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Significant Changes to the Way Certain Mental Disorders are Diagnosed in DSM-V

January 3rd, 2013

The New Year brings significant changes to the way certain mental disorders are diagnosed, in the    Diagnostic and Statistical Manual of Mental Disorders –V (“DSM-V”).   In December,  the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual.   The final version of the DSM-V will be available in May 2013.

One of the most controversial changes for the DSM-V is creating a single “autism spectrum disorder” category, with stricter requirements than the DSM-IV.   After considerable study and controversy, the American Psychiatric Association voted to approve a new, streamlined definition of autism, that technically eliminates the diagnosis of Asperger’s Syndrome or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS).    The Work Group has proposed that autism, Asperger‘s disorder, PDD-NOS and childhood disintegrative disorder be consolidated within  the category of Autism Spectrum Disorder.  But the new definition notes that psychiatrists should  with take into account a person’s diagnostic history. Thus, the new definition would include anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before.   According to Commentary by the America Psychiatric Association, “The change signals how symptoms of these disorders represent  a continuum from mild to severe, rather than being distinct disorders. The new category is expected to help clinicians more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, instead of providing general  labels that tend not to be consistently applied across different clinics and centers.”

Specifically, the new definition requires:

A.    Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:


1.     Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,

2.     Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated-verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3.     Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different
social contexts through difficulties in sharing imaginative play and  in making friends to an apparent absence of interest in people.

B.    Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of  the following:
1.     Stereotyped or repetitive speech, motor movements, or use of objects (such as simple motor stereotypes, echolalia, repetitive use of objects, or idiosyncratic phrases);
2.     Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes);
3.     Highly restricted, fixated interests that are abnormal in intensity or focus (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests);
4.     Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects);
C.    Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities).
D.         Symptoms together limit and impair everyday functioning.

Pediatric bipolar disorder also posed a challenge to the Work Group.   Psychiatrists are more frequently giving the diagnosis of Bipolar disorder, characterized by episodes of depression and mania, even  to children as young as 2 — along with powerful psychiatric drugs and tranquilizers.  To stop this trend, the committee created an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.

The DSM-V new mental disorders include:

  • Hoarding; (previously considered a symptom of obsessive-compulsive behavior)
  • “Premenstrual dysphoric disorder,”
  • “Binge-eating disorder “

The changes above should not have a significant impact on school classification of students and will not result in fewer students being classified.   The 13 areas of disability under the Individuals with Disabilities Education Improvement Act remain constant and depend on the discussion and consensus of the Committee on Special Education, not on a medical diagnosis.  For autism, the changes proposed by DSM-5 are designed to better identify autism spectrum disorders and distinguish them from other conditions.   In some ways, the criteria for DSM-5 are actually broader.   For example, while DSM-IV criteria require evidence of difficulties related to autism prior to age 3, the DSM-5 definition only requires a child to show examples of unusual behavior in early childhood, whether or not they occur before age 3.

For more information, visit www.specialneedsnewyork.com.

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