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March will see the release of updated DSM-5 Text Revisions
March will see the release of updated DSM-5 Text Revisions
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), which will be released by American Psychiatric Association Publishing in March, will include significant changes, including the addition of prolonged grief disorder and the inclusion of symptom codes for suicidal behaviour and nonsuicidal self-injury, refinement of criteria, and comprehensive literature-based updates to the text.
According to a member of the DSM-5 Revision Subcommittee and the DSM-5-TR’s editor, the revised manual contains revisions that are critical to clinicians and researchers. Among these are updated to the descriptive text for the majority of disorders based on literature reviews and a comprehensive review of the impact of racism and discrimination on the diagnosis and manifestations of mental disorders that clarify modifications to the criteria sets for over 70 different disorders.
As First told Psychiatric News, “DSM is usually recognised as the most reliable source for information on most areas of mental diseases, except treatment. “The DSM text contains an ever-evolving body of knowledge. As a result, it is imperative that the text be updated as new psychiatric literature becomes available. On the basis of scientific advancements, the DSM-5 text sections on ‘Risk and Prognostic Factors’ and ‘Diagnostic Markers’ are more prone to being outdated. It’s been nine years since the publication of DSM-5 in 2013, which is significantly longer than the five to seven years that have passed between previous editions of DSM.
Long-term grieving disorder has been included as an additional disorder. After years of research and clinical experience, it was decided to include this since some people have a difficult time getting over the loss of a loved one and their symptoms can interfere with their day-to-day activities. According to him, one in ten persons who have experienced the nonviolent death of a loved one is at risk of developing chronic mourning disorder. (For a list of symptoms and diagnostic criteria for extended grief disorder, see the box below.)
New symptom codes in DSM-5-TR allow physicians to specify the presence or history of suicidal conduct and nonsuicidal self-injury, as well.
In Section II, “Other Conditions That May Be a Focus of Clinical Attention,” the codes for suicidal conduct and nonsuicidal self-injury are listed. Although these diseases and difficulties are not mental disorders in and of themselves, researchers and clinicians alike can benefit from having a systematic manner of collecting them in order to track the prevalence and correlates.
A person may utilise the suicidal conduct symptom code if they’ve engaged in self-injurious activity with the intention of dying as a result. The actions or circumstances of a person’s life can reveal whether or not they intend to take their own life. Attempting suicide may or may not lead to actual self-injury.
In the absence of suicidal intent, people who intentionally harm their bodies in ways that cause blood, bruising, or discomfort (such as cutting, burning, stabbing, hitting, or prolonged rubbing) can be diagnosed with the nonsuicidal self-injury symptom code.
It has also been reinstated in the DSM-5-TR for mixed mood presentations that do not fit the criteria of a bipolar or depressive disorder. There is no DSM-5 diagnostic category for an undefined mood disorder as a result of the decision to abolish the mood disorder diagnostic class in favour of elevating bipolar disorders and depressive disorders to top-level diagnostic categories.
Additionally, vocabulary and nomenclature have been updated in DSM-5-TR. The term “neuroleptic,” when used to describe a pharmaceutical class, is outdated because it highlights the negative side effects of the treatment. Only in the case of “neuroleptic malignant syndrome” will it be employed.
Depending on the context, other names are being used to replace “neuroleptic.” “Antipsychotic drug or other dopamine receptor blocking agent” is used to refer to the broader pharmacological class, frequently in the context of side effects such as tardive dyskinesia, while discussing the treatment of psychotic symptoms.
The vocabulary used to describe gender dysphoria has also undergone considerable changes. ‘Cross-sex medical treatment’ has been renamed ‘gender-affirming medical procedure,’ and the terms ‘natal male’ and ‘natal female’ have been replaced with ‘individually assigned male/female at birth.’
Diagnostic criteria have been revised for several disorders, primarily for clarification. These include changes in the criteria sets for the following diagnoses:
- Autism spectrum disorder
- Manic episode
- Bipolar I and bipolar II disorder
- Cyclothymic disorder
- Major depressive disorder
- Persistent depressive disorder
- PTSD in children
- Avoidant-restrictive food intake disorder
- Substance/medication-induced mental disorders
- Attenuated psychosis syndrome (in the chapter “Conditions for Further Study”)
Some disorders’ specifier definitions have been updated as well. As a result, they include modifications in the severity specifiers for a manic episode, the mood-congruent or mood incongruent specifier for bipolar disease, the mixed features specifier for major depressive disorder, narcolepsy specifiers, and the post-transition specifier for gender dysphoria.
Intellectual disability has been called an intellectual developmental disorder, while functional neurological symptom disorder (FNS) has been renamed conversion disease.
More than a year after DSM-5’s release in 2013, all coding changes have been made in the book so that it accurately reflects the most recent developments in diagnosis and treatment. Several new parts have been added to the Introduction and “Use of the Manual” chapters in Section I to better serve novice and experienced physicians alike.
Some three-quarters of disorder textbooks received significant modifications. “Prevalence,” “Risk and Prognostic Factors,” “culture-related Diagnostic Features,” “Sex- and Gender-Related Diagnostic Features,” “Association With Suicidal Thoughts or Behavior,” and “Comorbidity” are the text parts that have been most substantially changed.
“We at the American Psychiatric Association Publishing and the APA are happy to offer the DSM-5-TR as a crucial reference for all mental health professionals,” stated Dr Levin, CEO of the APA and Medical Director of the Association. For practitioners, researchers, academic institutions, as well as health systems, the new guidebook will be a tremendous asset.”
Diagnostic Criteria for Prolonged Grief Disorder (F43.8)
- People who have lost someone close to them at least 12 months ago (for children and adolescents, at least 6 months ago).
- Since the death, there has been a long-lasting grief response that includes one or both of the following symptoms. These symptoms have been present most days to a clinically important level. It has also happened almost every day for at least the last month:
- Intense desire or longing for the person who has died.
- Preoccupation with thoughts or memories of the person who has died (in children and adolescents, preoccupation may focus on the circumstances of the death).
- As a result of the death, at least three of the following symptoms have been present most days to the point where they have been clinically important. Also, the symptoms have been going on for at least a month now.
- Identity changes (e.g., feeling like a part of yourself has died) since the death.
- People were shocked by the death.
- There should be no reminders that the person is dead (in children and adolescents, may be characterised by efforts to avoid reminders).
- Intense emotional pain (e.g., anger, bitterness, sorrow) that comes from the death of someone.
- After someone dies, it can be hard to get back into their relationships and activities (e.g., problems engaging with friends, pursuing interests, or planning for the future).
- Emotional numbness, which is when there is no or a lot less emotional experience because of death.
- Feeling that life doesn’t have any value because of death.
- As a result of the death, there is a lot of loneliness.
- Clinicians say that the problem is causing a lot of pain and problems in important social, occupational, or other areas of functioning.
- The length and severity of the person’s bereavement reaction are clearly out of line with social, cultural, or religious norms for that person’s culture and environment.
- Mental health problems like major depressive disorder or posttraumatic stress disorder can’t explain the symptoms. They also can’t be blamed on substances like medication or another medical condition, and they aren’t caused by them.
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