New DSM-5 highlights presented

In correspondence with New England Psychologist, the DSM-5 Task Force chair David J. Kupfer, M.D., confirmed and elaborated on the following highlights of what practitioners can expect in the newest DSM.

Category: “Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence”

Changes: The Task Force has considered adding the following five disorders: Language Impairment, Late Language Emergence, Specific Language Impairment, Social Communication Disorder and Voice Disorder. The following have been suggested for elimination: Expressive Language Disorder, Mixed Receptive-expressive Language Disorder and “Communication Disorder Not Otherwise Specified” (which is being moved to a different category).

Kupfer’s Comments: “A noteworthy change…is that of Autism Spectrum Disorder (which will exist in a chapter entitled Neurodevelopmental Disorders). This diagnosis combines the former DSM-IV diagnoses of Autistic Disorder, Asperger’s Disorder, Child Disintegrative Disorder and Pervasive Developmental Disorder Not Otherwise Specified into a single diagnosis. Although these individual diagnoses are not new to DSM, their existence as a single spectrum disorder is.”

Category: “Mood Disorders”

Changes: The Task Force has considered adding the following: Premenstrual Dysphoric Disorder, Mixed Features Specifier and Mixed Anxiety Depression.

Kupfer’s Comments: “A particularly important addition, it will provide clinicians with a more precise definition of mixed symptomatology (depression plus mania/hypomania features) and will allow them to accurately and more quickly identify patients at risk for converting from a unipolar disorder to a bipolar disorder. Premenstrual Dysphoric Disorder currently exists in DSM-IV as an Appendix condition (i.e., as a disorder requiring further research), and its elevation to a disorder in the main manual means women suffering from severe mood symptoms and impaired functioning during the menstrual cycle can receive proper treatment.”

Category: “Other Disorders”

Changes: This category comprises new disorders that were not listed in the DSM-IV. In a sub-category of “Self Injury,” non-suicidal self injury (NSSI) is being proposed in light of the growing number of self-harming patients with behavior that leads to bruising, bleeding or pain. Also proposed for the “Other Disorders” category are two types of “Factitious Disorder” – in one’s self or about another – in which patients falsely report symptoms or illness in themselves or about another.

Kupfer’s Comments: “Regarding proposals for Self Injury Disorders, these were drafted in response to the high public health need to call greater attention to matters of suicide attempt and non-suicidal self injurious behavior (e.g., ‘cutting), particularly among adolescents. In DSM-IV, discussion of such issues is generally relegated to that of Borderline Personality Disorder and Major Depressive Disorder, yet suicidal and non-suicidal behavior is widely pertinent across clinical populations and should not be considered only among patients being treated for Personality or Mood Disorders. NSSI is under investigation in the DSM-5 Field Trials.”