The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for release in May 2013. On February 10, the draft DSM-5 was published on the American Psychiatric Association (APA) website, where anyone can leave comments until July 15. Obviously, this version of the document is not final, because additional changes will be made until 2012. However, it is already clear that a number of mental illnesses will be deleted from the Psychiatrist's Bible, or at least will be included in the next edition under a different name. A change in approach is proposed for the following disorders:

• Gender Identity Disorder, will probably be renamed "gender dysphoria". The diagnostic criteria for the state of acute dissatisfaction with one's gender status have been significantly changed.
• Internet addiction and sex addiction, to tell the truth, have never been officially recognized in any edition of the DSM. However, in recent times these problems have become so widespread that many psychiatrists tend to consider these addictions a real diagnosis. The DSM-5 will include a category of behavioral addictions that will include gambling addiction. The appendices to the document will call for more research to be included in the registry of future editions of the guidelines also for sexual and Internet addiction.
• hypochondriacal syndrome, manifested in constant anxiety about the possibility of getting sick and looking for symptoms of various ailments, will no longer be considered one of the four somatoform mental disorders. DSM-5 classifies this problem under the category of anxiety disorders.
• Asperger's Syndrome is a developmental disorder and is characterized socially and emotionally inappropriate behavior while maintaining an average level of intelligence. From 2013, the syndrome will be classified under the general diagnostic category of autism spectrum disorders. This does not mean that the term "Asperger's syndrome" will be done away with, but it will no longer be considered an autonomous disease.
• Drug addiction and substance abuse may be reduced to the general category of "drug addiction and related disorders". Specialists emphasize that the use of the term "addiction" inevitably ran into a number of difficulties, since there are "normal" forms of physical dependence on drugs such as opioid painkillers.
• Mental retardation, long a controversial term, will be renamed "intellectual disability".
• transvestite fetishism, associated with intense and repetitive sexual urges and fantasies and provoking a man to have a collection of women's clothing that he tries on when left alone, will still continue to make a slight mess in the classification of diseases. The new draft DSM-5 will begin using the term "transvestite disorders" to describe the above disorders.
• Histrionic Personality Disorder characterized by an inexhaustible need for attention and the use of their appearance for this purpose. DSM-5 eliminates not only this disease, but also all other "chauvinistic" (sexist) diseases at once.

In general, in the next manual, it is planned to radically change the approach to diagnosing mental illness: in accordance with it, the doctor must first identify a “general” personality disorder in a patient, and then characterize it with specific signs. Currently, psychiatrists immediately diagnose a specific personality disorder.

paranoid

Schizoid

schizotypal

Cluster B (theatrical, emotional or fluctuating disorders):

antisocial

Border

Hysterical

Narcissistic

Cluster C (anxiety and panic disorders):

avoidant

dependent

obsessive-compulsive

Personality disorders

This section begins with a general definition of personality disorder that applies to each of the 10 specific disorders. All personality disorders encoded along axis II.

General diagnostic criteria for a personality disorder.

A. A long-term pattern of inner experiences and behavior clearly deviating from cultural expectations. This pattern appears in two (or more) of the following areas:

1 - cognitive sphere (i.e. ways of perceiving or understanding oneself, other people and ongoing events),

2 - affective sphere (i.e. range, intensity, lability, acceptability of emotional reactions),

3 - interpersonal functioning,

4 - control of impulses.

C. This long-term pattern is inflexible and pervasive across a wide range of personal and social functioning situations.

C. This pattern results in overt clinical impairment or impairment in social, occupational, or other important areas of functioning.

D. This pattern is stable and long lasting and can be traced back to at least adolescence or adolescence.

E. This pattern is not a manifestation or consequence of another mental illness.

F. This pattern is not a direct psychological result of substance use (eg, drugs or medications) or general health (eg, head trauma).

Cluster a.

