Differences Between DSM-4 and DSM-5
When the American Psychiatric Association made the latest significant round of changes to the Diagnostic and Statistical Manual of Mental Disorders, they gave the psychiatric community an opportunity to improve patient care. The newest edition (the fifth), offered both major and minor adjustments to how practitioners identify and treat conditions.
Autism Spectrum Disorder: A New Umbrella Term
One of the biggest changes in the DSM-5 is the revised diagnosis of individuals with autism-related disorders.
Prior to the revision, patients could be characterized as having one of four disorders: autistic disorder, Asperger’s, childhood disintegrative disorder or an unidentified developmental disorder not otherwise specified. After medical and scientific review, researchers found that these labels were not consistently applied across clinics and treatment centers. The DSM-5 has therefore done away with the prior mentioned labels and has redefined these symptoms under one umbrella term. In doing so, they hope it will improve diagnoses without limiting criteria or changing the number of individuals being diagnosed.
People with autism spectrum disorder tend to display the following traits:
- Communication deficits
- Difficulty building friendships appropriate to their age
- Misreading nonverbal cues
- Over-dependence on routines
- High sensitivity to changes in their environment
Other Notable Changes Coming to DSM-5
Revisions to the DSM-5 help illustrate changing times and the evolution of human psychology. Other notable changes to the revised DSM-5 include:
- Additional clarification on what constitutes an individual with attention-deficit/hyperactivity disorder (ADHD).
- Disruptive mood dysregulation disorder (DMDD) – a new diagnosis – has been added to the manual to classify children with frequent severe outbursts.
- Binge eating has been classified as a mental disorder in the new manual.
- Gender identity disorder has been eliminated from the DSM-5 update and replaced with gender dysphoria to recognize emotional distress in children and adults about their gender.
- The creation of this specific learning disorder has broadened the previous manual’s criteria to identify distinct disorders that inhibit the attainment and use of one or more of the following academic skills: reading, written language, oral language or mathematics.
- The bereavement exclusion has been removed from the DSM-5. Instead, it has been replaced with notes that caution doctors to differentiate between typical grieving and major depression by looking at factors such as consistent negative mood and a patient’s self-esteem.
- Hoarding has been added to the DSM-5 as a disorder characterized by the inability to part with material possessions regardless of the value others may attribute to them.
- A skin-picking disorder – excoriation – has been classified as a new version of obsessive-compulsive disorder.
- The diagnostic clusters for post-traumatic stress disorder (PTSD) have been expanded from three to four in the revised DSM-5. The DSM-5 has also included two subtypes of PTSD: those in children younger than 6 years and PTSD with prominent dissociative symptoms.
- Substance abuse and substance dependence has been combined under substance abuse disorder in the DSM-5. The criteria for this disorder have been strengthened, now requiring two or three symptoms to be present for diagnosis.
- Internet gaming disorder has been identified as a condition requiring further investigation.
How New Changes Could Affect You
Autism support groups have kept a close eye on the changing manual in an effort to stay on top of how changes would affect their community. Those who have been diagnosed with Asperger’s syndrome, pervasive developmental disorder or other previous categories are now given the diagnosis of autism spectrum disorder. Those who wish to remain identified with their Asperger’s syndrome diagnosis may have health care providers indicate so on their medical record, but the coding will be that of ASD.
People with other disorders that are newly classified or altered by the DSM-5 could also be adversely affected by its update. Health care providers often use this manual to determine methods of treatment and patient care. Insurance companies often use the diagnostic manual to determine coverage options, while schools and government agencies depend on it to help allocate benefits and create special programs and provisions for people with mental or developmental disorders. People whose disorders have been adjusted or reclassified may experience a change in benefits. It is important to stay updated on changes for you or your child to ensure you don’t lose or miss key benefits and support programs.
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