Download An Overview of the DSM-5 - Chapman University Digital Commons

An Overview of the DSM-5
Naveen Jonathan, Ph.D., LMFT
October 2013
1
Saying Goodbye to the DSM-IV-TR
• https://www.youtube.com/watch?v=h3nxGb
-aM5g
October 2013
2
The following survey contains no correct or incorrect answers.
The questions are posed to assist the responder in
recognizing underlying beliefs regarding the practice
of diagnosis in psychology. These questions have
NOT been the content of formal scientific review
and no conclusions should be assumed from results.
Please select the score that most accurately
reflects your opinion on each of the following questions:
October 2013
3
Strongly
Disagree
Somewhat Somewhat
Disagree Agree
Strongly
Agree
1
2
3
4
2. Identifying a diagnosis for a client is more helpful
than harmful
1
2
3
4
3. If a client has symptoms that are in multiple
diagnosis, I use the one that is the most accurate
1
2
3
4
4. I have not observed negative effects on a client
due to a diagnostic label
1
2
3
4
2
3
4
2
3
4
1. A diagnosis is necessary for ethical treatment
5. I have never “fudged” on selecting a diagnosis that
was marginally supported so that a client could
1
qualify for services.
6. Diagnosis is too rigid and constrained by statistics
1
October 2013
4
7. I would do a diagnosis for my clients even if it was
not required.
Strongly
Disagree
Somewhat Somewhat
Disagree
Agree
Strongly
Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
8. I like reviewing GAF scores to identify progress
9. When coordinating services with treatment team
members, a diagnosis helps facilitate accurate
communication
10. If treatment is done properly, the label will not
have any negative impacts on the client.
October 2013
5
Message from Dr. Lieberman
https://www.youtube.com/watch?v=m7RCgCkrX
Xo
Dr. Jeffrey Lieberman, chair of Columbia
Psychiatry and APA's new president, gives an
overview of the DSM 5 (Published on May 17,
2013)
October 2013
6
Mental Illness as Defined -- DSM-5
“A mental illness is a condition characterized by
dysfunction in thought, mood or behaviors which cause
distress – The condition should not be a result of social
deviance or conflict with society”
DSM I
DSM II
DSM III
DSM IV
DSM-5
October 2013
-
102 conditions
182 conditions
265 conditions
365 conditions
400 conditions
7
Introducing DSM5
• Evidence Based
• International Efforts
• 16 years in development
October 2013
8
In Summary
• Format Changes that were significant
– Chapter organization
– Diagnosis procedure
• Minor Diagnosis Changes
– New ways to conceptualize and categorize former
disorders
– New forms of assessment
– Increased amount of specifiers
– No radically new criteria or disorders (15 fewer
diagnosis)
October 2013
9
What happened to the “V”
• DSM-5 (note the hyphen)
• Not DSMV
• What happened?
– 5.1, 5.2, 5.3, 5.4
– Digital text revision
– Welcome to the age of technology…
October 2013
10
The Process
•
•
•
•
Clinical Utility (highest priority)
Evidence-Based Recommendations
Continuity wit DSM IV
No Pre-Determined Constraints
• (Refer to dsm5.org)
October 2013
11
October 2013
12
October 2013
13
