Sunday, June 30, 2013

Changes in the DSM V (Part 1)

Folks, when I undertook to summarize the changes from DSM IV to DSM V, I was biting off more than could chew! At least, in one blog, that is. I will have to give it to you in chunks, and oversimplified chunks at that.  You are welcome to read the “not exhaustive” but exhausting (!) APA list of changes for yourself if you like. You will find them here: bit.ly12x42BU. There are far more categories than I ever realized.

But let’s start with an important victory right at the top of the document. From now on, the language of the DSM recognizes that a mental illness is a medical condition. When someone has a mental illness and a physical illness and both are mentioned, the physical illness will be referenced as “another medical condition” not a “general medical condition” as in the past. To some that may seem picky - but as anyone who’s ever worked for the equality of an underclass can tell you, language is important. The way we speak and write about things influences the way we think about them.

I’ll begin with the category “Psychotic Disorders.” There are a number of changes here. Perhaps the most signal is the elimination of the word “bizarre” in front of “delusions.” This is important, I think, as a step towards recognizing us as fellow human beings. Everybody has delusions, not just schizophrenics, and calling them names if they depart too far from the norm is not particularly helpful. Much better to rate them by whether a person can function with that particular delusion, or whether it makes life unmanageable. All this is implied by the APA’s own words: the term “bizarre” was abandoned due to “poor reliability in distinguishing bizarre from non-bizarre delusions.”

Also, two of Criterion A symptoms (delusions, hallucinations, and disorganized speech) are required now, not just one. A number of subtypes (paranoid, disorganized, catatonic) have been flat out eliminated due to “limited...stability...and poor validity,” which will no doubt please patients who dislike labels. Instead, measuring will be done on a basis of severity of core symptoms. Which goes right along with what I was saying above about judging by functionality.

A diagnosis of Schizoaffective Disorder will now require that a major mood episode be present for the majority of the disorder’s duration, “recognizing that the characterization of patients with both...symptoms...has been a clinical challenge.” Boy, you said it. I am still not sure if I am better described as Schizoaffective or, as my psychiatrist would have it, Bipolar with Psychotic Features. It kind of depends on which day you see me.

Delusional Disorder, with which I admit I am not familiar, is no longer separated from Shared Delusional Disorder, and can only be diagnosed if it is not better explained by Obsessive-Compulsive Disorder or Body Dysmorphic Disorder.

Lastly, Catatonia now has the same criteria whether it applies in a bipolar, psychotic, depressive or other medical context. All of them now require 3 catatonic symptoms.

Whew. That’s enough to digest for now, don’t you think? I’ll go on with more next time. We have yet to cover Bipolar, Depressive, Anxiety, Obsessive-Compulsive and Panic Disorders, just to name a few. It looks like a long ride from here.

Deborah is the author of Is There Room for Me, Too? 12 Steps & 12 Strategies for Coping with Mental Illness, available at Amazon and other major vendors. Visit her web page at or see her catalog at