Skip to main content

Advertisement

SpringerLink
Log in

What Should Primary Care Providers Know About the Changes in DSM-5?

  • Psychiatry in Primary Care (BN Gaynes, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Primary care providers are increasingly involved in the management of patients with mental disorders, particularly as integrated models of care emerge. The recent publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) represents a shift in the classification of several mental disorders commonly encountered by primary care providers. With the advent of ICD-10 and the movement toward diagnostic specificity, it is crucial that primary care providers understand the rationale behind these changes. This paper provides an overview of the changes in the classification of mental disorders in DSM-5, a description of how these changes relate to frequently used screening tools in the primary care setting, and a critique of how these changes will affect mental health practice from a primary care perspective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

  2. World Health Organization. Mental Disorders in Primary Care: a WHO Education Package. Geneva: World Health Organization. 1998.

  3. Ader J, Stille CJ, Keller D, Miller BF, Barr MS, Perrin JM. The medical home and integrated behavioral health: advancing the policy agenda. Pediatrics. 2015;135(5):909–17.

    Article  PubMed  Google Scholar 

  4. Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatr. 1993;50(2):85–94.

    Article  CAS  PubMed  Google Scholar 

  5. Nemeroff CB, Weinberger D, Rutter M, et al. DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions. BMC medicine. 2013;11:202. This article provides a summary of the major critiques, positive and negative, of the changes in DSM-5 from the point of view of leading international psychiatrists.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Allen F. The new crisis of confidence in psychiatric diagnosis. Ann Intern Med. 2013;159(3):221–2.

    Google Scholar 

  7. Insel T. http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml. Accessed September 26, 2016.

  8. Kupfer DJ, Regier DA. Neuroscience, clinical evidence, and the future of psychiatric classification in DSM-5. Am J Psychiatry. 2011;168(7):672–4.

    Article  PubMed  Google Scholar 

  9. Regier DA, Narrow WE, Kuhl EA, Kupfer DJ. The conceptual development of DSM-V. Am J Psychiatry. 2009;166(6):645–50.

    Article  PubMed  Google Scholar 

  10. Esterberg ML, Compton MT. The psychosis continuum and categorical versus dimensional diagnostic approaches. Curr Psychiatry Rep. 2009;11(3):179–84.

    Article  PubMed  Google Scholar 

  11. Lopez MF, Compton WM, Grant BF, Breiling JP. Dimensional approaches in diagnostic classification: a critical appraisal. Int J Methods Psychiatr Res. 2007;16 Suppl 1:S6–7.

    Article  PubMed  Google Scholar 

  12. McCarron RM. The DSM-5 and the art of medicine: certainly uncertain. Ann Intern Med. 2013;159(5):360–1.

    Article  PubMed  Google Scholar 

  13. Association AP. Highlights of changes from DSM-VI-TR to DSM-5. In: Publishing AP, ed2013. This article written by the publisher of DSM provides a concise summary of the major changes in the classification of disorders in DSM-5.

  14. Hazen EP, McDougle CJ, Volkmar FR. Changes in the diagnostic criteria for autism in DSM-5: controversies and concerns. J Clin Psychiatry. 2013;74(7):739–40.

    Article  PubMed  Google Scholar 

  15. Halfon N, Kuo AA. What DSM-5 could mean to children with autism and their families. JAMA pediatrics. 2013;167(7):608–13.

    Article  PubMed  Google Scholar 

  16. Sansone RA, Forbis JS, Sosa T. Primary care perspectives on treating bipolar disorder: a cross-sectional survey. Prim Care Companion CNS Disord. 2011;13(2):doi:10.4088/PCC.10m01072.

  17. Zimmerman M, Ruggero CJ, Chelminski I, Young D. Is bipolar disorder overdiagnosed? J Clin Psychiatry. 2008;69(6):935–40.

