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this video is for students and mental
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health professionals alike who want to
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orient themselves to the changes to the
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dsm-5 that were just published in march
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of 2022
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this presentation is not affiliated with
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or endorsed through the american
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psychiatric association but it's my
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summary of some of the key changes that
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have happened based on directly from the
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source it assumes a basic understanding
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of the dsm-5 and just focuses on the
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updates made so if you want a more
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comprehensive overview of the dsm i have
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another video that you can check out but
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let's explore what's changed in the tr
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if you weren't aware tr stands for text
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revision and can you believe it has been
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nine years since the dsm-5 came out
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replacing the four well now it is time
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for our
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beloved purple friend here to make way
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for the new tr
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and it's the updated fifth edition with
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the most current text updates based on
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scientific literature and input from
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experts it's important to note that this
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is not the dsm-6 it's more like 5.2 if
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you will
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and it's got the same overall purpose
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it's got a lot of the same information
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it's a manual that helps clinicians and
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researchers to define and classify
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mental disorders which can help improve
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diagnosis treatment and research
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so how did we get here
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the apa has lots of fact sheets which i
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used to create this presentation but one
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of them gives detail about exactly how
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it was developed but in short the apa
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started work on the tr in spring of 2019
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and it involved the work of over 200
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subject matter experts a lot of those
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people who are actually involved in the
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development of the original five
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and they came from a lot of different
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diverse
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backgrounds and
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internationally recognized folks with
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backgrounds in psychiatry psychology
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social work
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pediatrics neurology nursing
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epidemiology anthropology and the list
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goes on and the whole process was
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overseen by a variety of task force
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steering committees and subcommittees
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so what did they come up with let me
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preface this by saying don't shoot the
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messenger okay i know all the versions
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of the dsm have inspired vigorous
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discussions and lively debate and i'm
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not here to analyze the merits or
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provide a critique although there
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certainly is room for that
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but to describe what is and just
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summarize what we have
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in a nutshell if you don't have time for
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this whole video you're in luck i have a
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quick
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summary of everything i'm going to talk
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about in a little bit more detail so
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here are the highlights
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there's a new disorder that's been added
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added it's called prolonged grief
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disorder
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there are new icd codes for suicidal
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behavior and suicidal self-injury we're
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also now only using the icd-10 instead
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of the nine
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we've clarified criteria and includes
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updated information to capture the
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experiences and symptoms of children
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more precisely and other criteria
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changes that i'll talk about
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and there's increased attention to
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culture racism and discrimination
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throughout
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let's talk about these in a little bit
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more detail starting with our brand new
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disorder prolonged grief disorder
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previously in the dsm-5
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they included a category of persistent
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complex bereavement disorder as one of
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those conditions for further study
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and it has now been promoted if you will
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to a real full disorder and it lives in
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the trauma and stressor related
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disorders category
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and according to the apa it is defined
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by quote a prolonged grief disorder
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with an intense yearning or longing for
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the deceased
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often with intense sorrow and emotional
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pain
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and preoccupation with thoughts or
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memories of the deceased
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in children and adolescents this
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preoccupation may focus on the
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circumstances of the death if you're
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interested in this and want to dig in
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more there's a fact sheet on apa and
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some other resources popping up to
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go into this in more detail in terms of
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what it is how we came how not we how
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they came to this decision
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and what it looks like and i'm sure
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there will be continued debate about it
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as well
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moving on to the icd codes so if you
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weren't aware in october of 2015 the
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official coding system in the u.s
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moved to the icd-10 that's the
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international classification of diseases
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and
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in the dsm-5 both the icd-9 and 10 were
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listed because when the dsm-5 was
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released the not the icd-9 was still in
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use in the u.s
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now that we're coming out with the tr
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and the icd-10 is well underway they've
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moved just to those 10 codes
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and additionally there are new codes two
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new codes one for suicidal behavior and
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one first non-suicidal self-injury
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there are also a large number of
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clarifications and updates to criteria
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and disorder
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descriptions
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they made updates to the descriptive
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text for most disorders over 70 of them
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and also did some clarifi clarification
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of modifications to criteria sets
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i mentioned before there are specific
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fact sheets on the apa website and
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there's several listed here but i'm just
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going to give you a few examples of the
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types of changes that were made
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so for example
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with autism spectrum disorder
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criterion a
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which used to say as manifested by the
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following
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was revised to say as manifested by all
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of the following
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to improve intent and clarity of the
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wording
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so there's these minor changes that
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actually can have a fairly big impact on
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how a diagnosis is given here's another
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example with gender dysphoria
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the text of gender dysphoria was updated
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to use more culturally sensitive
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language like desired gender was changed
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to experience gender
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and cross-sex medical procedure was
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updated to gender affirming medical
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procedure
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another example is with delirium and to
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clarify the meaning of criterion a
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the parentheses phrase reduced
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orientation to the environment was
