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Last May, the much-anticipated fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published. As with prior editions, there are many dramatic changes, and some of them have tended to spark debate and controversy in the psychiatric community.  Certainly, there are many ways in which the new edition will impact mental health care in general, and already have been in the past few m0nths.

Published by the American Psychiatric Association, the DSM is the standard by which doctors classify, diagnose and treat mental disorders.  Naturally, it’s also heavily referenced in the health care industry, as well.

The first revision of the DSM in nearly 20 years, it certainly has introduced some changes that have caused division. These include the elimination of Asperger’s disorder and the addition of conditions like cannabis withdrawal, gambling addiction and disruptive mood dysregulation disorder (DMD).

All of the subcategories of autism have now been grouped into a single category, autism spectrum disorder (ASD). This has led some to wonder if this development might have the unintended effect of excluding some of those already diagnosed with disorders like Asperger’s or PDD-NOS.

Further, in light of the trend in recent years to overmedicate very young children, the DSM V eliminated pediatric bipolar disorder, creating in its place what’s known as disruptive mood dysregulation disorder (DMDD). Specifically, DMDD is described as intense outbursts and irritability beyond plain old temper tantrums. Though it does address a growing problem, some have expressed concern that the new category may wind up being applied too broadly.

Substance abuse is treated differently in what is called the Substance Use Disorders chapter.  In particular, diagnostic criteria have been expanded, and the arguably stronger word “addiction” replaces “dependence”. Gambling disorders and cannabis withdrawal have been added, and most substance use disorders are categorized on a sliding scale that depends on a particular patient’s condition.

Obsessive compulsive disorder (OCD), now has its own category, rather than being categorized under anxiety disorders.  The new category also includes Body Dysmorphic Disorder (BDD) and Hoarding Disorder.

Just as in 1994, the new edition of the DSM brings some interesting and far-reaching changes that will certainly impact the field of mental health care in the years to come.


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