appears to be recognized as an Occupational Therapy diagnosis. I remember early research in the 1960s that showed that children with autism had significant problems with cross-modal integration, a sign of sensory problems. I have tried to look to see if children with sensory problems might have autism, but that does not always comply. Unfortunately, the public, particularly insurance companies and government organizations, view the APA as the ultimate authority on mental health and the APA is reluctant to grant too much credence or credit to any other health professionals. They are “doctors” after all. But, I have usually found there is some room within categories to fit the problems that would otherwise fall between the cracks.
Very disappointed that Sensory Processing Disorder (SPD) was not included. My wife noticed something wrong with our daughter since about age 2. Diagnosed and started therapy at 4 years old. Now 5 years old and having issues in school because the teacher doesn’t know how to deal with her and the school district won’t help with special accommodations because its not a diagnoses in the DSM. The teacher attributes her difficulties to behavioral problems. These doctors that decides what goes in the DSM needs to take a closer look at SPD.
I am psychotherapist in the North Alabama area and I m interested in workshops in the area with training on the new DSM 5. When will it be ready to purchase?
I personally think that the rejection of hypersexual disorder, aka sex addiction, is an ethical, scientifically-based decision. The belief in sex addiction, by both addicts and the sex addiction treatment industry, is more akin to a fath, than a scientific practice. This decision is merely the latest in many that show that there is poor science behind this pop-psychology concept. I hope that this decision leads to more people considering the questions of why there is such a discrepancy, between the believers and the skeptical scientific community. The sex addiction label obscures the high rates of comorbidity, moral issues, relationship issues, and socio-sexual values conflicts that are truly behind this alleged disorder. Rather than mere strengthening of resolve to “keep fighting” for sex addiction, I hope that this might spur greater open, non-defensive dialogue about what is actually going on here, and how people can be helped.
I disagree with the rejection of hypersexual disorder. I also am of the firm thinking that pornography addiction exists. I wonder if those deciding diagnoses have personal reasons for rejection and acceptance.
Just like the DSM-IV, the DSM-V will be abused to prescribe medication: synthesized substances, foreign to the body, with often frightening results, like suicide, homicide and self mutilation.
So instead of concentrating on all the newly described and often ludicrous sounding disorders in the DSM-V, I plead for looking at the causes of symptoms and behaviour in people.
True health, physical and emotional, never is a question enough of medication or enough vaccines…
True health and wellbeing are created and maintained by a safe and effective nutritious diet (the correct balance in vitamins, minerals, fatty acids, trace elements), a safe, loving and nurturing environment…
And all of it starts before conception!
It is a complete travesty that Parental Alienation Syndrome will not be part of the DSM V. It is also surprising that the board of trustees state that more research is needed, especially since there is so much out there already. Nonetheless, this should not discourage all of us to expand our efforts and give them more than enough research, so that when the next release is due, their excuse will not be valid.
So there is new section on Trauma?
What about the proposed Developmental Trauma Disorder, authored by Bessel van der Kolk and colleagues?
DTD essentially acknowledges that trauma can occur from “non-life-threatening”stressors (such as physical and emotional abuse and neglect) that are experienced over a prolonged period of time.
In my opinion and experience, the result of such stressors is every bit as debilitating and dangerous as any other mental illness, and should therefore be accounted for in the DSM, which seems to serve as the gateway to obtaining financial and psychological support in order to recover.
An excellent description of DTD is at:
http://www.attachmentdisordermaryland.com/traumadisorders.htm
I am a patient. I have been diagnosed in the past with BPD, GAD and Bipolar II. Non of these fit as well as DTD for me. I have had a lifetime of suicidal ideation and attempts and social anxiety attacks. Essentially, it seems that because I am able to articulate what is going on so clearly, I am not mentally ill, and have no disability.
Trauma survivors get left in the dust until we get desperate enough to act out. This must be changed.
I was in a workshop yesterday and it was stated that the PD section was being deleted. Is that true?
I am quite glad that the DSM-V has finally been accomplished. Of course, as a work, it will be updated, again, to comply with ongoing research. It is not perfect, of course. It is meant to be a guideline for professionals, who can elicit more details from their clients, in order to provide a more exact diagnosis of their problems. While inconsistencies still exist,such as duplication of symptoms, or overlapping criteria,it is better that the old DSM-IV has been updated,into the new DSM-V version, rather than utilizing criteria which no longer has any evidentiary validity, nor reliability. The DSM-V is merely a guideline–not the final word–but it is in the most current form that the APA could muster. While some diagnoses, and criteria, have been eliminated, others have been added and updated. It is up to the professional to determine what applies to the client, as always, and, while some criteria may no longer apply, professionals need to recognize the changes, and the research, and alter their services to insure that their clients will receive the best treatment that their client can receive. After all, a psychologist should be able to roll with the changes, right? Trying new things should not be met with resistance, especially by the professional community. If your client no longer falls within the criteria guidelines, perhaps your client is misdiagnosed, and you should rethink the details you have been provided to give a more accurate diagnosis.
I welcome the changes, and the new DSM-V.
My question is about studies done using DSMIV criteria. For example, autism twin studies: Would there be some kind of conversion factor for studies using the CAST (childhood asperger syndrome test) as the selection factor?
How will future studies be able to be related to past studies? This is an important issue, since it can direct researchers in the most effective direction to study causes (i.e., genetic vs. environmental risk factors), of autism.