October 2013
14
October 2013
15
Cross Disorder Specifiers
• With Catatonia (for neurodevelopmental
psychotic, mood, etc.)
• With anxious distress (depression, bipolar)
• With panic attacks (all)
• With poor insight (OCD and certain anxiety)
Note: there are also new disorder-specific
specifiers
October 2013
16
NOS vs. NEC
• DSM5 eliminates Not Otherwise Specified
(NOS)
– Not directly useful
– Tends to be overused
• Not Elsewhere Classified
– Incorporates specific criteria and codes
including symptoms.
October 2013
17
October 2013
18
October 2013
19
New Disorders
1. Social (Pragmatic) Communication Disorder
2. Disruptive Mood Dysregulation Disorder
3. Premenstrual Dysphoric Disorder (DSM‐IV appendix)
4. Hoarding Disorder
5. Excoriation (Skin‐Picking) Disorder
6. Disinhibited Social Engagement Disorder (split from Reactive
Attachment Disorder)
7. Binge Eating Disorder (DSM‐IV appendix)
8. Central Sleep Apnea (split from Breathing‐Related Sleep Disorder)
9. Sleep-Related Hypoventilation (split from Breathing‐Related Sleep
Disorder)
October 2013
20
New Disorders (continued)
10. Rapid Eye Movement Sleep Behavior Disorder
(Parasomnia NOS)
11. Restless Legs Syndrome (Dyssomnia NOS)
12. Caffeine Withdrawal (DSM‐IV Appendix)
13. Cannabis Withdrawal
14. Major Neurocognitive Disorder with Lewy Body Disease
(Dementia Due to Other Medical Conditions)
15. Mild Neurocognitive Disorder (DSM‐IV Appendix)
October 2013
21
Eliminated Disorders
• Sexual Aversion Disorder
• Polysubstance‐Related Disorder
October 2013
22
Combined Specific Disorders
(Hang in there…there are 22)
1. Language Disorder (Expressive Language Disorder & Mixed
Receptive Expressive Language Disorder)
2. Autism Spectrum Disorder (Autistic Disorder, Asperger’s Disorder,
Childhood Disintegrative Disorder, & Rett’s disorder—PDD-NOS is
in the NOS count)
3. Specific Learning Disorder (Reading Disorder, Math Disorder, &
Disorder of Written Expression)
4. Delusional Disorder (Shared Psychotic Disorder & Delusional
Disorder)
5. Panic Disorder (Panic Disorder Without Agoraphobia & Panic
Disorder With Agoraphobia)
October 2013
23
Combined Specific Disorders (cont)
6. Dissociative Amnesia (Dissociative Fugue & Dissociative
Amnesia)
7. Somatic Symptom Disorder (Somatization Disorder,
Undifferentiated Somatoform Disorder, & Pain Disorder)
8. Insomnia Disorder (Primary Insomnia & Insomnia Related
to Another Mental Disorder)
9. Hypersomnolence Disorder (Primary Hypersomnia &
Hypersomnia Related to Another Mental Disorder)
10. Non-Rapid Eye Movement Sleep Arousal Disorders
(Sleepwalking Disorder & Sleep Terror Disorder)
October 2013
24
Combined Specific Disorders (cont)
11. Genito‐Pelvic Pain/Penetration Disorder (Vaginismus &
Dyspareunia)
12. Alcohol Use Disorder (Alcohol Abuse and Alcohol
Dependence)
13. Cannabis Use Disorder (Cannabis Abuse and Cannabis
Dependence)
14. Phencyclidine Use Disorder (Phencyclidine Abuse and
Phencyclidine Dependence)
15. Other Hallucinogen Use Disorder (Hallucinogen Abuse and
Hallucinogen Dependence)
16. Inhalant Use Disorder (Inhalant Abuse and Inhalant
Dependence)
October 2013
25
ARE WE HAVING FUN YET?