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removed
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and the second half was instead changed
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to accompanied by
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reduced awareness of the environment so
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from orientation to awareness
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these might seem like minor it's a one
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word difference right but it can really
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make a big impact
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the other thing that is notable here is
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that they added more specific language
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for diagnostics relevant to children
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so more precise criteria especially for
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autism spectrum
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disruptive mood dysregulation disorder
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ptsd and
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the new prolonged grief disorder
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so here's an example for ptsd it says
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for children six and younger
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they noted that witnessing does not
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include events that are witnessed only
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in electronic media television movies or
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pictures
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the next thing we have is increased
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attention to culture racism and
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discrimination
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so one of the focuses in the development
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of the tr was reviewing the impact of
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racism and discrimination on the
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diagnosis and manifestations of mental
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disorders
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and attention was paid to the risk of
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misdiagnosis when evaluating individuals
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who are from historically marginalized
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or
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socially oppressed groups the apa has
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fact sheets on this as well but i've
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summarized what i thought were some of
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the biggest changes in terms of language
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and approach
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the term racialized
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is used instead of race or racial to
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highlight the socially constructed
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nature of race
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and taking these bullets directly from
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the apa so they they get the credit for
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some of this um wording and all that but
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the term ethnoracial was used to denote
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the u.s census categories such as
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hispanic white or african-american that
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combine ethnic and racialized
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identifiers
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let's see what else we have here the
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terms minority and non-white were
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avoided because they described social
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groups in relation to a racialized
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majority
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and that tends to perpetuate social
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hierarchies
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the emerging term latinx is used in
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place of latino or latina to promote
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gender inclusive terminology
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the term caucasian is not used because
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it's based on obsolete and erroneous
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views about the geographic origin of a
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prototypical pan-european ethnicity
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and prevalence data on specific
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ethnographial groups were included when
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that existing research documented
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reliable estimates that were based on
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representative samples from those groups
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they also included more information on
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variants and how symptoms are expressed
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depending on some of these factors
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related to culture and race and
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similarly talking about the ways that
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cultural norms affect how we perceive
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pathology in certain communities and
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cultures
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again don't shoot the messenger here i'm
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merely relaying what was changed and so
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love it or hate it that's how it is in
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the tr right now
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then moving on to section three that's
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that part at the very back of the dsm
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that talks about assessment cultural
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context and conditions for further study
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which everyone's always very interested
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in
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so that's emerging
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measures and models basically is what
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this section is and they still have it
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in the tr
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it's meant to offer tools and techniques
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to help clinicians enhance clinical
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practice understand the cultural context
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of mental disorders and facilitate
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further study of proposed emerging
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diagnoses that was a quote from the apa
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as well
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some of the big changes in tr though is
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that in those
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assessment measures the check boxes for
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male or female was removed to eliminate
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the use of binary classification
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in terms of those clinician-rated
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dimensions of psychosis and symptom
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severity measures they basically edited
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those instructions to be in keeping with
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the criteria and severity specifiers for
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schizophrenia spectrum and other
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psychotic disorders which were one of
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the big things that changed
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in this list of 70. so if you are
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working in the field of psychosis and
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related disorders or want to i would
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definitely check that out because
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there's some information about that
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and then the who's disability
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assessment schedule the world health
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organization
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they have clarifications about
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instructions on calculating summary
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scores
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for the
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w-h-o-d-a-s
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2.0 the 36 item full version
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in terms of culture i mentioned a few of
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those
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that they've hit on previously but in
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this section specifically there are some
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key terms that highlight cultural
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context and
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how that context impacts how illnesses
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are experienced
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and
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some of the concept of distress were
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revised to provide more clarifications
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and ensure that there was no
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stigmatizing or generalizing language
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the cultural formulation section also
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presents an outline for a more
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systematic person-centered cultural
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assessment
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there is a cultural concept of distress
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section that
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goes into more detail about the ways
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that individuals will express report and
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interpret those experiences of illness
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and distress
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and this includes examples like idioms
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or
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culturally normative explanations causes
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for certain syndromes
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and there's another section here that i
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don't have listed on the slide that's
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the alternative dsm-5 model for
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personality disorders there's no changes
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in that that one got to stay just as it
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is
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and then we have the last section which
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is conditions for further study
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and as i mentioned previously what used
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to be persistent complex bereavement
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disorder
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has now moved to the trauma stressor
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related section as an official diagnosis
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that is now
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deemed prolonged grief disorder
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those are the changes to the dsm 5tr i
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hope that you found this summary to be a
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helpful review here are some of my
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references and opportunities for further
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study and good luck