301.0 Paranoid personality disorder

A. Profound distrust and suspicion of others with an interpretation of their motives as malevolent, beginning in adolescence and present in a variety of contexts, as determined by four (or more) of the following:

1 - Suspicion without good reason that others are exploiting, harming or deceiving him/her

2- preoccupation with unjustified doubts about the fidelity or reliability of friends or partners

3- unwillingness to disclose to others due to unjustified fears that the information received will be used maliciously against him/her

4- search for hidden meanings or threatening signs of harmless remarks or events

5 - constant ill will, i.e. refusal to forgive insults, insults, ridicule

6 - feeling attacks on one's character or reputation that are not visible to others, with an immediate reaction of anger or a counterattack

7 - repeated suspicions, without sufficient grounds, of the fidelity of a spouse or sexual partner.

B. Does not occur solely in association with schizophrenia, mood disorders with psychotic features, other psychotic disorders, and is not a direct physiological result of a medical condition.

Note: If these factors occur before the onset of schizophrenia, add "premorbid", eg "paranoid personality disorder (premorbid)".

The new American classification of mental disorders DSM-5 is released to the world

Dutch De Psychiater publishes short review changes in the new version of the American classification of mental disorders DSM-5:

""DSM-5 consists of three sections: it is (1) an introductory part with instructions for use and a warning about the forensic psychiatric application of the DSM-5; (2) diagnostic criteria and codes for routine clinical use; and (3) tools and techniques to inform clinical decision making.

Main changes:

Neurodevelopmental Disorders

The severity of the disorder is not determined by IQ, but by the level of adaptive functioning. Speech disorders have entered the new category "social communication disorder", in which some of the syndromes coincide with "autism spectrum disorder". The category "Autism Spectrum Disorders" replaces the DSM-4 diagnoses of autism, Asperger's syndrome, childhood disintegrative disorder, and an unspecified general developmental disorder, all of which cease to exist as separate diagnoses. ADHD may start later (before 12) and is otherwise treated in different areas. Learning disorders and movement disorders are organized differently in this chapter and somewhat combined.

Schizophrenia spectrum and other psychotic disorders (Schizophrenia spectrum and other psychotic disorders)

For the diagnosis of schizophrenia, the symptoms of the first rank of Schneider lose their special weight. One positive symptom is required for a diagnosis to be made. Subtypes are removed - in favor of the dimensional indicator of severity. For schizoaffective disorder, the mood aspect is emphasized, and for delusional disorder, frivolous content is no longer excluded – although it is evaluated separately. The "catatonia" section has been expanded: this code can now be entered as an adjacent diagnosis (specifying indicator) for depressive, bipolar and psychotic disorders.

Bipolar and similar disorders (Bipolar and related disorders)

Bipolar and related disorders are now separated from depressive disorders and placed in a separate category. A clearer definition of mania is given and refinements for mixed episodes are introduced, which lowers the threshold for disorder. Added a residual subcategory ""other"" and a qualifying score for anxiety symptoms.

Depressive disorders

Disruptive mood dysregulation disorder and premenstrual dysphoric disorder have been added. Chronic depression and dysthymia are combined into one diagnosis, now it is ""persistent depressive disorder (dysthymia)"" with a number of clarifying indicators. Major depressive disorder remained virtually unchanged, however, for "subthreshold" symptoms, a clarifying indicator ""mixed manifestations"" was introduced. A clarifying indicator for anxious distress has also been introduced. Removed grounds for exclusion for grief.

Anxiety disorders

Obsessive-compulsive disorder and post-traumatic disorder are placed in separate chapters on neurophysiological and epidemiological grounds (see below). Various phobia criteria are slightly adapted, and agoraphobia and panic are decoupled. Panic attacks can act as a clarifying indicator for other diagnoses. The diagnoses of separation anxiety disorder and selective mutism are no longer specific "childhood" diagnoses.

Obsessive-compulsive and related disorders

For obsessions and "Body Dysmorphic Disorder" added clarifying indicators of severity and criticism, incl. ""delusional character"". The same goes for "Pathological Picking" (Hoarding Disorder) - a completely new diagnosis in the DSM-5, as well as "Excoriation" (Skin-Picking) Disorder. This included trichotillomania, and, in addition, exogenous causes of OCD were added, in particular, due to the use of psychoactive substances and drugs, as well as in connection with other medical conditions.

