A Quick Guide To The DSM 5 Criteria
What is the DSM?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and is used to diagnose mental and behavioral conditions, including personality disorders. It contains detailed descriptions, symptoms, and other criteria that are important for such diagnosis.
The DSM 5th Edition (DSM-V) is a living document which provides a common language for clinicians, patients, and researchers to communicate information about symptoms and diagnoses. In order to establish the DSM-V criteria, APA enlisted the services of over 160 prominent researchers and clinicians from around the world.
Participation in this task force is strictly voluntary. It is a broad-based task force as specialists from several medical and mental health disciplines, such as psychology, pediatrics, psychiatry, nursing and social work, are included.
The fifth edition was released on May 18, 2013 and, although three years have passed since then, there is still confusion as to what the new criteria are, and which subcategories have been excluded.
That’s why we have set out to write this blog - an attempt to give you all the updates you need to know in one post.
What is the cause for the change?
Changes have been incorporated into the DSM based on updates in research and ongoing psychiatric practice. The criteria were revised in order to improve the accuracy of clinical diagnosis and to allow experts to include their inputs on various symptoms seen in individuals they had previously evaluated. The goal was to develop an evidence-based manual that serves as a useful guide for clinicians to accurately diagnose mental, behavioral and personality disorders.
What is the DSM-V Criteria?
For some diagnoses, the DSM-V has merged all of the formerly individual diagnoses, such as Childhood Disintegrative Disorder, Asperger’s, Autistic Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), into two separate diagnoses: Autism Spectrum Disorder and Social Pragmatic Communication Disorder.
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder. Its primary characteristics include:
Severe and pervasive impairments in reciprocal social communication and social interaction (verbal and nonverbal); and
Restricted, repetitive patterns of behavior, interests, and activities.
So, what are some of the important changes in the new DSM-V?
The first and foremost change is the introduction of the classification of Autism Spectrum Disorders. In order to make a diagnosis of Autism Spectrum Disorder, at least five out of seven criteria must be met.
The second most significant change and the key reason behind all the initial uproar DSM-V has caused - is the elimination of separate categories under the overarching ASD heading. What this means is that the new manual no longer recognizes specific diagnoses, such as Autistic Disorder, Asperger’s Syndrome, or PDD-NOS. With DSM-5, most of these disorders now fall under the classification of Autism Spectrum Disorder (ASD) or Social Pragmatic Communication Disorder.
Of course, this change is not very easy to accept. If you have a child that had been previously identified as someone with PDD-NOS or Asperger’s and then you are told that the diagnosis no longer exists, it can cause a great deal of apprehension.
However, it is worthwhile to note that, even though the category or label may be changing, the main aim of APA in developing the DSM-V was to be able to better describe the various types of behaviors that children exhibit rather than group all behaviors into one category. The next point will better explain how DSM-V accomplishes this.
The DSM-V manual also sets a more stringent benchmark in order to meet criteria in the restricted, repetitive patterns of behavior (RRB) area. The new DSM-V reflects recent research which has shown that RRB impairments are an important symptom of ASD, coupled with social communication. The ambit of restricted, repetitive patterns of behavior, interests, or activities, has now been expanded to include abnormalities in sensory processing.
The DSM-V features a more efficient way of gathering information on the level of language, IQ, adaptive skills, loss of skills, and other medical issues. This helps clinicians in delivering a more personalized and thorough diagnosis.
Another important change is that the three key domains (social impairment, language/communication impairment and repetitive/restricted behaviors) are now combined into two: 1) deficits in social communication and interaction, and 2) restricted, repetitive patterns of behavior, interests, or activities.
The next change involves the widened age of onset criteria. According to the new criteria, the onset of symptoms must be present in the early developmental period.
The new DSM-V criteria also contains added “specifiers” in order to describe features, such as “associated with known medical genetic condition”, “with or without intellectual impairment,” “with or without language impairment”, and “with catatonia.”
Another change involves the addition of various levels or specifiers. For example, level 1 (“requiring support”), level 2 (“requiring substantial support”) or level 3 (“requiring very substantial support”), with key criteria for each.
The APA also included a new diagnosis of Social (Pragmatic) Communication Disorder in order to more accurately describe individuals experiencing “difficulties in the social use of verbal and nonverbal communication” but without “restricted, repetitive, and stereotyped behavior, interests, and activities,” thereby distinguishing it from ASD.
Many clinicians surmise that the older criteria may have been too broad. This would sometimes result in the incorrect inclusion of individuals who did not actually have autism. The new criteria has been found to be a more meticulous approach to evaluation and diagnosis, as it relies more on clinical judgment, allowing the clinician to observe the subtleties of the disorder more carefully.
Rather than “putting people into boxes” by following a checklist of extremes, we now have personalization in the DSM-V diagnostic criteria. The fifth edition of the DSM represents the most current scientific thoughts, in both structure and criteria.
The objective of this new manual framework is to help clinicians perform the diagnosis more accurately. Proper diagnosis ensures appropriate therapeutic processes are employed in the treatment of your child or loved one. The DSM-V criteria allow clinicians to identify cases requiring advanced treatment with greater accuracy and helps them better equip your child with the ability to achieve their life goals.