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Focus on Specific Diagnoses in DSM-5

The DSM-5

Conditions Designated for Further Study in DSM-5 in Section III
Attenuated Psychosis Syndrome
Depressive Episodes with Short-Duration Hypomania
Persistent Complex Bereavement Disorder
Caffeine Use Disorder
Internet Gaming Disorder
Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure
Suicidal Behavior Disorder
Nonsuicidal Self-Injury
Possible  Disorders Discussed But Not Included in Section III of DSM-5

Dissociative Trance Disorder

Anxious Depression

Factitious disorder imposed on another

Hypersexual Disorder

Olfactory Reference Syndrome

Paraphilic Coercive Disorder

Attenuated Psychosis Syndrome-Now listed for Further Study

Attenuated Psychosis Syndrome
This condition would need to be all six of the following criterion:

  1. Characteristic symptoms: at least one of the following in attenuated form with intact reality testing, but of sufficient severity and/or frequency that it is not discounted or ignored
    1. Delusions
    2. Hallucinations
    3. disorganized speech 
  2. Frequency/Currency: symptoms meeting criterion A must be present in the past month and occur at an average frequency of at least once per week in past month 
  3. Progression: symptoms meeting criterion A must have begun in or significantly worsened in the past year; 
  4. Distress/Disability/Treatment Seeking:  symptoms meeting  first criterion are sufficiently distressing and disabling to the patient and/or parent/guardian to lead them to seek help
  5. Symtpoms meeting first criterion are not better explained by any DSM-5 diagnosis, including substance-related disorder.
  6. Clinical criteria for any DSM-5 psychotic disorder have never been met

Critque of Attentuated Psychosis Syndrome

The British Psychological Society (2011) stated that the concept of “attenuated psychosis system” appears very worrying; it could be seen as an opportunity to stigmatize eccentric people, and to lower the threshold for achieving a diagnosis of psychosis.


The Society for Humanistic Psychology (2011) stated that Attenuated Psychosis Syndrome describes experiences common in the general population, and which was developed from a “risk” concept with strikingly low predictive validity for conversion to full psychosis.

Disruptive Mood Dysregulation Disorder Now Listed under Depressive Disorders

DSM-5 Criteria:

Disruptive Mood Dysregulation Disorder

A. The disorder is characterized by severe recurrent temper outbursts in response to common stressors.

1.  The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property. 

2.  The reaction is grossly out of proportion in intensity or duration to the situation or provocation.

3.  The responses are inconsistent with developmental level.

B. Frequency: The temper outbursts occur, on average, three or more times per week.

C. Mood between temper outbursts:

1.  Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad).

2.  The negative mood is observable by others (e.g., parents, teachers, peers).

D. Duration: Criteria A-C have been present for at least 12 months.  Throughout that time, the person has never been without the symptoms of Criteria A-C for more than 3 months at a time.

E. The temper outbursts and/or negative mood are present in at least two settings (at home, at school, or with peers) and must be severe in at least in one setting. 

F.  Chronological age is at least 6 years (or equivalent developmental level).

G. The onset is before age 10 years.

H. In the past year, there has never been a distinct period lasting more than one day during which abnormally elevated or expansive mood was present most of the day for most days, and the abnormally elevated or expansive mood was accompanied by the onset, or worsening, of three of the “B” criteria of mania (i.e., grandiosity or inflated self esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increase in goal directed activity, or excessive involvement in activities with a high potential for painful consequences; see pp. XX).  Abnormally elevated mood should be differentiated from developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation.

I.  The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) and are not better accounted for by another mental disorder (e.g., Pervasive Developmental Disorder, post-traumatic stress disorder, separation anxiety disorder). (Note: This diagnosis can co-exist with Oppositional Defiant Disorder, ADHD, Conduct Disorder, and Substance Use Disorders.) The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.

Critique of Disruptive Mood Dysregulation Disorder

Society for Humanistic Psychology (2011) stated that Children and adolescents will be particularly susceptible to receiving a diagnosis of Disruptive Mood Dysregulation Disorder or Attenuated Psychosis Syndrome.

