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The Making of the DSM-5
Presented by David J. Kupfer, MD
Chair of the DSM-5 Task Force
CARNEGIE LIBRARY OF PITTSBURGH
SATURDAY, OCTOBER 26, 2013
Why we need DSM
2
 Provides a common language
to use to understand and
communicate about mental
disorders
Goal of DSM-5 Revisions
3
A clinical guidebook that more precisely
defines disorders and better characterizes
groups of people who are seeking
treatment, ultimately improving care
patients and families receive
• Diagnostic criteria were revised and new diagnoses
were added in light of scientific and clinical
advances
• In the process we reduced the number of mental
disorders from DSM-IV
DSM-5 Key Dates
4
DSM-5’s 14-year revision process involved more than 1,500 mental
health and medical experts from around the world
1999-2007
PrePlanning
White
Papers and
Conferences
20082010
Review of
DSM
criteria
20062008
DSM-5
Task Force
Work
Group
members
appointed
May 18,
2013
DSM-5
published
2011
Second
comment
period
2010
Launch
DSM5.org/
first
comment
period;
Field Trials
2012
Third
comment
period;
Review;
DSM-5
criteria
approved
Overarching Changes
6





Used the strongest scientific evidence to support changes to
diagnostic criteria
Revised chapter order based on underlying vulnerabilities and
symptom characteristics
Organized manual in sequence with developmental lifespan
Decreased the number of “Not Otherwise Specified” diagnoses
through greater criteria specificity
Aligned manual with international classifications
Disorder Specific Changes
7
Autism Spectrum
Disorder
AttentionDeficit/Hyperactivity
Disorder
Disruptive Mood
Dysregulation
Disorder
Major Depressive
Disorder /
Bereavement
Exclusion
Mild Neurocognitive
Disorder
Substance Use
Disorders
Autism Spectrum Disorder
8
Revised diagnosis represents more medically and
scientifically accurate and useful way of diagnosing
individuals with autism-related disorders
Single umbrella disorder will improve diagnosis of
ASD without limiting the sensitivity of criteria or
changing number of children being diagnosed
Individuals with ASD must show symptoms from
early childhood, even if those symptoms are not
recognized until later
Attention-Deficit/Hyperactivity Disorder
9
Several of the individual’s ADHD symptoms
must be present prior to age 12 years
(compared to 7 in DSM-IV)
New criteria addresses adults affected by
ADHD to ensure they get the care they need
No exclusion criteria for people with autism
spectrum disorder
Disruptive Mood Dysregulation Disorder
10
DMDD is characterized by severe and recurrent temper
outbursts that are grossly out of proportion in intensity or
duration of the situation
- Occur three more times each week for one year or more
(on average)
Children with DMDD display persistently irritable or
angry mood, most of the day and nearly every day
Onset of symptoms must be before age 10
- Diagnosis should not be made for the first time before
age 6 or after age 18
Major Depressive Disorder / Bereavement
Exclusion
11
Exclusion is replaced by notes in the criteria and text
that caution clinicians to differentiate between normal
grieving associated with a significant loss and a
diagnosis of a mental disorder
- Removing exclusion helps prevent major depression from
being overlooked
- Criteria for major depressive disorder now clarifies that the
normal and expected response to a significant loss may
resemble a depressive episode
Bereavement exclusion in DSM-IV suggested that grief
somehow protected someone from major depression or
only lasted two months
Hoarding
12
 Listed as a distinct disorder within the Obsessive-
Compulsive and Related Disorders chapter

Many severe cases of hoarding are not accompanied by obsessive or
compulsive behavior, warranting listing as a distinct disorder
Mild Neurocognitive Disorder
13
Mild neurocognitive disorder goes beyond normal
issues of aging
- Describes level of cognitive decline, including changes
that impact cognitive functioning
Early identification of neurocognitive decline may
enable use of treatments not effective at more
severe levels of impairment and may prevent or
slow progression
Substance Use Disorders
14
Combines DSM-IV categories of substance abuse and
substance dependence into a single disorder measured on
a continuum from mild to severe
Each specific substance is addressed as a separate
disorder (same overarching criteria)
Mild substance use disorder in DSM-5 requires two to
three symptoms from list of 11, as opposed to one in DSMIV
Section III
15
 Section III introduces emerging measures and
models to assist clinicians in their evaluation of
patients
Outlines
conditions in
need further
study before
inclusion in
Section II of the
manual
Addresses how
cultural
influences can
impact diagnosis
and treatment
Includes
assessment tools
and crosscutting symptom
measures
Future Forward
16
 The best clinical tool available for diagnosing mental
disorders

Clinical utility of the manual is unparalleled
 DSM-5 was revised to be a “living document”
 Manual will continue to update its criteria to reflect the most
up to date science