Differences between DSM-IV and DSM5 ,

in diagnosing Psychological and Emotional Disorders in Children and Adolescents

Dr. Ahmed ALbehairy, M.DConsultant of Psychiatry

REF: DSM5, C. Nuckols, PhD, George Haarman Psy.D

Broad Aspects in DSM 5

Organizational Structure Changes

DSM-5DSM-5- “…the boundaries between many disorder

‘categories’ are more fluid over the life course than DSM-IV recognized, and many symptoms assigned to a single disorder may occur, at varying levels of severity, in many other disorders.”

- Scientific evidence places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms.

DSM-5DSM-5

• “DSM is a medical classification of disorders and as such serves as a historically determined cognitive schema imposed on clinical and scientific information to increase its comprehensibility and utility.”

DSM-5DSM-5 Personality Disorders are discussed in 2

areas, 1) DIAGNOSTIC CRITERIA & CODES, and 2) EMERGING MEASURES & MODELS (Alternative Model for Personality Disorders) .

First represents an update of the text associated with the same criteria found in DSM-IV-TR, whereas 2nd discussion I includes the proposed research model for personality disorder diagnosis and conceptualization.

DSM-5DSM-5• Harmonization with ICD-11 ( International Classification of

Disease)– DSM-5 and proposed structure of ICD-11 are working

toward consistency– ICD-10 is scheduled for US implementation in October

2014– ICD-9 codes are used in DSM-5

• Dimensional Approach to Diagnosis– Previous DSM’s considered each diagnosis categorically

separate from health and other diagnoses– Doesn’t capture the widespread sharing of symptoms and

risk factors (why we had some many NOS diagnoses)

Dimensional Approach to Dimensional Approach to DiagnosisDiagnosis

• Shared neural substrates• Family traits• Genetic risk factors• Specific environmental risk factors• Biomarkers• Temperamental antecedents• Abnormalities of emotional or cognitive processing• Symptom similarity• Course of illness• High comorbidity• Shared treatment response.

Dimensional Approach to Dimensional Approach to DiagnosisDiagnosis

• It is demonstrated that the clustering of disorders according to internalizing and externalizing factors represent an empirically supported framework. Within both the internalizing group (anxiety, depression and somatic) and externalizing group (impulsive, disruptive conduct and substance use), the sharing of genetic and environmental risk factors likely explains the comorbidities

DSM-5DSM-5Developmental and Lifespan Considerations:

– Begins with diagnoses that occur early in life (neurodevelopmental and schizophrenia spectrum), followed by diagnoses that more commonly manifest in adolescence and young adulthood (bipolar, depressive and anxiety disorders and ends with diagnoses relevant to adulthood and later life (neurocognitive disorders).

– After neurodevelopmental disorders, see groups of internalizing (emotional and somatic) disorders, externalizing disorders, neurocognitive disorders and other disorders.

DSM-5DSM-5Developmental and Lifespan Considerations:

– Cultural Issues– Gender Differences– Use of Other Specified and Unspecified

Disorders» Replaces NOS designation» Other Specified used when clinician

wishes to communicate the specific reason the presentation does not meet criteria for diagnoses

» If clinician does not choose to specify the reason Unspecified Disorder is used

Differences between DSM-IV and DSM5

• General changes.

• Coding and reporting procedures.

• Specific disorders.

World Health Organization Disability assessment Schedule 2.0

Psychiatric Disorders in

Children

In DSM5• RED = NEW LABEL. • BLUE = NEW CORRELATION .In DSM-IV • Green = moved

DSM-IVDisorders usually first diagnosed in

infancy, childhood, or adolescence )DSM-IV): 10 LABELS

1-Mental retardation ( on axis II) mild MR moderate MR severe MR profound MR MR, severity unspecified.

2- Learning disordersReading dis.Mathematics disDisorder of written expression Learning disorder NOS

DSM5

Neurodevelopment disorders.7 LABELS1-ntellectual disabilityMildModerateSevere ProfoundGlobal developmental delayUnspecified intellectual disability

2- Specific learning disorder Specify if With impairment in reading With impairment in written expressionWith impairment in mathematics.Specify severity ( mild , moderate ,

sever).

Intellectual disabilities (I.D)

• Intellectual disabilities (I.D) is a term more consistent with international thinking .

• Diagnostic specifier in I.D includes not only psychometry ( IQ),but also adaptive functions of daily life activities.

3- Motor skills disorder. Developmental coordination

disorder.

4- Tic disorders Tourette’s dis Chronic motor or vocal tic disorder.Transient tic disorderNOS

3-Motors disorders :

Developmental coordination disorder.Stereotype movement disorder

( specify with or without self injurious / specify known medica,genetic,neurodevep,environ/ specify severity).

Tic disorders Tourette’s disPersistant ( chronic) motor or vocal tic

disorder.Provisional tic disorderOther specified unspecified

5-Communication disorders:expressive language disorder.Mixed receptive expressive

language disorder.Phonological disorder.Stuttering Communication dis NOS.

6- Pervasive developmental disorders

Autistic disorderRett’s disorderChildhood disintigrative disAsperger Pervasive developmental disorders NOS

4-Communication disorders:Language disorder

Speech sound disorderChildhood fluency disorder

(stuttering ) Social (pragmatic ) communication

disorder Unspecified5- Autism spectrum disorderspecify known

medica,genetic,neurodevep,environ/

specify severity specify if intellectual imparement

7-ADHD and disruptive behaviorADHDADHD NOSConduct disOppositional defiant Disruptive behavior NOS8- Feeding & eating disorders of infancy or

childhood PicaRuminationFeeding dis of infancy and children

9- Elimination disordersEncorporesis Enuresis not due to GMC, N,D,N&D

10 -Other disorders of infancy, childhood , adolescence

Separation anxietymutismReactive attachment disorderStereotype movement disorderNOS

6- ADHD Specify severity, specify in partial remission

Other specified ADHDUnspecified ADHD

7- Other neurodevelopmental disorder

Other specifiedunspecified

DSM5• FEEDING AND EATING DISORDERSPica In children , in adult Rumination disorder avoidant/restrictive food intakeA.N ( specify restricting , binge/purging)B.NBinge eating Otherunspecified

DSM5

Elimination disorders.

Disruptive , impulse control and conductconduct and oppositional defiant move to it .

Trauma and stressors related disorders Reactive attachment disorder move to it and

divided to RAD and disinhibited social engagment dis.

DSM5

• Anxiety disorders :

separation anxiety disorder and selective mutism move to it .

THANK YOU