The British Psychological Society (2011) stated that the putative diagnoses such as Disruptive Mood Dysregulation Disorder presented in DSM-5 are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgments, with little confirmatory physical 'signs' or evidence of biological causation. They stated that the criteria used for this diagnosis in the DSM-5 are not value-free, but rather reflect current normative social expectations.

Mild Neurocognitive Disorder  - Now listed under Neurocognitive Disorders

DSM-5 Criteria: Mild Neurocognitive Disorder 

A. Evidence of minor cognitive decline from a previous level of performance in one or more of the domains outlined above based on:

1. Concerns of the patient, a knowledgeable informant or the clinician that there has been a mild decline in cognitive function


2. Mild decline in neurocognitive performance, typically between 1 and 2 standard deviations below appropriate norms (i.e., between the 3rd and 16th percentile) on formal testing, or equivalent clinical evaluation.

B.  The cognitive deficits are insufficient to interfere with independence (i.e., instrumental Activities of Daily Living [more complex tasks such as paying bills or managing medications] are preserved), but greater effort, compensatory strategies, or accommodation may be required to maintain independence.

C. The cognitive deficits do not occur exclusively in the context of a delirium.

D. The cognitive deficits are not wholly or primarily attributable to another Axis I disorder (e.g., Major Depressive Disorder, Schizophrenia).

Critique of Mild Neurocogntive Disorder 

Society for Humanistic Psychology (2011) stated that

“We are also gravely concerned about the introduction of disorder categories that risk misuse in particularly vulnerable populations. For example, Mild Neurocognitive Disorder might be diagnosed in elderly with expected cognitive decline, especially in memory functions.

Comparison of a DSM-V-TR Diagnosis with a DSM-5 Diagnosis


Compare Dysthymic in DSM-IV-TR To Chronic Depressive Disorder in DSM-5

Rationale Given by DSM-5 Team for this Classification Modification

DSM-IV classifies individuals who experience two or more years of depressive symptoms into either of two categories. Dysthymic disorder specifies an initial two years of depressive symptoms that do not accumulate at any point to meet criteria for a major depressive episode and excludes individuals with any history of mania or hypomania. Major depression with a chronic specifier applies to those who experience no recovery within two years of the onset of a major depressive episode. This label can be applied to individuals with histories of mania or hypomania.


Existence of these two categories implies that meaningful differences exist between them in terms of the conventional external measures of validity--laboratory measures, course and outcome and family history. However, none of the studies that have compared chronic non-bipolar major depression to dysthymia, with or without superimposed major depression, have found significant differences in demographic variables, symptom patterns, treatment response or family history (McCullough et al., 2000; McCullough et al., 2008; Klein et al., 2004; Yang and Dunner, 2001).


Added to this is the questionable reliability of the distinction. Though some reports have described the reliability of dysthymic disorder, none have done so within a sample consisting entirely of chronic depressive states.  Poor reliability is very likely, though, because individuals are being asked to recall whether, in a two-year period that might be decades in the past, they did or did not experience two or more weeks when a symptom level of two, three or four criteria symptoms rose to five or more symptoms.


There is, on the other hand, considerable evidence that chronic depressive states, whether labeled as dysthymic disorder or as chronic major depression, are, in comparison to non-chronic major depression, associated with poorer treatment response, higher long-term morbidity on follow-up, and greater familial loading for affective disorders.


In this light, we propose that the category of major depression with chronic specifier be combined with dysthymic disorder under the term “chronic depressive disorder”. The current definition of dysthymia would serve this purpose after the elimination of criteria D (the exclusion of those with major depressive episodes in the first two years of illness) and of criteria E (a history of mania or hypomania). Bipolar I, bipolar II and non-bipolar distinctions would apply.

Articles Concerning Specific Diagnoses for Inclusion into DSM-5


Neurodevelopmental Disorders

Achenbach, T.M. (2009). Some needed changes in DSM-V: But what about children? Clinical Psychology: Science and Practice, 16(1):50-53.


Bernet, W., Von Boch-Galhau, W., Baker, A.J.L. & Morrison, S.L. (2010). Parental alienation, DSM-V, and ICD-11. American Journal of Family Therapy,38:76-187.


