Changes from DSM-IV-TR to DSM-5

Dr. Hani Hamed Dessoki, M.D.Psychiatry

Prof. Psychiatry

Chairman of Psychiatry Department

Beni Suef University

Supervisor of Psychiatry Department

El-Fayoum University

APA member

Somatoform disorders

Somatic symptom and related disorders

Somatic Symptom Disorders

Joel E. Dimsdale, M.D. ChairJames L. Levenson, M.D., Text Coordinator Michael R. Irwin, M.D.Francis J. Keefe, Ph.D. (2007-2011)Arthur J. Barsky III, M.D. Sing Lee, M.D.Francis Creed, M.D. Michael Sharpe, M.D.Nancy Frasure-Smith, Ph.D. (2007-2011) Lawson R. Wulsin, M.D.

Somatic symptom and related disorders

Somatoform disorders are now called somatic symptom and related disorders.

In DSM-IV, there was significant overlap across the somatoform disorders and a lack of clarity about their boundaries.

These disorders are primarily seen in medical settings, and nonpsychiatric physicians found the DSM-IV somatoform diagnoses problematic to use.

Somatic symptom and related disorders

The DSM-5 classification reduces the number of these

disorders and subcategories to avoid problematic overlap.

Diagnoses of somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder have been removed.

Somatic Symptom Disorder

The diagnosis of somatization disorder was essentially based on a long and complex symptom count of medically unexplained symptoms.

DSM-5 criteria for somatic symptom disorder includes the maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms.

Somatic Symptom Disorder

In DSM-IV, the diagnosis undifferentiated somatoform disorder did not prove to be a useful clinical diagnosis.

The distinction between somatization disorder and undifferentiated somatoform disorder was arbitrary.

Somatic Symptom and Related Disorders (161)

300.82 (F45.1)Somatic Symptom Disorder (161)

Specify if: With predominant pain

Specify if: Persistent

Specify current severity: Mild, Moderate,

Severe

Medically Unexplained Symptoms

The DSM-5 classification defines disorders on the basis of positive symptoms (i.e., distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms).

Medically unexplained symptoms do remain a key feature in conversion disorder and pseudocyesis.

Hypochondriasis and Illness Anxiety Disorder J02

In DSM-5, individuals with high health anxiety without somatic symptoms would receive a diagnosis of illness anxiety disorder (unless their health anxiety was better explained by a primary anxiety disorder, such as generalized anxiety disorder).

Specify whether: Care seeking type,

Care avoidant type

Somatic symptom and related disorders

In DSM-5, people with chronic pain can be diagnosed with 

somatic symptom disorder with predominant

pain;

or psychological factors that affect other medical

conditions;

or with an adjustment disorder.

Psychological Factors Affecting Other Medical Conditions and Factitious Disorder

Psychological factors affecting other medical conditions is a new mental disorder in DSM-5, having formerly been included in the DSM-IV chapter “Other Conditions That May Be a Focus of Clinical Attention.”

Specify current severity: Mild, Moderate, Severe, Extreme

Conversion Disorder (Functional Neurological Symptom Disorder) J03

Criteria for conversion disorder (functional neurological symptom disorder) are modified to emphasize the essential importance of the neurological examination, and in recognition that relevant psychological factors may not be demonstrable at the time of diagnosis.

Conversion Disorder (Functional Neurological Symptom Disorder) (163)

Specify symptom type:

(F44.4)With weakness or paralysis

(F44.4)With abnormal movement

(F44.4)With swallowing symptoms

(F44.4)With speech symptom

(F44.5)With attacks or seizures

(F44.6)With anesthesia or sensory loss

(F44.6)With special sensory symptom

(F44.7)With mixed symptoms

Specify if: Acute episode, Persistent

Specify if: With psychological stressor (specifystressor), Without psychological stressor

Specific Changes Per Diagnostic Category in DSM-5

Obsessive-Compulsive and Related DisordersOCD is now a stand alone categoryBody Dysmorphic Disorder listed under OCD as

F01Added Hoarding under category of OCD as F02Trichotillomania now called Hair-Pulling Disorder is

listed under OCD as F03Skin Picking Disorder moved under OCD as F04

Factitious Disorder 300.19

Factitious Disorder (includes Factitious Disorder Imposed on Self,

Factitious Disorder Imposed on Another) (165)

Specify Single episode,

Recurrent episodes

More radical criticisms

The extremely high rates of comorbidity (ranging from dimensional diagnosis to various forms of etiopathogenetic diagnosis).

The financial association of DSM-5 panel members with industry continues to be a concern for financial conflict of interest.

Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members.