DSM-5:

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), published in
2013, is the key diagnostic tool for psychiatric conditions in the U.S., updated in 2022 as DSM-5-
TR. It plays a significant role in treatment and healthcare payments, although some healthcare
providers use the ICD for diagnosis. Notably, the DSM-5 marks several changes from the DSM-
IV-TR, including merging Asperger syndrome into the autism spectrum, eliminating
schizophrenia subtypes, and removing the bereavement exclusion from depressive disorders.
It also introduced new diagnoses like binge eating disorder and redefined gender identity
disorder as gender dysphoria. Despite its impact, the DSM-5 faced criticism for lacking
empirical support for some changes, low inter-rater reliability, and potential pharmaceutical
industry influence.
The sections of DSM-5:
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is organized
into three main sections that provide essential guidance for diagnosing mental disorders. These
sections cover the manual's structure, its diagnostic criteria, and the use of the manual in practice.
Below are the detailed descriptions of the three primary sections of the DSM-5:

1. Section I: Basics of DSM-5

This introductory section offers an overview of how to use the DSM-5, explaining its purpose
and structure, as well as how to approach diagnosis in clinical settings. Key components of this
section include:

 Introduction to DSM-5: This part introduces the manual, explaining its role in the
classification of mental disorders. It also highlights the importance of making accurate
diagnoses and the use of the DSM-5 in clinical practice.
 Use of the Manual: This section provides guidance on how to navigate and interpret the
DSM-5's content. It emphasizes the importance of the diagnostic criteria and provides
advice on clinical decision-making when using the manual.
 Changes from DSM-IV-TR: This section highlights the differences between the DSM-
IV-TR (the previous edition) and the DSM-5, providing a summary of major revisions,
such as the reclassification of certain disorders, the removal of the five-axis system, and
the incorporation of new disorders.

2. Section II: Diagnostic Criteria and Codes

The second section of the DSM-5 presents the diagnostic criteria for each mental disorder,
grouped into categories. These categories help clinicians identify and classify a wide variety of
mental health conditions. The section includes:

 Diagnostic Criteria: Each disorder is listed with its official diagnostic code (aligned with
the ICD system) and a detailed set of criteria for diagnosis. These criteria include a list of
symptoms, the duration of symptoms, and any exclusions or limitations for diagnosis
(e.g., symptoms not due to another medical condition or substance use).
 Disorder Categories: The disorders are categorized into broad groups based on
similarities in symptoms, such as:
o Neurodevelopmental Disorders (e.g., Autism Spectrum Disorder, ADHD)
o Schizophrenia Spectrum and Other Psychotic Disorders
o Bipolar and Related Disorders
o Depressive Disorders
o Anxiety Disorders
o Obsessive-Compulsive and Related Disorders
o Trauma- and Stressor-Related Disorders
o Dissociative Disorders
o Somatic Symptom and Related Disorders
o Feeding and Eating Disorders
o Elimination Disorders
o Sleep-Wake Disorders
o Sexual Dysfunctions
o Gender Dysphoria
o Disruptive, Impulse-Control, and Conduct Disorders
o Substance-Related and Addictive Disorders
o Neurocognitive Disorders
o Personality Disorders
o Paraphilic Disorders
o Other Mental Disorders
 Severity and Specifiers: Some diagnoses include specifiers, which provide further detail
about the nature of the disorder, such as the severity or specific symptoms. For example,
depression may be specified as "with melancholic features" or "with psychotic features."

3. Section III: Emerging Measures and Models

This section is devoted to conditions and areas where further research is needed or where
emerging concepts and models are being explored. It includes:

 Conditions for Further Study: The DSM-5 lists several conditions that are not officially
recognized as disorders yet but may be important for future inclusion based on ongoing
research. These conditions include:
o Attenuated Psychosis Syndrome
o Caffeine Use Disorder
o Internet Gaming Disorder

These conditions are recognized as needing more empirical support and are presented to
encourage further study and consideration for future editions of the DSM.

 Cultural Formulation: This part provides a framework for understanding how culture
may influence the diagnosis and presentation of mental disorders. It includes guidance on
how cultural factors should be integrated into clinical assessment and diagnosis.
 Alternative DSM-5 Model for Personality Disorders: This model offers a dimensional
approach to diagnosing personality disorders, focusing on personality functioning and
pathological traits, rather than the categorical approach used in the main DSM-5 section.
 Cross-Cutting Symptoms: This section introduces cross-cutting symptoms, which are
symptoms that span across various disorders. These include issues like sleep disturbance,
anxiety, or somatic complaints, which can appear in many different mental disorders and
may guide clinicians in recognizing patterns that could cross diagnostic boundaries.

Additional Sections:

While Sections I-III are the primary structural components, other elements of the DSM-5
include:

 Glossary of Terms: This section defines important terms used in the manual, ensuring
that users have a clear understanding of terminology.
 Index: The DSM-5 includes a comprehensive index that allows clinicians to quickly find
specific disorders, symptoms, or other relevant information.
 Bibliography: A list of references and further reading for clinicians who wish to deepen
their understanding of the disorders listed in the manual.

Historical Perspective:
In 1999, a DSM-5 Research Planning Conference was held by the APA and the National
Institute of Mental Health (NIMH) to establish research priorities for the DSM-5. Six
workgroups were formed to focus on areas like nomenclature, neuroscience and genetics,
developmental issues, personality disorders, mental disorders and disability, and cross-
cultural issues. Additional white papers were produced by 2004 on topics like gender issues,
geriatric diagnostics, and mental disorders in infants and children. These workgroups helped
shape the recommendations for the DSM-5 through conferences with invited researchers.

