DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) – a nosological system in use in the United States since 2013, the “nomenclature” of mental disorders. The DSM-5 was published on May 18, 2013, replacing the 2000 DSM-IV-TR. The descriptive and phenomenological classification approach used by DSM-IV-TR, with the latest research results, is inaccurate.
In the United States, DSM has a high profile in psychiatry. Recommendations on the use of psychological disorders, as well as DSM, so the appearance of a new version is of great practical importance.
Changes in the DSM-5 are confirmed by new research in the field of psychiatry and advances in neuroscience. Many standard diseases were in the 11th revision (ICD-11).
Over 400 specialists of various specialties (psychiatry, neurology, pediatrics, first aid, epidemiology, research methodology and statistics, psychology) from 13 countries took part in the work on DSM-5.
As a result of the accumulation of new information on gender and cultural differences, the experts decided to briefly review the chapters accompanying each set of diagnostic criteria, mention gender, age, and cultural aspects. Almost all diagnostic categories in the new manual have this data. Since the social environment is currently preoccupied with heredity, epigenetics, the risk of upsets, and protective factors, these questions are raised in the DSM-5 text.
Also, when developing a new guide, the characteristics of the manifestation of symptoms in different cultures were taken into account. For example, criterion “B” DSM-5 (criterion “A” in DSM-IV-TR) of a social anxiety disorder (English social anxiety disorder) has been expanded to include not only fear of disgrace or fear of self-humiliation but also anxiety about insult by others. This symptom is taken from Japanese culture.
Assessment of the severity of the disorder: severity scales, specifiers
As described in the chapter, “Schizophrenic Spectrum Disorders and Other Psychotic Disorders,” psychotic disorders are heterogeneous, and symptoms can predict important consequences, such as the degree of cognitive and/or neurobiological deficiency.
The document states: severity is based on impaired social communication and limited, repetitive patterns of behavior. Depending on the severity, 3 levels are indicated: 1) “Significant help is required”, 3) “Very significant help is required.” Even though all these conditions are combined into disorders, depending on the state of the person, variants of the disorders can be determined, including structural impairment of speech, loss of acquired skills, concomitant somatic diseases and the presence or absence of a decrease in intelligence.
The assessment of disorders in the DSM-5 is dimensional (measurement), and many specifications and subtypes are available that describe the phenomenological variants of the disorders. For example, in depressive, bipolar and mixed conditions, the “mixed traits” specifier is installed, which replaces the 2 diagnostic headings DSM-IV-TR (type I bipolar disorder and mixed episode). The specifier “with mixed functions” is currently used to diagnose both bipolar and unipolar conditions.
DSM-5, in addition to categories, includes the dimensional aspects of the diagnosis. Subtypes, qualifiers, “end-to-end symptom ratings” (integrated symptom rating), and severity scales have been introduced. The severity scale of the disorders: “mild”, “moderate”, “severe”, in other disorders – 1/2/3 level. Evaluation symptoms will help psychiatrists better determine the severity of mental disorders and choose a radiation therapy strategy.
In the section “adaptation disorders”, the specifier with pronounced social emotions was added to describe overly rude children with negative affectivity, expressed more pronounced (for example, more frequent and severe outbreaks of aggression).
For paraphilic disorders, the specifiers “in remission” and “in a controlled environment” are created.