Trauma- and stressor-related disorders

For both acute trauma and post-traumatic stress disorder, the stressor criterion has been changed to include the bystander experience and the indirect effects of the stressor when making a diagnosis. Also ruled out is the requirement to directly experience fear, horror, or feelings of helplessness. Avoidance and emotional flattening are separated, and at the same time, emotional flattening is added, incl. persistent depressed mood. Recklessness, (auto) destructive behavior, irritability and aggression are added to the already known symptoms of arousal. For children and adolescents in puberty, lower diagnostic thresholds are used. The adjustment disorder remained unchanged. Reactive attachment disorder has been moved to this chapter.

Dissociative Disorders

Various changes have been made to the criteria for dissociative identity disorder, including, for example, the perception of identity transition (change) by third parties. Depersonalization and derealization are combined into one disorder. Dissociative fugues have ceased to be a separate diagnosis, and have become a clarifying indicator in ""dissociative amnesia"".

Somatic symptom and related disorders

This is what was previously called somatoform disorders. Removed somatization disorder, hypochondriasis, pain disorder, and unspecified somatoform disorder from DSM. A diagnosis of a "disorder with somatic symptoms" can be made on par with a diagnosis from another medical specialty only if the somatic symptoms are associated with abnormal thoughts, feelings, and behaviors. Unexplained medical symptoms play a decisive role only in false pregnancy and conversion (i.e. functional disorder with neurological symptoms). In other cases, positive symptoms should be sought in this group.

Disorders related to food and nutrition (Feeding and Eating Disorders)

The former "childish" diagnoses, such as "peak" (absorption of inedible substances) and "rumination" (i.e., regurgitating food with repeated chewing), got here, but the age criterion was removed for them. There is also a new diagnosis: ""avoidant / restrictive food intake"" (Avoidant / Restrictive Food Intake). Anorexia no longer requires amenorrhea and binge eating episodes, although for bulimia nervosa and the new Binge-Eating Disorder category, binge eating episodes must occur at least once a week.

Sleep-Wake Disorders

The distinction between truly psychiatric and other ("somatic") sleep disorders is no longer present in the DSM-5, given the original concept of overlapping diagnoses. The chapter presents a large number of sleep disorders described through physical characteristics due to circadian rhythms and respiratory disorders. This group includes Restless legs syndrome and REM Sleep Behavior Disorder. A large diagnostic choice predisposes to move away from the use of "unspecified" diagnoses.

Sexual Dysfunctions

In order to avoid overdiagnosis, the thresholds for diagnosis in this group are raised. Vaginismus is grouped with dyspareunia under the category Genito-Pelvic Pain/Penetration Disorder. Removed sexual aversion disorder. All disorders are subtyped according to psychological or combined factors, situation, and achievement.

Gender Dysphoria

Disruptive, impulse control, and conduct disorders

This is also a new chapter, which partly included the missing chapter "Disorders usually first diagnosed in childhood and adolescence"". In addition to a variety of impulse control disorders, antisocial personality disorder, dubbed from the chapter on personality disorders, also got here. The criteria for oppositional defiant disorder have been revised and weighted. In conduct disorder (Conduct Disorder), the grounds for excluding the diagnosis have been removed, but the clarifying indicator “callous-unemotional” has been added. Intermittent Explosive Disorder can now be verbal, and the rest of the criteria for this disorder are much more refined.

Substance-related and addictive disorders

This chapter includes for the first time a disorder not caused by a chemical, gambling addiction. For chemical substances abuse and dependence are combined under the name Substance Use Disorder. "Craving" appears as a criterion, and problems with the justice authorities have been removed. There was a new code for tobacco related disorders, while caffeine was already in the DSM-IV TR. There is a measure of severity, as well as a mention of ""under controlled circumstances"" or ""as maintenance treatment"" (for methadone).

This concludes our review. It is far from complete. We are dealing only with the first attempts to comprehend the changes that have taken place, taking into account the accumulated knowledge. More detailed information about the relevant sections can be found on the Internet.

According to materials:

* (that is, the fifth edition of the DSM), the next generation of the classifier.

According to DSM-IV, when formulating a complete diagnosis, the following factors (“axes”) are taken into account:

• presence or absence
  • mental illness (axis I),
  • background psychopathy (axis II),
  • somatic disease (axis III),
• aggravating psychosocial factors (axis IV),
• general level of adaptation (axis V).

