DSM-5 expected to be more 'user-friendly'
EXPERT ANALYSIS FROM THE AMERICAN COLLEGE OF PSYCHIATRISTS ANNUAL MEETING
Depressive disorders are now organized in a dedicated chapter separate from bipolar and related disorders. In major depressive episode, the bereavement exclusion has been eliminated. "The basic message in the bereavement exclusion from DSM-IV was that we as clinicians could not diagnose major depression during the first 2 months following a bereavement," Dr. Kupfer said. "This would be independent of how the person might be suffering during that 2-month period. The other thing that seemed to be implied, which was very unfortunate, was that a number of people concluded that bereavement may only last 2 months, when in fact all of us know that bereavement often lasts a lot longer than 2 months." The DSM-5 includes a criteria note "that allows one to think about the presence of major depression while someone is also experiencing a significant loss."
Anxiety disorders are now organized in a dedicated chapter separate from other anxiety-related disorders. "With panic attacks" is a specifier for any mental disorder, and panic disorder and agoraphobia have become unlinked.
Another set of changes that were made in the DSM-5 related to either new disorders or in named disorders. For example, disruptive mood dysregulation disorder (DMDD) is a newcomer that addresses presentations of severe, nonepisodic irritability that has contributed to an upsurge of pediatric bipolar disorders. In DMDD, "symptoms overlap with oppositional defiance disorder but are considered more severe," Dr. Kupfer said. Meanwhile, premenstrual dysphoric disorder has been elevated from the appendix to the depressive disorders section of DSM-5, while binge eating disorder has been elevated from the appendix to the feeding and eating disorders section of the document.
Hoarding disorder is another newcomer to the DSM-5. "This is one of major public health significance because every department of public health in every county in the country has to deal with a hoarding issue, whether it’s animal-related or other forms of excessive acquisition," Dr. Regier said.
One change to posttraumatic stress disorder diagnoses includes removal of the A2 criteria, "which was that an individual not only has to be exposed an overwhelming stress but they have to react with horror or disgust," Dr. Regier said. "What was happening is that soldiers who are trained to immediately deal with horrendous experiences would say that their training ‘kicked in.’ They didn’t have the reaction – the A2 criteria – yet they subsequently would have clear criteria for PTSD. There was a need to eliminate that criteria to focus on four symptom clusters that filled out the syndrome." Now, the avoidance/numbing cluster has been divided into two distinct clusters: avoidance and persistent negative alterations in cognition and mood.
Dr. Regier predicted that the DSM-5 will make a significant contribution to assisting clinicians with diagnosing neurocognitive disorders. "An enormous amount of information has emerged in the area of neurocognitive disorders [in terms of] early differentiation of a probable Alzheimer’s disease versus a frontal temporal dementia diagnosis and differentiating dementia with Lewy bodies versus vascular dementia," he said. Going forward, he continued: "I think the biggest challenge is going to be making the distinction between mild dementia and normality. We’re working to develop a computer-assisted neurocognitive test that clinicians can use in their office to do some screening in this area. It would also be helpful for looking at cognitive impairment in schizophrenia. That’s in the future, but it’s an area we know we need to move forward with."
Neither Dr. Kupfer nor Dr. Regier had relevant financial conflicts to disclose.