    Article  PubMed  Google Scholar 

  18. Angst J. Bipolar disorders in DSM-5: strengths, problems and perspectives. Int J Bipolar Disord. 2013;1:12.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Cerimele JM, Chwastiak LA, Dodson S, Katon WJ. The prevalence of bipolar disorder in primary care patients with depression or other psychiatric complaints: a systematic review. Psychosomatics. 2013;54(6):515–24.

    Article  PubMed  Google Scholar 

  20. Baldessarini RJ, Faedda GL, Offidani E, et al. Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: a review. J Affect Disord. 2013;148(1):129–35.

    Article  CAS  PubMed  Google Scholar 

  21. Tondo L, Vazquez G, Baldessarini RJ. Mania associated with antidepressant treatment: comprehensive meta-analytic review. Acta Psychiatr Scand. 2010;121(6):404–14.

    Article  CAS  PubMed  Google Scholar 

  22. Mixed Features Specifiers American Psychiatric Association; 2013. http://www.dsm5.org/Documents/Mixed%20Features%20Specifier%20Fact%20Sheet.pdf. Accessed November 18, 2015

  23. Hu J, Mansur R, McIntyre RS. Mixed specifier for bipolar mania and depression: highlights of DSM-5 changes and implications for diagnosis and treatment in primary care. The Primary Care Companion for CNS Disorders. 2014;16(2):PCC.13r01599.

    PubMed Central  PubMed  Google Scholar 

  24. Force USPST. Screening for depression in adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2009;151(11):784–92.

    Article  Google Scholar 

  25. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Kenneth S, Kendler MD, John Myers MS, Sidney Zisook MD. Does Bereavement-Related Major Depression Differ From Major Depression Associated With Other Stressful Life Events? Am J Psychiatry. 2008;165(11):1449–55.

    Article  Google Scholar 

  27. Spitzer RL, Wakefield JC. DSM-IV diagnostic criterion for clinical significance: does it help solve the false positives problem? Am J Psychiatry. 1999;156(12):1856–64.

    CAS  PubMed  Google Scholar 

  28. Wakefield JC, Schmitz MF, Baer JC. Does the DSM-IV clinical significance criterion for major depression reduce false positives? Evidence from the National Comorbidity Survey Replication. Am J Psychiatry. 2010;167(3):298–304.

    Article  PubMed  Google Scholar 

  29. Hofler M, Wittche HU. Why do primary care doctors diagnose depression when diagnostic criteria are not met? Int J Method Psychiatr Res. 2000;9:110–20.

    Article  Google Scholar 

  30. Biggs WS, Demuth RH. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2011;84(8):918–24.

    PubMed  Google Scholar 

  31. Badour CL, Resnick HS, Kilpatrick DG. Associations Between Specific Negative Emotions and DSM-5 PTSD Among a National Sample of Interpersonal Trauma Survivors. J Interpers Violence. 2015. Epub ahead of print.

  32. Tarn DM, Heritage J, Paterniti DA, Hays RD, Kravitz RL, Wenger NS. Physician communication when prescribing new medications. Arch Intern Med. 2006;166(17):1855–62.

    Article  PubMed  Google Scholar 

  33. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). Boston, MA: National Center for PTSD; 2013.

    Google Scholar 

  34. Spoont MR, Williams Jr JW, Kehle-Forbes S, Nieuwsma JA, Mann-Wrobel MC, Gross R. Does this patient have posttraumatic stress disorder?: rational clinical examination systematic review. JAMA. 2015;314(5):501–10.

    Article  CAS  PubMed  Google Scholar 

  35. Liebschutz J, Saitz R, Brower V, et al. PTSD in urban primary care: high prevalence and low physician recognition. J Gen Intern Med. 2007;22(6):719–26.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res. 2003;12(1):34–43.

    Article  PubMed  Google Scholar 

  37. Dimsdale JE, Creed F, Escobar J, et al. Somatic symptom disorder: an important change in DSM. J Psychosom Res. 2013;75(3):223–8. This article provides an overview of implications of the replacement of the somatoform disorders cluster with somatic symptom disorder and illness anxiety disorder.

