Meeting News CoveragePerspective

Countdown to DSM-5

PHILADELPHIA —Researchers assigned to reviewing proposed changes to the Diagnostic and Statistical Manual of Mental Disorders met at the 2012 American Psychiatric Association Annual Meeting to discuss details of the revised diagnostic criteria.

Thirteen diagnostic work groups tested planned revisions in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Many of these work groups, according to the APA, cross-collaborated in drafting the proposed criteria. The work groups were assigned to the following classifications:

  • ADHD and disruptive behavior disorders.
  • Anxiety, obsessive-compulsive spectrum, posttraumatic and dissociative disorders.
  • Childhood and adolescent disorders.
  • Eating disorders.
  • Mood disorders.
  • Neurocognitive disorders.
  • Neurodevelopmental disorders.
  • Personality and personality disorders.
  • Psychotic disorders.
  • Sexual and gender identity disorders.
  • Sleep-wake disorders.
  • Somatic symptoms disorders.
  • Substance-related disorders.

Researchers from these work groups, as well as members of the task force itself, offered a number of examples of changes that will be reflected in the DSM-5:

  • The inclusion of dimensional assessments.
  • Replacing substance abuse and dependence with “substance abuse disorder.”
  • Creating two separate classifications for sexual disorders and gender identification.
  • Updating sleep disorders.
  • Elevating binge eating from “not otherwise specified” to a legitimate disorder.
  • Categorizing “substance use disorder” as a unidimensional condition — combining the previous separate substance abuse and substance dependence disorders — and reclassifying “pathological gambling” as “gambling disorder” under the Substance Use Disorder and Other Addictive Disorders chapter.
  • Providing a dimensional measure of severity for each of the criteria domains of autism spectrum disorder.

Darrel A. Regier, MD, MPH, vice chair of the DSM-5 task force, said it was the goal of the work groups to offer the most inclusive and open review process.

All of the diagnoses in the manual have been thoroughly reviewed first by a series of conferences between 2000 and 2008 and since then by thirteen diagnostic area work groups that are composed of a multidisciplinary international group of expert clinicians and research investigators,” Regier told Healio.com.“Their proposals have been put up on our website on three separate occasions for review and comment by clinicians, research teams, advocacy groups and the general public.  This has been very helpful to get the widest possible review of the impact of proposed changes on all of these groups.”

The DSM-5 will be published in May 2013. Draft criteria are open for public comment until June 15.

To review all of the proposed changes to the DSM, visit http://www.dsm5.org/proposedrevisions/pages/default.aspx. To view the individual work groups, visit http://www.dsm5.org/meetus/pages/workgroupmembers.aspx.

Disclosure: Dr. Regier reports no relevant financial disclosures.

PHILADELPHIA —Researchers assigned to reviewing proposed changes to the Diagnostic and Statistical Manual of Mental Disorders met at the 2012 American Psychiatric Association Annual Meeting to discuss details of the revised diagnostic criteria.

Thirteen diagnostic work groups tested planned revisions in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Many of these work groups, according to the APA, cross-collaborated in drafting the proposed criteria. The work groups were assigned to the following classifications:

  • ADHD and disruptive behavior disorders.
  • Anxiety, obsessive-compulsive spectrum, posttraumatic and dissociative disorders.
  • Childhood and adolescent disorders.
  • Eating disorders.
  • Mood disorders.
  • Neurocognitive disorders.
  • Neurodevelopmental disorders.
  • Personality and personality disorders.
  • Psychotic disorders.
  • Sexual and gender identity disorders.
  • Sleep-wake disorders.
  • Somatic symptoms disorders.
  • Substance-related disorders.

Researchers from these work groups, as well as members of the task force itself, offered a number of examples of changes that will be reflected in the DSM-5:

  • The inclusion of dimensional assessments.
  • Replacing substance abuse and dependence with “substance abuse disorder.”
  • Creating two separate classifications for sexual disorders and gender identification.
  • Updating sleep disorders.
  • Elevating binge eating from “not otherwise specified” to a legitimate disorder.
  • Categorizing “substance use disorder” as a unidimensional condition — combining the previous separate substance abuse and substance dependence disorders — and reclassifying “pathological gambling” as “gambling disorder” under the Substance Use Disorder and Other Addictive Disorders chapter.
  • Providing a dimensional measure of severity for each of the criteria domains of autism spectrum disorder.

Darrel A. Regier, MD, MPH, vice chair of the DSM-5 task force, said it was the goal of the work groups to offer the most inclusive and open review process.

All of the diagnoses in the manual have been thoroughly reviewed first by a series of conferences between 2000 and 2008 and since then by thirteen diagnostic area work groups that are composed of a multidisciplinary international group of expert clinicians and research investigators,” Regier told Healio.com.“Their proposals have been put up on our website on three separate occasions for review and comment by clinicians, research teams, advocacy groups and the general public.  This has been very helpful to get the widest possible review of the impact of proposed changes on all of these groups.”

The DSM-5 will be published in May 2013. Draft criteria are open for public comment until June 15.

To review all of the proposed changes to the DSM, visit http://www.dsm5.org/proposedrevisions/pages/default.aspx. To view the individual work groups, visit http://www.dsm5.org/meetus/pages/workgroupmembers.aspx.

Disclosure: Dr. Regier reports no relevant financial disclosures.

    Perspective
    Darrel A. Regier

    Darrel A. Regier

    The main reason for updating the diagnostic criteria and considering additional diagnoses is to address deficits in the previous edition that have been in use for the past 18 years. This has been an adequate time to demonstrate that there are several areas of considerable public health importance that can be addressed better with current scientific knowledge. One example is based on the known lack of clinicians’ ability to clearly differentiate four different disorders in what has now been proposed as autism spectrum disorder. The previous four types of autism—pervasive developmental disorder, not otherwise specified, Asperger’s syndrome and childhood disintegrative disorder—could not be reliably differentiated by different clinicians in the same setting or in multiple settings. More importantly, the diagnoses did not really identify the different deficit levels in social communication or fixated interests/repetitive movement that are important to guide clinical treatment.

    The new diagnostic criteria provide a dimensional measure of severity for each of these criteria domains and should be much more helpful to clinicians. Autism spectrum disorder is one of the best examples of how a more dimensional approach to characterizing current disorders can help to guide treatment by noting quantitative responses to treatment interventions — often referred to as measurement-based care. We hope to provide both cross-cutting dimensional measures of psychological symptoms such as depression, anxiety, anger, sleep, cognition, substance use, suicidal ideation and personality traits that would be important to consider for any diagnosis.  In addition, having more explicit measures of severity for each diagnosis will encourage clinicians to consider treatment alternatives if a patient remains “stuck” in a nonresponse mode for the existing treatment.

     

    • Darrel A. Regier, MD, MPH
    • Director, Division of Research American Psychiatric Association; Vice-Chair, DSM-5 Task Force; Director, American Psychiatric Institute for Research and Education

    Disclosures: Dr. Regier reports no relevant financial disclosures.

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