Bravender, T., Bryant-Waugh, R, Herzog, D., Katzman, D.,  Kriepe, R.D., Lask, B., Le Grange, D., Lock, J., Loeb, K.L., Marcus, M.D., Madden, S., Nicholls, D., O’Toole, J., Pinhas, L., Rome, E., Sokol-Burger, M., Wallin, U. & Zucker, N.(2010). Classification of eating disturbance in children and adolescents: Proposed changes for the DSM-V. European Eating Disorders Review, 18:79-89.


Burke, J.D., Waldman, I. & Lahey, B.B. (2010). Predictive validity of childhood oppositional defiant disorder and conduct disorder: Implications for DSM-V. Journal of Abnormal Psychology, 119(4):739-751.


Ghanizadeh, A. (2011). Overlap of ADHD and Oppositional Defiant Disorder DSM-IV Derived Criteria. Archives of Iranian Medicine, 14(3):178-182.


Ghaziuddin, M. (2010). Brief report: Should the DSM V drop Asperger Syndrome? Journal of Autism & Developmental Disorders, 40:1146-1148.


Lahey, B.B. & Willcutt, E.G.(2010). Predictive Validity of a continuous alternative to nominal subtypes of attention-deficity/hyperactivity disorder for DSM-V. Journal of Clinical Child & Adolescent Psychology, 39(6):761-775.


Moffitt, T.E., Arseneault, L., Jaffee, S.R., Kim-Cohen, J., Koenen, K.C., Odgers, C.L., Slutske, W.S. & Viding, E. (2008). Research review: DSM-V conduct disorder: research needs for evidence base. Journal of Child Psychology and Psychiatry, 49(1):3-33.


Nigg, J.T., Tannock, R. & Rohde, L.A. (2010). What is the fate of ADHD subtypes? An introduction to the special section on research on the ADHD subtypes and implications for the DSM-V. Journal of Clinical Child and Adolescent Psychology,39(6):723-725.


Tackett, J.L. (2010). Toward an externalizing spectrum in DSM-V: Incorporating developmental concerns. Child Development Perspective, 4(3):161-167.


Todd, R.D., Huang, H. & Henderson, C.A.(2008). Poor utility of age of onset criterion for DSM-IV attention deficit/hyperactivity disorder: recommendations for DSM-V and ICD-11. Journal of Child Psychology and Psychiatry, 49(9):942-949.


Walkup, J.T., Ferrao, Y., Leckman, J.F., Stein, D.J. & Singer, H. (2010). Tic Disorders: Some key issues for DSM-V. Depression and Anxiety, 27:600-610.


Schizophrenia and Other Psychotic Disorders

Fink, M. (2011). Catatonia from its creation to DSM-V: Consideration for ICD. Indian Journal of Psychiatry, 53(3):214-217.


Gaebel, W. & Zielasek, J. (2008). The DSM-V initiative “deconstruction psychosis” in the context of Krepelin’s concept on nosology. European Archives of Psychiatry & Clinical Neuroscience, 258[Suppl2]:41-47.


Pierre, J.M. (2008). Deconstructing schizophrenia for DSM-V: Challenges for clinical and research agendas. Clinical Schizophrenia & Related Psychoses, July 166-174.


van Os, J. (2008). ‘Salience syndrome’ replaces ‘schizophrenia’ in DSM-V and ICD-11: Psychiatry’s evidenced-based entry into the 21st century? Acta Psychiatria Scandinavica, 120:363-372.


Depressive Disorders

Joyce, P.R. (2008). Classification of mood disorders in DSM-V and DSM-VI. Austrailian and New Zealand Journal of Psychiatry,48:851.862.


Nierenberg, A.A., Rapaport, M.H., Schettler, P.J., Howland, R., Smith, J.A., Edwards, D., Schneider & Mischoulon, D. (2010). Deficits of psychological well-being and quality-of-life in minor depression: Implications for DSM-V. CNS Neuroscience & Therapeutics,16:208-216.


Prigerson, H.G., Horowitz, M.J., Jacobs, S.C., Parkes, C.M., Aslan, M., Goodkin, K., Raphael, B., Marwit, S.J., Wortman, C., Neimeyer, R.A., Bonanno, R., Block, S.D., Kissane, D., Boelen, P., Maercker, A., Litz, B.T., Johnson, J.G., First, M.B. & Maciejewski, P.K. Prolonged Grief Disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine,6(8):1-12.