    Article  PubMed  Google Scholar 

  38. Aragona M. Epistemological reflections about the crisis of the DSM-5 and the revolutionary potential of the RDoC project. Dial Phil Ment Neuro Sci. 2014;7:11–20.

    Google Scholar 

  39. Cosgrove L, Krimsky S. A comparison of DSM-IV and DSM-5 panel members' financial associations with industry: a pernicious problem persists. PLoS Med. 2012;9(3), e1001190.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Charney DS, Barlow DH, Botteron K, et al. Neuroscience research agenda to guide development of a pathophysiologically based classification system. In: Kupfer DJ, First MB, Regier DA, editors. A Research Agenda for DSM-V. Washington, D.C.: American Psychiatric Association; 2002. p. 31–83.

    Google Scholar 

  41. insel T. Director's Blog: Transforming Diagnosis 2013; http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml. Accessed September 30, 2015

  42. Insel TR, Lieberman JA. DSM-5 and RDoC: shared interests. 13 May 2013. http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-shared-interests.shtml (accessed 27 Jun 2013). Accessed September 24, 2015.

  43. Frances A. The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill. Bmj. 2013;346:f1580.

    Article  PubMed  Google Scholar 

  44. Frances A. Saving normal: an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. New York: HarperCollins Publishers; 2013.

    Google Scholar 

  45. Batstra L, Frances A. Diagnostic inflation: causes and a suggested cure. J Nerv Ment Dis. 2012;200(6):474–9. Co-authored by the chair of the DSM-IV writing committee, provides a summary of the critique that DSM-5 fosters overdiagnosis of mental disorders.

    Article  PubMed  Google Scholar 

  46. Olfson M, Blanco C, Liu SM, Wang S, Correll CU. National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatr. 2012;69(12):1247–56.

    Article  PubMed  Google Scholar 

  47. Hampton LM, Daubresse M, Chang HY, Alexander GC, Budnitz DS. Emergency department visits by adults for psychiatric medication adverse events. JAMA psychiatry. 2014;71(9):1006–14.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Pincus HA, Davis WW, McQueen LE. Subthreshold' mental disorders. A review and synthesis of studies on minor depression and other 'brand names. Br J Psychiatry. 1999;174:288–96.

    Article  CAS  PubMed  Google Scholar 

  49. Manaker S. Time to Get Off the Diagnosis Dime Onto the 10th Revision of the International Classification of Diseases. Ann Intern Med. 2015;163(7):557–8.

    Article  PubMed  Google Scholar 

  50. Crowley RA, Kirschner N, Health, Public Policy Committee of the American College of P. The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: executive summary of an American College of Physicians Position Paper. Ann Intern Med. 2015;163(4):298–9. Sponsored by the American College of Physicians, this position paper provides a passionate, evidence-based call-to-action for increased integration of mental health services into primary care.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Medicine, Columbia University Medical Center, 622 W. 168th Street, PH9-311, New York, NY, 10032, USA

    Ian M. Kronish & Nathalie Moise

  2. Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Box 104, New York, NY, 10032, USA

    Ravi N. Shah

Authors
  1. Ian M. Kronish
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ravi N. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nathalie Moise
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ian M. Kronish.

Ethics declarations

Conflict of Interest

Ian M. Kronish and Nathalie Moise declare that they have no conflict of interest.

Ravi N. Shah is a Board of Trustees member of the American Psychiatric Association (APA) which publishes DSM-5. Dr. Shah is not financially compensated by the APA.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Psychiatry in Primary Care

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kronish, I.M., Shah, R.N. & Moise, N. What Should Primary Care Providers Know About the Changes in DSM-5?. Curr Psychiatry Rep 18, 30 (2016). https://doi.org/10.1007/s11920-016-0666-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-016-0666-5

Keywords

Search

Navigation