The guidelines use ICD-9-CM (ICD-9-CM) codes to codify disorders.

Description

First axle(axis I) includes transient, reversible disorders that come and go, such as phobias, generalized anxiety disorder (GAD), depression, addictions, etc. These disorders are "symptomatic" because patients with disorders on this axis often find themselves the presence of mental disorders (“symptoms”) that bother them and need treatment.

Second axis(axis II) includes personality disorders and other stable, practically unreversible long-term mental disorders, such as mental retardation or mental retardation.

The attitude of patients to violations of the First Axis is ego-dystonic, that is, alien, unusual for the ego, while violations of the Second Axis, including personality disorders, are ego-syntons and are considered by patients as their inherent characterological features and / or natural reactions to current situation.

third axis(axis III) contains a list of physical disorders or conditions that can be observed in a patient with mental disorders, that is, all somatic and psychosomatic diseases (for example, epilepsy, arterial hypertension, gastric ulcer, infectious diseases, etc.). Axis III contains codes borrowed from the International Classification of Diseases - (ICD).

fourth axis(axis IV) includes past psychosocial stresses (eg, divorce, trauma, death of a loved one) related to the disease; are ranked (separately for adults and separately for children and adolescents) on a scale with a continuum from 1 (no stress) to 6 (catastrophic stress).

Fifth axis(axis V) characterizes highest level functioning observed in the patient during the past year (for example, in public, professional activity and mental activity); ranking on a scale with a continuum from 100 (upper limit) to 1 (gross dysfunction).

Story

• - DSM-II (7th Reissue with Excluded Homosexuality)
• - DSM-III-R (third edition, revised)
• - DSM-IV-TR (TR - eng. text revision; fourth edition, revised)
• - DSM-5 (development started in 1999, published May 18, 2013)

The addition or exclusion of diseases in the DSM is decided by a vote of psychiatrists.

Criticism

Of the 170 people who contributed to the DSM-IV and DSM-IV-TR, ninety-five (56%) had financial ties to pharmaceutical companies, according to a study published in the journal Psychotherapy and Psychosomatics. Of all the psychiatrists who were involved in the development of the DSM rubrics Mood Disorders and Schizophrenia and Other Psychotic Disorders, 100% had ties to pharmaceutical companies.

Sources

• American Psychiatric Association (1987) "Diagnostic and statistical manual of mental disorders" (3rd ed., rev.). Washington. DC: A.P.A.
• American Psychiatric Association (1994) "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.) (DSM-IV). Washington, DC: A.P.A.
• American Psychiatric Association."Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision: DSM-IV-TR". - Washington, DC: American Psychiatric Publishing, Inc., 2000. - ISBN 0890420254.

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Literature

• Korolenko Ts. P., Dmitrieva N. V. Personality and dissociative disorders: expanding the boundaries of diagnosis and therapy. - Novosibirsk: Publishing house of NGPU, 2006. S. 6-7. ISBN 5-85921-548-7
• Kaplan G.I., Sadok B.J. Clinical psychiatry (from a synopsis on psychiatry) in 2 volumes, volume 1. - M .: Medicine, 1998, 672 p.: ill. pp. 30, 31, 53, 54. ISBN 5-225-00533-0
• Regier DA, Kuhl EA, Kupfer DJ// World Psychiatry. - June 2013. - V. 12, No. 2. - S. 88-94.

see also

• ICD-10 - International Statistical Classification of Diseases and Related Health Problems 10th Revision
• CCMD (Chinese Classification of Mental Disorders) - Chinese Classification of Mental Disorders
• Codes from the DSM-IV (eng.), Codes from the DSM-IV alphabetically (eng.)

Notes

Links

Criticism

• Spiegel A.(English) . The New Yorker (January 3, 2005). - About the development of DSM. Retrieved September 6, 2009. .
• Pavlovets V.. Private Correspondent (January 11, 2010). - Criticism of DSM-IV and DSM-V. Retrieved January 21, 2010. .

