In March, the APA published the DSM-5-TR – the first major revision to the widely used manual since 2013. It features updated text and references, overhauled diagnostic criteria, more inclusive language and a new disorder.
With contributions from more than 200 subject matter experts, the American Psychiatric Association (APA) says the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) “is the most comprehensive, current and critical resource for clinical practice available to today’s mental health clinicians and researchers”1.
Importantly for psychologists, it’s the most recent revision since 2013 and it contains several significant changes that reflect shifts in the literature as well as language to promote inclusivity. After the upheaval of the past two years and the increasing focus on mental health, the DSM-5-TR is a timely addition to the psychologist’s toolkit.
A decade in the making
Since its first publication in 19522, the Diagnostic and Statistical Manual of Mental Disorders has served as an authoritative guide to the diagnosis of mental disorders for healthcare professionals. It provides a common language for clinicians to communicate about patients and provide consistent and reliable diagnoses3 – in the US, Australia and around the world4.
This new edition is a full update of the DSM-5 based on current scientific literature5. It includes fully revised text and new references, clarifications to diagnostic criteria and updates to ICD-10-CM codes.
According to the APA, the goal was to incorporate new research findings that have emerged since the DSM-5 was published in 20136. A global network of subject matter experts – spanning expertise in neuroscience, biology, genetics, statistics, epidemiology, social and behavioural sciences, nosology and public health – proposed changes and updates, which were then reviewed by DSM-5-TR editors and the DSM steering committee.
As with previous versions, the DSM-5-TR is best considered a companion publication to the World Health Organization’s International Classification of Disease (ICD)7. It contains the code numbers listed in the DSM-5-TR – and all of medicine – which are used for monitoring by national and international health agencies.
In plain language
The DSM-5-TR includes revised text for almost all disorders, while some sections have undergone significant updates8. These include Prevalence, Risk and Prognostic Factors, Culture-Related Diagnostic Issues, Sex- and Gender-Related Diagnostic Issues, Association with Suicidal Thoughts or Behavior, and Comorbidity.
Social discourse has undergone a marked shift since 2013. To reflect this, the DSM text has been reviewed to ensure appropriate attention is paid to sociocultural influences on mental health and risk factors like racism, discrimination and the use of non-stigmatising language9.
‘Race’, for example, was replaced with ‘radicalised’ in acknowledgement of race as a social construct10. Exclusionary and incorrect terms like ‘non-White’, ‘minority’ and ‘Caucasian’ are no longer used.
Likewise, terms surrounding gender dysphoria – as well as the chapter itself – have also undergone an update11. ‘Experienced gender’ replaces ‘desired gender’, ‘gender affirming medical procedure’ is favoured over ‘cross-sex medical procedure’ and ‘individual assigned male/female at birth’ is used instead of ‘natal male/female’.
Modifying criteria
Notably, the DSM-5-TR includes modifications to criteria for more than 70 disorders, including autism spectrum disorder, bipolar I and II disorders, major depressive disorder, post-traumatic stress disorder (PTSD) in children and substance-induced mental disorders12.
There is also the addition of a new diagnosis called ‘prolonged grief disorder’, which is defined as “intense yearning or longing for the deceased” and “preoccupation with thoughts or memories of the deceased”13. It can be diagnosed when acute grief remains distressing and disabling for longer than 12 months following bereavement14.
The inclusion allows clinicians to make a formal diagnosis for people who have experienced difficulty coping with loss for an extended period of time. It’s not intended to pathologise grief; rather, it reflects an experience of grief that is much more intractable and disabling than what is considered typical15.
Diagnostic codes have also been added for suicidal behaviour and non-suicidal self-injury16. They can be used for people who have engaged in potentially self-injurious behaviour with at least some intent to die as a result of the act, or intentional self-inflicted damage that is likely to induce bruising, bleeding or pain17. The addition will allow clinicians to document the conditions in patients who do not have other diagnoses and help to estimate risk factors for future suicide attempts or death.
The APA says including these codes will also encourage research targeting treatment of the specific conditions rather than simply addressing the behaviours as symptoms of a related condition like major depressive disorder18.
The publication of the DSM-5-TR marks a shift in the practice of psychology in Australia and around the world, as well as broader society, towards inclusivity and greater acceptance of mental health disorders. Until it is time for the next revision or edition, it will chart the course of the profession.
Find out more about the DSM-5-TR