October 2013
26
Combined Specific Disorders (cont)
17. Opioid Use Disorder (Opioid Abuse and Opioid Dependence)
18. Sedative, Hypnotic, or Anxiolytic Use Disorder (Sedative,
Hypnotic, or Anxiolytic Abuse and Sedative, Hypnotic, or Anxiolytic
Dependence)
19. Stimulant Use Disorder (Amphetamine Abuse; Amphetamine
Dependence; Cocaine Abuse; Cocaine Dependence)
20. Stimulant Intoxication (Amphetamine Intoxication and Cocaine
Intoxication)
21. Stimulant Withdrawal (Amphetamine Withdrawal and Cocaine
Withdrawal)
22. Substance/Medication-Induced Disorders (aggregate of Mood
(+1), Anxiety (+1), and Neurocognitive (-3)
October 2013
27
Disconnections
Panic Disorder

Agoraphobia
Anxiety Disorder

Agoraphobia
Anxiety Disorder

PTSD
October 2013
28
New Boundaries
• Addiction
– Substance and Behavioral Addiction
• Somatic Symptom Disorder
– Overreactions to “imagined” and
“real” medical Ailments.
October 2013
29
Shifts in Criteria
• ADHD – Symptoms before age 12
• Separation Anxiety Disorder – Any age
• Bulimia Nervosa – One binge/purge per
week
• Schizophrenia – No Subtypes
October 2013
30
New Clusters
• Obsessive-Compulsive & Related Disorders
– OCD
– Body Dysmorphic Disorder
– Hoarding Disorder
– Trichotillomania
– Excoriation Disorder
October 2013
31
New Clusters (cont)
• Somatic Symptom & Related Disorders
– Somatic Symptom Disorder
– Illness Anxiety Disorder
– Conversion Disorder
– Factitious Disorder
– Psychological factors affecting other medical
conditions
October 2013
32
October 2013
33
October 2013
34
October 2013
35
October 2013
36
October 2013
37
October 2013
38
October 2013
39
October 2013
40
October 2013
41
October 2013
42
October 2013
43
October 2013
44
October 2013
45
Hoarding Disorder
October 2013
46
October 2013
47
October 2013
48
October 2013
49
October 2013
50
October 2013
51
October 2013
52
October 2013
53
October 2013
54
October 2013
55
October 2013
56
October 2013
57
October 2013
58
October 2013
59
October 2013
60
October 2013
61
Let’s Practice
October 2013
62
VIGNETTE 1:
Cheri is a 19 year old single Mexican American
female and college freshman who is brought in for evaluation by her
parents; she is attending college while living with them. Cheri’s
parents are very concerned about her declining weight. Two weeks
ago Cheri’s mother found a large supply of diuretic hidden in her
daughter’s closet. The parents also report that Cheri is a
perfectionist; when not in class, she spends her time studying in her
room. She has never dated, has few friends, and is a straight A
student. The mother reluctantly reports that large boxes of cookies,
pies, and cake have disappeared from the kitchen. On examination
Cheri appears extremely thin. She weighs 85 pounds and is 5 feet 7
inches tall. She denies any problems with food intake, and denies
use of diuretics or laxatives. She does admit that her last menstrual
period was more than 4 months ago. She does not agree with her
parents’ concerns about her weight; she angrily states, “I don’t have
a problem!”
October 2013
63
VIGNETTE 2:
Frank is a married African American male and
presents with extraordinary concern about the safety of his wife and
young daughter. He rarely leaves them alone when away (e.g., at
work) he telephones home every hour. He has lost one job because
of this, and his wife has threatened to leave him if he does not seek
psychiatric help. Six months ago, the symptoms, which have been
present for years, became worse after his wife had a serious
automobile accident. Frank describes recurrent, unbidden thoughts
in which dangerous events befall his family and he is not there to
save them. He knows the thoughts are “silly” and they come from his
own mind rather than any real danger, but he cannot resist
contacting his wife or daughter in some way to be certain they are
safe. His wife has arranged to lift the telephone receiver briefly, and
then hang up, which is usually sufficient to allay his fears for an hour
or so. There is no history of significant medical illness or Substance
Abuse. Frank completed 2 years of college and has a responsible
job. He performs well, and is not particularly perfectionistic, overly
conscientious (except with regard to his family’s safety), rigid, or
preoccupied
with details.
October 2013
64
October 2013
65
Cultural Formulation
October 2013
66
October 2013
67
WHODAS 2.0
Who- what?
Who – where?
Who- why?
Who dis?
Ohh…..who das?
World Health Organization Disability Assessment Scale
October 2013
68
October 2013
69
Any questions? NO? Good!
THANK YOU!!
Contact information:
Naveen Jonathan, Ph.D., LMFT [email protected]
October 2013
70