An excerpt characterizing the DSM-IV

“Come in, if you need anything, everyone at headquarters will help…” said Zherkov.
Dolokhov chuckled.
“You better not worry. What I need, I won't ask, I'll take it myself.
"Yeah, well, I'm so...
- Well, so am I.
- Goodbye.
- Be healthy…
... and high and far,
On the home side...
Zherkov touched his horse with his spurs, which three times, getting excited, kicked, not knowing where to start, coped and galloped, overtaking the company and catching up with the carriage, also in time with the song.

Returning from the review, Kutuzov, accompanied by the Austrian general, went to his office and, calling the adjutant, ordered to give himself some papers relating to the state of the incoming troops, and letters received from Archduke Ferdinand, who commanded the forward army. Prince Andrei Bolkonsky with the required papers entered the office of the commander in chief. In front of the plan laid out on the table sat Kutuzov and an Austrian member of the Hofkriegsrat.
“Ah ...” said Kutuzov, looking back at Bolkonsky, as if by this word inviting the adjutant to wait, and continued the conversation begun in French.
“I’m only saying one thing, General,” Kutuzov said with a pleasant grace of expression and intonation, forcing one to listen to every leisurely spoken word. It was evident that Kutuzov listened to himself with pleasure. - I only say one thing, General, that if the matter depended on my personal desire, then the will of His Majesty Emperor Franz would have been fulfilled long ago. I would have joined the Archduke long ago. And believe my honor, that for me personally to transfer the highest command of the army more than I am to a knowledgeable and skillful general, such as Austria is so plentiful, and to lay down all this heavy responsibility for me personally would be a joy. But circumstances are stronger than us, general.
And Kutuzov smiled with an expression as if he were saying: “You have every right not to believe me, and even I don’t care whether you believe me or not, but you have no reason to tell me this. And that's the whole point."
The Austrian general looked dissatisfied, but could not answer Kutuzov in the same tone.
“On the contrary,” he said in a grouchy and angry tone, so contrary to the flattering meaning of the words spoken, “on the contrary, Your Excellency’s participation in the common cause is highly valued by His Majesty; but we believe that a real slowdown deprives the glorious Russian troops and their commanders of those laurels that they are accustomed to reap in battles, ”he finished the apparently prepared phrase.
Kutuzov bowed without changing his smile.
- And I am so convinced and, based on the last letter that His Highness Archduke Ferdinand honored me, I assume that the Austrian troops, under the command of such a skilled assistant as General Mack, have now already won a decisive victory and no longer need our help, - Kutuzov said.
The general frowned. Although there was no positive news about the defeat of the Austrians, there were too many circumstances that confirmed the general unfavorable rumors; and therefore Kutuzov's assumption about the victory of the Austrians was very similar to a mockery. But Kutuzov smiled meekly, all with the same expression that said that he had the right to assume this. Indeed, the last letter he received from Mack's army informed him of the victory and the most advantageous strategic position of the army.
“Give me this letter here,” said Kutuzov, turning to Prince Andrei. - Here you are, if you want to see it. - And Kutuzov, with a mocking smile on the ends of his lips, read the following passage from the letter of Archduke Ferdinand from the German-Austrian general: “Wir haben vollkommen zusammengehaltene Krafte, nahe an 70,000 Mann, um den Feind, wenn er den Lech passirte, angreifen und schlagen zu konnen. Wir konnen, da wir Meister von Ulm sind, den Vortheil, auch von beiden Uferien der Donau Meister zu bleiben, nicht verlieren; mithin auch jeden Augenblick, wenn der Feind den Lech nicht passirte, die Donau ubersetzen, uns auf seine Communikations Linie werfen, die Donau unterhalb repassiren und dem Feinde, wenn er sich gegen unsere treue Allirte mit ganzer Macht wenden wollte, seine Absicht alabald vereitelien. Wir werden auf solche Weise den Zeitpunkt, wo die Kaiserlich Ruseische Armee ausgerustet sein wird, muthig entgegenharren, und sodann leicht gemeinschaftlich die Moglichkeit finden, dem Feinde das Schicksal zuzubereiten, so er verdient.” [We have a fully concentrated force, about 70,000 people, so that we can attack and defeat the enemy if he crosses the Lech. Since we already own Ulm, we can retain the advantage of commanding both banks of the Danube, therefore, every minute, if the enemy does not cross the Lech, cross the Danube, rush to his communication line, cross the Danube lower and the enemy, if he decides to turn all his strength on our faithful allies, to prevent his intention from being fulfilled. Thus, we will cheerfully look forward to the time when the imperial Russian army completely prepared, and then together we can easily find an opportunity to prepare the fate of the enemy, which he deserves.