Anxiety Disorders

Andrews, G., Hobbs, M.J., Borkovec, T.D., Beesdo, K., Craske, M.G., Heimberg, R.G., Rapee, R.M., Ruscio, A.M. & Stanley, M.A. (2010), Generalized Worry Disorder: A review of DSM-IV Generalized Anxiety Disorder and options for DSM-V. Depression and Anxiety, 27:134-147.


Bogels, S.M., Alden, L., Beidel, D.C., Clark, L.A., Pine, D.S., Stein, M.B. & Voncken, M. (2010). Social Anxiety Disorder: Questions and answers for DSM-V. Depression and Anxiety, 27:168-189.


Craske, M.G., Kircanski, K., Epstein, A., Wittchen, H.U., Pine, D.S., Lewis-Fernandez, R., Hinton, D. & DSM V Anxiety, OC Spectrum, Posttraumatic and Dissociative Disorder Work Group (2010). Panic Disorder: A review of DSM-IV Panic Disorder and proposals for DSM-V. Depression and Anxiety, 27: 93-112.


Lebeau, R.T., Glenn, D., Liao, B., Wittchen, H.U., Beesler-Braum, K., Ollendick, T. & Graske, M.G. (2010). Specific Phobia: A review of DSM-IV Specific Phobia and preliminary recommendations for DSM-V. Depression and Anxiety, 27:148-167.


Lewis-Fernandez, R., Hinton, D.E., Laria, A.J., Patterson, E.H., Hoffman, S.G., Craske, M.G., Stein, D.J., Asnaani, A. & Liao, B. (2010). Culture and Anxiety Disorders: Recommendations for DSM-V. Depression and Anxiety, 27:212-229.


Obsessive-Compulsive Disorder and Related Disorders

Feusner, J.D., Phillips, K.A. & Stein, D.J.(2010). Olfactory reference syndrome: Issues for DSM-V. Depression and Anxiety,27:592-599.


Hollander, E., Braun, A & Simeon, D. (2008). Should OCD leave the anxiety disorders in DSM-V? The case for Obsessive Compulsive-Related Disorders. Depression and Anxiety, 25:317-329.


Leckman, J.F., Denys, D., Simpson,H.B., Mataix-Cols, D., Hollander, E., Saxena, S., Miguel, E.C., Rauch, S.L., Goodman, W.K., Phillips, K.A., & Stein, D.J. Obsessive-Compulsive Disorder: A review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V. Depression and Anxiety, 27:507-527.


Mataix-Cols, D., Frost, R.O., Pertusa, A., Clark, L.A., Saxena, S., Leckman, J.F., Stein, D.J., Matsunaga, H. & Wilhelm, S. (2010). Hoarding Disorder: A new diagnosis for DSM-V? Depression and Anxiety,27:556-572.


Phillips, K.A., Stein, D.J., Rauch, S.L., Hollander, E., Fallon, B.A., Barsky, A., Fineberg, N., Mataix-Cols, D., Ferrao, Y.A., Saxena, S., Wilhelm, S., Kelly, M.M., Clark, L.A., Pinto, A., Bienvenu, O.J., Farrow, J. & Leckman, J. (2010). Should an Obsessive-Compulsive Spectrum Grouping of Disorders be included in DSM-V? Depression and Anxiety, 27:528-555.


Phillips, K.A., Wilhelm, S., Koran, L.M., Didie, E.R., Fallon, B.A., Feusner, J. & Stein, D.J. (2010). Body Dysmorphic Disorder: Some key issues for DSM-V. Depression and Anxiety,27:573-591.


Stein, D.J., Naomi A. Fineberg, N.A., O. Joseph Bienvenu, O.J., Denys, D., Lochner, C.,  Nestadt, G., Leckman, J., Rauch, S.L. & Phillips, K.A. (2010). Should OCD be classified as an anxiety disorder in DSM-V? Depression and Anxiety, 27:495-506.


