Lec 11 Current Perspectives
Diagnostic and Statistical Manual (DSM)
• DSMV Very few changes from DSMIV-TR
o Cosmetic and substantive changes
o Two Major Changes
Reorganization of disorders
• 5 Axes of diagnoses in DSM4, removed in DSM5 (EXCEPTION:
• Disorders are grouped by similar symptoms
Definition of disorders are much broader
o DSM is clinically and empirically derived
DSM5 is more dimensional than categorical
• Dimensional Different severities
• Similar symptoms in same categories, with varying degree of severity
• Major Changes:
o 1. DSM4 containedAsperger’s Syndrome (mild form of Autism) has been
removed from DSM5.
DSM5 includes Asperger’s, Retts, etc. as Autism Spectrum Disorder.
Broader definition=includes more people, over-diagnosis
RATIONALE: Diagnose people sooner to get help sooner
o 2. DSM4 had different subtypes of schizophrenia (ex. Paranoid,
undifferentiated), DSM5 eliminates the subtypes
RATIONALE: most people being diagnosed as undifferentiated-
showed symptoms of all subtypes.
Some schizophrenia types had more positive symptoms than
o 3. Diagnosis of Depression Has separate section on both DSM4 & 5.
Depression defined as sad affect, no enjoyment, over a long period
of time – usually due to an environmental condition.
DSM4 excluded Bereavement (death of a loved one).
• DSM5 includes bereavement as abnormal.
o 4. Post-Traumatic Stress Disorder (PTSD), categorized as anxiety disorder
in DSM4, separate section in DSM5.
DSM4 Have an anxious arousal in response to a past traumatic
On DSM4 requirement that traumatic event induced extreme fear
Requirement is eliminated in DSM5. DSM5 concludes that PTSD
does not require anxiety or fear at the time event occurred, could
have been onset afterwards.
o 5. DSM5 eliminated Gender Identity Disorder o 6. Elimination of disorders of Childhood orAdolescence. Have been
placed in different categories based on symptoms.
• Development of DSM5 Controversial
• New learning disorders & “Autistic Spectrum Disorder” (ASD)
o Autism Can’t learn, cant socialize
o Learning disorders, autism, and mental retardation are the same.
o Autism Spectrum Disorder Inability to absorb information from other
o Learning disorders andASD are separate from mental retardation (now
• New Category “Addiction and Related Disorder”
o Redefine “Addiction”
o DSM4 defined addiction as substance abuse. DSM was very specific to
o DSM5 is broader to include things not considered a drug. Ex. Internet,
DSM5 sets out to include these things. Did not include sex. RATIONALE:
Sex is a normal part of life, should not stigmatize those who have healthy sex
• BehaviouralAddictions (Gambling)
o Gambling addiction clearly included on DSM5 not DSM4
• New “Suicide Scales”
o Measurement of suicidal ideation
o Different types of risks for suicide
o Stage 1 Depression?
o Stage 2 Thought of suicide?
o Stage 3 Have a plan? – Should begin to concern and diagnose
o Stage 4 Have tried?
• “Risk Syndromes” Category
o Mood disorders of sad affect as oppose to anxious. Depression and Bipolar
• Childhood bipolar disorder
o Significant amount of research indicating Bipolar disorder can develop in
o Bi-polar Episodes of Depression and episodes of Mania (extreme
o Suggestion in past that children could not show bi-polar disorder
Significant evidence against this
• Binge Eating
o People who eat copious