Kutuzov sighed heavily, having finished this period, and carefully and affectionately looked at the member of the Hofkriegsrat.
“But you know, Your Excellency, the wise rule of assuming the worst,” said the Austrian general, apparently wanting to end the jokes and get down to business.
He glanced involuntarily at the adjutant.
“Excuse me, General,” Kutuzov interrupted him and also turned to Prince Andrei. - That's what, my dear, you take all the reports from our scouts from Kozlovsky. Here are two letters from Count Nostitz, here is a letter from His Highness Archduke Ferdinand, here's another,” he said, handing him some papers. - And from all this cleanly, on French, compose a memorandum, a note, for the visibility of all the news that we had about the actions of the Austrian army. Well, then, and present to his excellency.
Prince Andrei bowed his head as a sign that he understood from the first words not only what was said, but also what Kutuzov would like to tell him. He collected the papers, and, giving a general bow, quietly walking along the carpet, went out into the waiting room.
Despite the fact that not much time has passed since Prince Andrei left Russia, he has changed a lot during this time. In the expression of his face, in his movements, in his gait, there was almost no noticeable former pretense, fatigue and laziness; he had the appearance of a man who has no time to think about the impression he makes on others, and is busy with pleasant and interesting business. His face expressed more satisfaction with himself and those around him; his smile and look were more cheerful and attractive.
Kutuzov, whom he caught up with back in Poland, received him very affectionately, promised him not to forget him, distinguished him from other adjutants, took him with him to Vienna and gave him more serious assignments. From Vienna, Kutuzov wrote to his old comrade, the father of Prince Andrei:
“Your son,” he wrote, “gives hope to be an officer who excels in his studies, firmness and diligence. I consider myself fortunate to have such a subordinate at hand.”
At Kutuzov's headquarters, among his comrades, and in the army in general, Prince Andrei, as well as in St. Petersburg society, had two completely opposite reputations.
Some, a minority, recognized Prince Andrei as something special from themselves and from all other people, expected great success from him, listened to him, admired him and imitated him; and with these people, Prince Andrei was simple and pleasant. Others, the majority, did not like Prince Andrei, they considered him an inflated, cold and unpleasant person. But with these people, Prince Andrei knew how to position himself in such a way that he was respected and even feared.
Coming out of Kutuzov's office into the waiting room, Prince Andrei with papers approached his comrade, adjutant on duty Kozlovsky, who was sitting by the window with a book.
- Well, what, prince? Kozlovsky asked.
- Ordered to draw up a note, why not let's go forward.
- And why?
Prince Andrew shrugged his shoulders.
- No word from Mac? Kozlovsky asked.
- Not.
- If it were true that he was defeated, then the news would come.
“Probably,” said Prince Andrei and went to the exit door; but at the same time, slamming the door to meet him, a tall, obviously newcomer, Austrian general in a frock coat, with a black scarf tied around his head and with the Order of Maria Theresa around his neck, quickly entered the waiting room. Prince Andrew stopped.
- General Anshef Kutuzov? - quickly said the visiting general with a sharp German accent, looking around on both sides and without stopping walking to the door of the office.
“The general is busy,” said Kozlovsky, hurriedly approaching the unknown general and blocking his way from the door. - How would you like to report?
The unknown general looked contemptuously down at the short Kozlovsky, as if surprised that he might not be known.
“The general chief is busy,” Kozlovsky repeated calmly.
The general's face frowned, his lips twitched and trembled. He took out notebook, quickly drew something with a pencil, tore out a piece of paper, gave it away, went with quick steps to the window, threw his body on a chair and looked around those who were in the room, as if asking: why are they looking at him? Then the general raised his head, stretched out his neck, as if intending to say something, but immediately, as if carelessly starting to hum to himself, made a strange sound, which was immediately stopped. The door of the office opened, and Kutuzov appeared on the threshold. The general with his head bandaged, as if running away from danger, bent over, with large, quick steps of thin legs, approached Kutuzov.