CHANGES FROM DSM 4 TO DSM 5

~VRINDA GUPTA AND ISHITA WADHWANI

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The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is the most widely used manual by mental health practitioners to recognize and diagnose specific disorders.

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Although this manual is distributed by the American Psychiatric Association, psychologists have for long contributed to its development – and increasingly so in recent years.
Here in this article, we will be listing the key changes made to the DSM-V diagnostic criteria and texts since its last publication in the year 1994 (DSM-IV).

 

1. ELIMINATION OF THE MULTI-AXIAL SYSTEM :

DSM-IV used the multi-axial system to facilitate psychiatric evaluation and organize relevant bio-psychosocial information. It had five axes.



This approach has been dropped in the DSM 5, for its lack of conceptual clarity. The new non-axial diagnostic system of DSM-5 has simplified categorization in an attempt to eliminate artificial distinctions between diagnoses.
 

2. RECLASSIFICATION OF DISORDERS:

Six new categories were added, four were removed and several were renamed. Therefore, numerous individual disorders have been reclassified from one class to another in DSM-5. The changes in diagnostic categories from DSM-IV to DSM-5 have been documented in the table below.



 

3. REVISIONS TO ADHD DIAGNOSIS:

Though the symptoms are essentially the same as DSM-IV, there are a few changes in ADHD’s diagnostic criteria. Since adults have better-evolved brains and show better control over their impulses, they can be diagnosed with ADHD even if they have lesser signs and indications than children.

4. ELIMINATION OF CHILDHOOD BIPOLAR DISORDER:

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The DSM-5 has replaced Childhood Bipolar Disorder with Disruptive Mood Dysregulation Disorder (DMDD). While not all kids who were earlier determined to have Bipolar Disorder will fall under DMDD, the new diagnosis precisely coordinates the cluster of symptoms characterized by extraordinary temper upheavals.
 

5. THE AUTISM SPECTRUM:

In the DSM-5, four individual disorders namely: Pervasive Developmental Disorder, Autism, Asperger’s, and Childhood Disintegrative Disorder have been unified under the name of Autism Spectrum Disorder.

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6. INTELLECTUAL DISABILITY:

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The disorder previously referred to as “Mental Retardation” in DSM-IV has been renamed to “Intellectual Disability” in DSM-5. However, this term has been subject to criticism and therefore the DSM-5 also uses the term Intellectual Development Disorder. The diagnostic criteria for this disorder have also been revised to emphasize adaptive functioning over IQ scores.

DSM-5 may have some advantages over DSM-IV, but it has been subject to severe criticism. Experts and clinicians have raised concerns about the inherent limits of the very principles of the manual. The manual is set to have several revisions that aim to improve the validity, reliability, and clinical utility of DSM-5.