DSM-IV and DSM-V Differences: Ending the Confusion
The DSM-5 has been out for a year now and – fourteen years in the making – it has been the subject of seemingly endless discussion. Are you “up with the play” on the changes – or just up to your ears in confusion?
One source said that there were 464 changes, although many of these are minor. Some have criticised it on the grounds that it pathologises normal everyday stress, leads doctors to prescribe unnecessary medications, and serves as a “nice little earner” for the APA which put it out. Among the dozens of revisions in this new edition are the elimination of a bereavement exclusion from major depressive disorder and the creation of binge-eating disorder, but how much will such changes alter your clinical practice?
The answer is “not much, if at all” according to psychiatrist Sally Satel, M.D., writing an opinion piece in the New York Times Sunday Review. She then goes on to ask what the fuss is all about, and the answer here in Australia is as significant for all of us – not just mental health professionals – as it is in the United States. The truth is that psychiatrists tend to treat according to symptoms. The D.S.M. – in any version – is at best “an imperfect guide to predicting what treatments will benefit patients most – a reality tied to the fact that psychiatric diagnoses are based on clinical appearances that tend to cluster [in symptoms], not on the mechanism behind the illness, as is the case with, say, bacterial pneumonia” (Satel, 2013).
But the other truth, which Satel also acknowledges, is that diagnoses using the D.S.M. carry “unwarranted clout” with the rest of society. Diagnoses, even if imprecise, mean insurance coverage, access to special educational and behavioural services in schools, and eligibility for disability benefits. So it behoves us as counsellors, psychotherapists, psychologists, and social workers, to find out what the main differences are and not unduly disadvantage our clients through ignorance of which symptoms will command resources to help.
Here are a few sites that discuss the differences between DSM-IV and DSM-V. Some just skim the surface, making general summaries. Others go into greater depth, so you can choose the ones which give you the amount of detail you need for the clients you serve:
- American Psychiatric Publishing has put out this detailed but clear PDF signalling the differences, entitled: Highlights of Changes from DSM-IV to DSM-V. Click here for more details.
- PsychCentral has a short, readable article on the main changes, called: “DSM-5 released: The big changes”. Click here for more details.
- Psychiatric Times has an article: DSM-5: What it will mean to your practice. Click here for more details (paid article). This source has tables detailing coding and nomenclature changes between the two versions.
- Particularly valuable is this site, also by the American Psychiatric Association, which has numerous fact sheets and also relatively brief downloadables, including coding updates, online assessment measures, and insurance implications of using DSM-5. Click here for more details.
- A short summary of the chapters of the DSM-5 and the main changes summarised appears here.(Papers from Sidcup: Changes in DSM-5).
- The Seattle Children’s Hospital Research Foundation has put out a 78 page document entitled, “Overview of DSM-5 Changes”. Click here for more details. This is called an “overview”, yet the document provides extensive information.
- The next link is to a course by Masterpsych.com (American Physician Institute for Advanced Professional Studies), and is the only site we include where the information is not free. Costing $USD397, the course would take an estimated 10 hours to do. It is not endorsed by the APA. Click here for more details.
You can also search the internet looking for differences between the two versions as applied to particular issues, such as Alcohol Use Disorder or Neurocognitive Disorders. Hopefully some of the sites we list above will give you an overall sense of the differences, the reasons why things changed, and some reliable links to go back to when you need to reference a particular area of change. In the meantime, Satel would probably recommend – despite the veneration accorded the D.S.M. – that you not imbue any version of it with the precision and authority that it does not have.
Reference: Satel, S. (2013). Why the Fuss over the D.S.M.-5? The New York Times Sunday Review: The Opinion Pages. Retrieved on 25 June, 2014. Click here to access the original article.