Stein, D.J., Grant, J.E., Franklin, M.E., Keuthen, N., Lochner, C., Singer, H.S. & Woods, D.W. (2010). Trichotillomania (Hair pulling disorder), skin picking disorder, and stereotypic movement disorder: Toward DSM-V. Depression and Anxiety, 27:611-626.


Trauma and Stressor-Related Disorders

Berwin, C.R., Lanius, R.A., Novac, A., Schnyder, U. & Galea, S. (2009). Reformulating PTSD for DSM-V: Life after criterion A. Journal of Traumatic Stress, 22(5):366-373.


Bracha, H.S. & Maser, J.D. (2008). Anxiety and Posttraumatic Stress Disorder in the context of human brain evolution: A role for theory in DSM-V? Clinical Psychology: Science and Practice, 15(1):91-97.


McNally, R.J. (2009). Can we fix PTSD in DSM-V? Depression and Anxiety, 26:597-600.


Pynoos, R.S., Steinberg, A.M., Layne, C.M., Briggs, E.C., Ostrowski, S.A. & Fairbank, J.A. (2009). DSM-V PTSD Diagnostic criteria for children and adolescents: A developmental perspective and recommendations. Journal of Traumatic Stress, 22(5):391-398.


Yehuda, R. & Bierer, L.M. (2009). The relevance of epigenetics to PTSD: Implications for the DSM-V. Journal of Traumatic Stress, 22(5):427-434.


Eating Disorders

Becker, A.E., Eddy, K.T. & Perloe, A. (2009). Clarifying critera for cognitive signs and symptoms for eating disorders in DSM-V. International Journal of Eating Disorders, 42:611-619.


Becker, A.E., Thomas, J.J. & Pike, K.M.(2009). Should non-fat-phobic anorexia nervosa be included in DSM-V? International Journal of Eating Disorders, 42:620-635.


Sexual Dysfunctions

Binik, Y.M., Brotto, L.A., Graham, C.A. & Segraves, T. (2010). Response to the DSM-V Sexual Dysfunctions Subworkgroup to commentaries published in JSM. Journal of Sexual Medicine, 7:2382-2387.


Editors. (2010). Responses to Proposed DSM-V Changes. Journal of Sexual Medicine, 7:1998-2016.


Waldinger, M.D. & Schweitzer, D.H. (2008). The use of old and recent DSM definitions of premature ejaculation in observational studies: A contribution to the present debate for a new classification of PE in the DSM-V. Journal of Sexual Medicine, 5:1079-1087.


Substance Abuse and Addictive Disorders

Boudreau, A., Labrie, R. & Shaffer, H.J.(2009). Towards DSM-V: ‘Shadow Syndrome’ symptom patterns among pathological gamblers. Addiction Research and Theory,17(4):406-419.


Cunningham-Williams, R.M., Gattis, M.N., Dore, P.M., Shi, P. & Spitznagel, E.L. (2009). Toward DSM-V: considering other withdrawal-like symptoms of pathological gambling disorder. International Journal of Methods in Psychiatric Research, 18(1):13-22.


Helzer, J.E., van den Brink, W. & Guth, S.E. (2006). Should there be both categorical and dimensional criteria for the substance use disorders in DSM-V? Addiction, 101[Suppl.1]:17-22.


Nunes, E.V. & Rounsavile, B.J. (2006). Comorbidity of substance use with depression and other mental disorders: from Diagnostic and Statistical Manual of Mental Disorders, four edition (DSM-IV) to DSM-V. Addiction, 101 [Suppl.1]:89-96.


Slade,T., Grove, R. & Teesson, M. (2009). A taxometric study of alcohol abuse and dependence in a general population sample: evidence of dimensional latent structure and implications for DSM-V. Addiction, 104:742-751.


Personality Disorders

Hesse, M. (2010). What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)? BioMed Central Medicine,8:66.


Kalapatapu, R.K., Patil, U. & Goodman, M.S. (2010). Using the internet to assess perceptions of patients with Borderline Personality Disorder: What do patients want in the DSM-V? Cyperpsychology, Behavior and Social Networking, 13(5):483-494.


Miller, J.D., Widiger, T.A. & Campbell, W.K. (2010). Narcissistic Personality Disorder and the DSM-V. Journal of Abnormal Psychology, 110(4):640-649.