In 2007, the APA announced the DSM-5 Task Force, consisting of 27 members, including
researchers, clinicians, and family advocates. Task force members were required to disclose any
conflicts of interest, and some were excluded due to ties with the pharmaceutical industry.
Notably, 68% of DSM-5 task force members and 56% of panel members had connections to
the pharmaceutical industry, such as consulting roles or stock ownership.

The DSM-5 field trials included test-retest reliability studies, where different clinicians
independently evaluated the same patient to assess diagnostic consistency.\

HOW DSM-5 HELPS IN DIOGNOSIS OF MENTAL DISORDERS AND THE GAME &
EXAMPLES OF CODES DISEASES:

In the DSM-5, each mental disorder is assigned a specific diagnostic code that is aligned with
the International Classification of Diseases (ICD) system, which is the global standard for
health diagnoses. This system allows healthcare providers to classify mental health conditions
consistently across countries, facilitating clinical, research, and billing purposes. Along with
these codes, the DSM-5 provides detailed diagnostic criteria to help clinicians make accurate
diagnoses based on observable symptoms, symptom duration, and the exclusion of other medical
or psychological conditions.

How Diseases Are Diagnosed Using DSM-5 Criteria:

The diagnostic criteria for each disorder typically follow a structured format that includes the
following elements:

1. Symptom Criteria:
This section lists the specific symptoms that must be present for a diagnosis. These
symptoms are usually described in terms of frequency, intensity, or severity. For
example, for Major Depressive Disorder, the diagnostic criteria specify that the patient
must experience at least five of the following symptoms for at least two weeks:
o Depressed mood most of the day
o Loss of interest or pleasure in activities
o Significant weight change or appetite disturbance
o Insomnia or excessive sleeping
o Fatigue or lack of energy
o Feelings of worthlessness or guilt
o Difficulty concentrating
o Thoughts of death or suicide

2. Duration:
The criteria specify the minimum length of time the symptoms must be present for a
diagnosis. For example, the symptoms of Major Depressive Disorder must be present
for at least two weeks, while for Generalized Anxiety Disorder, symptoms must be
present for at least six months.

3. Exclusion Criteria:
Certain conditions must be excluded to ensure that the diagnosis is accurate. For
example, the symptoms of a disorder cannot be due to substance use, medical
conditions, or other mental disorders. In Major Depressive Disorder, the symptoms
must not be explained by substance use (e.g., alcohol or drugs) or a medical condition
(e.g., hypothyroidism).

4. Specifiers:
Some disorders can include additional specifiers that describe the severity, onset, or
features of the condition. For example, in Bipolar I Disorder, specifiers might include
whether the current episode is manic, depressive, or mixed.

5. Functional Impairment:
Many diagnoses also require that the symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
Example: Major Depressive Disorder (MDD)

Here’s how a disorder like Major Depressive Disorder would be diagnosed in DSM-5 using its
diagnostic criteria:

ICD-10 Code: F32 (for a single episode) or F33 (for recurrent episodes).
Diagnostic Criteria for Major Depressive Disorder (DSM-5):

 A. Five (or more) of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning; at least one of the symptoms is
either (1) depressed mood or (2) loss of interest or pleasure:
1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day.
3. Significant weight loss or gain, or decrease or increase in appetite.
4. Insomnia or excessive sleeping.
5. Psychomotor agitation or retardation (restlessness or slowed movements).
6. Fatigue or loss of energy.
7. Feelings of worthlessness or excessive guilt.
8. Diminished ability to think or concentrate.
9. Thoughts of death or suicide, or suicide attempt.

 B. The symptoms cause clinically significant distress or impairment in social,

occupational, or other important areas of functioning.

 C. The episode is not attributable to the physiological effects of a substance or another

medical condition.
Exclusion Criteria:

 Symptoms cannot be explained by the physiological effects of substances or other medical

conditions (e.g., hypothyroidism, substance use, etc.).
 The symptoms are not better explained by another mental disorder, such as bipolar disorder or
schizoaffective disorder.

Example: Generalized Anxiety Disorder (GAD)

ICD-10 Code: F41.1

Diagnostic Criteria for Generalized Anxiety Disorder (DSM-
5):

 A. Excessive anxiety and worry occurring more days than not for at least 6 months,
about a number of events or activities (such as work or school performance).

 B. The individual finds it difficult to control the worry.

 C. The anxiety and worry are associated with three (or more) of the following six
symptoms (with at least some symptoms being present for more days than not for the past
6 months):
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

 D. The anxiety, worry, or physical symptoms cause clinically significant distress or

impairment in social, occupational, or other important areas of functioning.

 E. The disturbance is not due to the physiological effects of a substance or another

medical condition (e.g., hyperthyroidism).
Exclusion Criteria:
 Not attributable to a medical condition (such as hyperthyroidism or caffeine use).
 The disturbance is not better explained by another mental disorder, such as Panic Disorder or
Social Anxiety Disorder.

Summary of Key Diagnostic Elements:

 ICD Code: For international and billing purposes, every disorder has an ICD code.
 Symptoms: Specific signs that must be present for diagnosis.
 Duration: Symptoms must persist for a minimum period of time.
 Exclusion Criteria: Symptoms cannot be better explained by other conditions or substance use.
 Functional Impact: The disorder must significantly affect the person’s life (e.g., work,
relationships).
 Specifiers: Additional details that refine the diagnosis, such as severity or features.

Conclusion:

The DSM-5 provides a clear set of diagnostic criteria for each disorder, using a combination of
symptoms, their duration, and exclusion criteria. This ensures that diagnoses are made
consistently and accurately. The inclusion of ICD codes allows for integration with global health
systems, aiding in international consistency and billing practices