DSM-5-between the good and the bad.
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the product of over 10 years of efforts made by hundreds of internationally renowned experts in diverse fields of mental health. The outcome is precisely a volume that has become an authority in the field, which defines and classifies psychiatric disorders with the final purpose of optimizing diagnostic and therapeutic strategies and of opening new research directions at the same time.
Addressed to both clinicians and scientists, as main diagnostic and classification instrument for psychiatric disorders, the DSM-5 comprises concise but explicit criteria, in order to facilitate a more objective approach to symptoms and to the entire array of manifestations-most of the times polymorphic and heterogeneous-of mental conditions. At the same time, DSM-5 aims to categorize disorders more precisely, by the severity of symptoms, considering the need of therapeutic home care, in conditions of hospitalization or partial hospitalization or outpatient care, thus delimiting more accurately the needs of mental patients.
The most apparent characteristic of the DSM-5 is precisely the elimination of diagnostic axes, previously promoted by the DSM-4, which forced clinicians to assess each patient by criteria that often deviated from their main psychiatric diagnostic. In the same multiaxial context of the DSM-4, there was an artificial association on axis II of mental deficiency and of personality disorders, because all the other disorders were on axis I. Another shortcoming solved by the DSM-5 is the categorization of other mental disorders of childhood-a collection of unrelated disorders that "originated in childhood" (but not "mental retardation")-within a common section, not taking into account the symptomatic particularities. The DSM-5 places all psychiatric disorders in section II, thus replacing the first three axes, while axis IV was replaced by significant psychosocial and contextual features. Axis V, concerning Global Assessment of Functioning, known as GAF, was removed altogether. Therefore, the elimination of diagnostic axes represents, at least apparently, a positive element of the DSM-5, which clarifies a series of nosological categorisation confusions. The new version of the DSM also replaces the NOS categories with two options: other specified disorder and unspecified disorder to increase the utility to the clinician, the first allowing the clinician to specify the reason that the criteria for a specific disorder are not met and the second allowing the clinician the option to forgo specification. Another beneficial change of the DSM-5 is that "mental retardation" is no longer being used as a diagnosis but is being replaced by "intellectual disability," which makes DSM-5 consistent with established practices in the field. Moreover, other diagnostics with potentially stigmatizing names were modified, including Hypochondriasis, now called "Illness Anxiety Disorder" and the Paraphilias, now called "Paraphilic Disorders", and the list goes on. At the same time, autistic disorders were eliminated and replaced by "autistic spectrum disorder", which is a more operational name. These terminological modifications go beyond the authors' wish for political correctness: they aim to find more accurate names for psychiatric disorders. Other disorders-previously included artificially within larger nosological categories --were re-categorized, such as Obsessive Compulsive Disorder, which is now independent, not included within anxiety disorders, and PTSD, which is now included within "Trauma and Stressor-Related Disorders". One must also highlight the disambiguation and liberation of schizophrenia from too-limited forms: currently, they focus on more precise means for assessing the severity of symptoms. Guidelines for evaluating suicidality are also being included in DSM-5, providing clinicians with greater structure in assessing individuals who may present a risk to themselves.
Aside from these strong points of the DSM5, which endow the classification of mental disorders with a clear, diagnostic-adapted style and which tend to destigmatize mental patients, the manual has also received its fair share of criticism, concerning the perfectible aspects of the latest diagnostic and classification system. For instance, the inclusion of "Mild Neurocognitive Impairment" has the very real potential to pathologize the normal age-related changes in cognition that many people experience. This extends to an apparent trend of pathologizing normal human re actions, thus altering the concept of bereavement for instance.
The Diagnostic and Statistical Manual-5 (DSM-5), published in May 2013, represents the materialisation of years-long efforts, of clinical trials, debates and tests conducted by hundreds of scientists who activate in the field of psychiatry and in related domains. Called the Bible of psychiatry, the DSM-5 includes almost all possible variations of human behaviour. Be yond the strong and weak points of the DSM-5, it represents a step forward, a change saluted by some and detested by others, but which definitely clarifies certain diagnostic aspects dominated by ambiguity in the past. Only time will decide how these changes promoted by the DSM5 will impact mental health and the evolution of psychiatry in both clinical and research fields.
Roxana CHIRITA-Prof., M. D., Ph. D., "Socola" Institute of Psychiatry, Iasi, Romania
Ilinca UNTU-M. D., Ph. D. Student, "Socola" Institute of Psychiatry, Iasi, Romania
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|Author:||Chirita, Roxana; Untu, Ilinca|
|Publication:||Bulletin of Integrative Psychiatry|
|Date:||Jun 1, 2016|
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