by Joye C. Anestis
I was going to find a new and exciting article to write about today, but I got so wrapped up in exploring the DSM-5 website that it has taken up my entire morning (MAJOR nerd alert). So I thought I'd give my thoughts on few more of the big changes being proposed.
One proposal I'm struck by is the restructuring of the multiaxial system. It appears that the major impetus for this is to make the DSM-5 be more similar the ICD-10 (the World Health Organization's International Classification of Diseases, the system used by pretty much the rest of the world). They are considering collapsing Axis I, II, & III disorders into one axis containing all psychiatric and medical conditions. Axis IV allows clinicians to document psychosocial or environmental problems the client is having. The DSM-5 subgroup is considering changing the current Axis IV codes to the ones used by the ICD. And Axis V, where clinicians rate a client's overall functioning level, may also be shifted to match the ICD's system of allowing disability and dysfunction to be assessed separately for each disorder (I wrote about this briefly here). In my opinion, this all seems reasonable. One of the general purposes of a classification system is to allow for communication between professionals. Perhaps making the DSM behave more similarly to the ICD will better facilitate global sharing of information. I guess only time will tell. In regard to the collapsing to Axes I-III into one, again this seems reasonable. The separation of personality disorders and mental retardation onto Axis II, away from the Axis I mental illnesses, was done simply to make clinicians consider these diagnoses as additional possibilities. It was not done for an scientific purpose or based on any data. So I don't know if I see the harm in mixing them back in with Axis I. What do you think?
Another exciting potential addition is a suicide assessment dimension. The DSM-5 website didn't offer a ton of information on this but, in my opinion, it seems very worthwhile. Anything that encourages a more thorough assessment of suicide risk gets my vote!
I'm also a bit overwhelmed by the large number of potential new diagnoses that are being considered. What I really like about the website is that, for almost every change, they provide the rationale for the change, how they suggest severity should be rated, references for the data they cite, and what the DSM-IV definition looks like for comparison purposes. Here's just a handful I've come across (this doesn't even come close to the total number of potential new diagnoses, I just picked out a few):
- Hoarding disorder: The task force argues that this syndrome exists in about 2-5% of the population, and that most of the cases do not meet criteria for OCD or OCPD.
- Olfactory reference syndrome: If this gets in, it will most likely be in an Appendix for Future Research. It is a "preoccupation with the belief that one emits a foul or offensive body odor, which is not perceived by others." The task force argues that that there are important differences between ORS and social phobia, OCD, body dysmorphia, and some of the other disorders it has been associated with in the past.
- Skin picking disorder: The name describes it well. The syndrome description is similar to Trichotillomania (and, if it is included, will most likely be in the Appendix). Incidentally, Trichotillomania may be moved to the Anxiety Disorders section.
- Psychosis risk syndrome: This one could stir up some major controversy, in my opinion. It is an attempt to identify young people at risk for later development of a psychotic disorder. It could be argued that there are serious risks involved in applying this diagnosis, but the task force also raises a compelling argument for the benefits of it. A big question to be answered in field trials is can we reliably identify these individuals?
- Non-Suicidal Self Injury: Maybe I'm missing something, but I can only find this listed in the Childhood Disorders section. Nevertheless, considering NSSI as its own diagnosis is interesting, and there seems to be quite a bit of research backing it up.
- Callous and Unemotional Specifier for Conduct Disorder: This, in my opinion, is a big deal. The existence of C-U traits has a rich research basis, and these childhood traits have a connection with adult psychopathic traits.
I am wholly confused by the proposed personalty disorder changes...I'll have to get back to you on those.
Mike and I will continue to absorb the DSM-5 websites, and I'm sure many future posts on it are heading your way. In the meantime, we'd love to hear your thoughts and comments on DSM-5. Anything concern you? Any new disorders you're interested in? Thoughts on some of structural rearranging going on?
Joye Anestis is a doctoral candidate in clinical psychology at Florida State University.
Subscribe in a reader
