DSM-5: An Overview of Changes and Controversies
The DSM-5 offers many changes in the criteria and categories used in clinical diagnosis. The provocative and sometimes controversial nature of the changes has enlivened debate in the mental health field about how we should best understand our clients. I selectively survey what is new in DSM-5, why changes were made, and what about them is so controversial. First, I summarize the main metastructural and organizational changes, including elimination of the multiaxial system and changed chapter groupings. Second, I survey the most important new categories of disorder and the most important changes to the diagnostic criteria for existing categories of disorder. I focus on particularly controversial changes, such as those to substance use and addictive disorders, autism spectrum disorders, and posttraumatic stress disorder. Pros and cons are provided for changes in criteria as well as for the addition of new disorder categories, such as hoarding disorder and binge eating disorder. Finally, I offer a more in-depth review and analysis of the changes to the depressive disorders chapter, which was subject to some of the most intense controversies and had some of the most extensive changes.
KeywordsDSM-5 Clinical social work Diagnosis Depressive disorders Mental disorder Harmful dysfunction
- American Psychiatric Association. (2011). DSM-5 development: Premenstrual dysphoric disorder. Accessed October 22, 2011 at: http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid.484.
- Axelson, D., Findling, R. L., Fristad, M. A., Kowatch, R. A., Youngstrom, E. A., Horwitz, S. M., et al. (2012). Examining the proposed disruptive mood dysregulation disorder diagnosis in children in the Longitudinal Assessment of Manic Symptoms Study. Journal of Clinical Psychiatry, 73(10), 1342–1350.PubMedCrossRefGoogle Scholar
- Brown, J., O’Brien, P. M., Marjoribanks, J., & Wyatt, K. (2009). Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database of Systematic Reviews, Apr 15, 2009;(2):CD001396. doi: 10.1002/14651858.CD001396.pub2.
- Carey, B. (2012). Grief could join list of disorders. New York Times, January 25, 2012, A1.Google Scholar
- Dobbs, D. (2012). The new temper tantrum disorder. Slate, December 7, 2012. Accessed Dec. 7, 2012 at: http://www.slate.com/articles/double_x/doublex/2012/12/disruptive_mood_dysregulation_disorder_in_dsm_5_criticism_of_a_new_diagnosis.html.
- European Medicines Agency. (2011). Guideline on the treatment of premenstrual dysphoric disorder (PMDD). Accessed May 4, 2013 at: http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2011/08/WC500110103.pdf.
- Frances, A. (2010). Behavioral addictions are a slippery slope. Psychology Today Blog, March 24, 2010. Accessed March 20, 2011. http://www.psychologytoday.com/blog/dsm5-in-distress/201003/dsm5-suggests-opening-the-door-behavioral-addictions.
- Frances, A. (2011). Should temper tantrums be made into a DSM-5 diagnosis? Psychiatric Times, October 13, 2011. Accessed October 19, 2011 at: http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1970399.
- Frances, A. (2012). DSM-5 is a guide, not a bible: Simply ignore its 10 worst changes. Accessed December 25, 2012 at: http://www.huffingtonpost.com/allen-frances/dsm-5_b_2227626.html.
- Frances, A. (2013). The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill. BMJ, 346(3), f1580. doi: 10.1136/bmj.f1580.
- Halbreich, U., Borenstein, J., Pearlstein, T., & Kahn, L. S. (2003). The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology, 28(3), 1–23.Google Scholar
- Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. New York: Oxford University Press.Google Scholar
- Horwitz, A. V., & Wakefield, J. C. (2012). All we have to fear: Psychiatry’s transformation of natural anxieties into mental disorders. New York: Oxford University Press.Google Scholar
- Kendler, K. S. (2010). Statement on the proposal to eliminate the grief exclusion criterion from major depression. Accessed October 16, 2010 at: http://www.dsm5.org/about/Documents/grief%20exclusion_Kendler.pdf.
- Moran, M. (2013). Eating, sleep disorder criteria revised in DSM-5. Psychiatric News, 48(6), 14–15.Google Scholar
- Offman, A., & Kleinplatz, P. J. (2004). Does PMDD belong in the DSM? Challenging the medicalization of women’s bodies. Canadian Journal of Human Sexuality, 13, 17–27.Google Scholar
- Schwarz, A., & Cohen, S. (2013). A.D.H.D. seen in 11% of U.S. children as diagnoses rise. New York Times, April 1, 2013, A1.Google Scholar
- Wakefield, J. C. (2011). Should uncomplicated bereavement-related depression be reclassified as a disorder in DSM-5?: Response to Kenneth S. Kendler’s statement on the DSM-5 website defending the proposal to eliminate the bereavement exclusion. Journal of Nervous and Mental Disease, 199, 203–208.PubMedCrossRefGoogle Scholar
- Wakefield, J. C. (2013b). The DSM-5 debate over the bereavement exclusion: Psychiatric diagnosis and the future of empirically supported treatment. Clinical Psychology Review. doi: 10.1016/j.cpr.2013.03.007.
- Wakefield, J. C., & Schmitz, M. F. (2013b). Can the DSM’s major depression bereavement exclusion be validly extended to other stressors?: Evidence from the NCS. Acta Psychiatrica Scandinavica. doi: 10.1111/acps.12064.
- World Health Organization. (1978). International classification of diseases (9th ed.). Geneva: World Health Organization.Google Scholar