Comps - Psychopathology (Subdomain 4) Flashcards
What existed before the DSM? (APA, 2013)
-Focus was on practical care management, not nosology
-There was a fluid understanding of mental disorders
-After WWII, APA decided a system was needed
Nosology
A branch of medical science dealing with classification of disease
DSM-I release date
1952
What was the process for the DSM-1? (Blashfield et al., 2014)
-Created prose descriptions of symptoms
-Strong focus on inpatient
-Focus on organic disorders (e.g., things with physical causes like neurocognitive disorders)
What was going on in the world mental health community at the time of the DSM-1? (Stengel, 1959)
-All places had their own systems of diagnosis
-Stengel encouraged adopting the DSM
-WHO was prompted and they decided to develop the ICD-8
DSM-II release date
1968
What was the revision process like for the DSM-II? (Blashfield et al., 2014)
-Created an altered version of the ICD-8
-Introduced outpatient disorders (e.g., anxiety, depression, PDs)
-Introduced childhood/adolescent disorders
-Introduced a misc. category
What did Feighner et al. (1972) contribute? (Blashfield et al., 2014)
-Feighner and colleagues operationalized 15 disorders
-They proposed specific, operational definitions for each category in the form of diagnostic criteria and urged that these criteria be used in any future research on these 15 psychiatric disorders
DSM-III release date
1980
What was the process for the DSM-III? (Blashfield et al., 2014)
-Introduced the axis system
-Introduced more disorders
-Removed “sexual orientation disturbance”
-Changed from a psychoanalytic view to a neo-Kraepelinian view
-More of a medical model
-Head of revision (Spitzer) created structured clinical interviews to increase the reliability of diagnoses
Axis System
-Axis I: Clinical Disorders
-Axis II: Personality Disorders and what was then called “Mental Retardation”
- Axis III: Medical Conditions
-Axis IV: Psychosocial and Environmental Factors
-Axis V: The Global Assessment of Functioning (GAF) which was a Number
DSM-III-R release date
1987
What was changed with the DSM-III-R? (Blashfield et al., 2014)
-Added sleep disorders
-Added appendices for disorders that needed more research
DSM-IV release date
1994
What changed in the DSM-IV? (Blashfield et al., 2014)
-Used 13 work groups to update criteria
-Extensive literature reviews used
-Requested data from current research
-Did field trials of current diagnoses
DSM-IV-TR release date
2000
What was the process for the DSM-IV-TR?
-Revised the text
-No major changes
DSM-5 releate date
2013
What was the process for the DSM-5? (APA, 2013)
-Field studies and literature reviews conducted
-Put drafts online to receive feedback
-Removed the axis model
What principles drove the DSM-5 revision process? (APA, 2013)
- Meant to be clinician’s manual
- Intended to guide research
- Maintain continuity with past DSMs
- No constraints on the degree of change for this new model
What were the goals of the DSM-5 revision? (Blashfield et al., 2014)
- Trim misc and NOS categories
- Make dimensions (especially for PDs)
- Align with the ICD-11
- Reflect current research and restructure to meet the lifetime course of disorders
How successful were the goals of the DSM-5 revision? (Blashfield et al., 2014)
- Increased specificity of disorders meaning more people do not meet criteria
- APA board rejected the PD dimension/hybrid model
- Really just updated the ICD-10
- Made the DSM into sections (section 1: explained revisions, section 2: criteria model, section 3: alternative personality disorder model)
What was the response to the changes in the DSM-5? (Wakefield, 2016)
Outcry over axis removal
What were the other major DSM-5 changes? (APA, 2013)
-Mood disorders are now 2 different chapters (bipolar and depressive)
-Anxiety disorders are now 3 chapters (anxiety, OCD, trauma-related)
-Eliminated bereavement clause in the depressive disorders diagnosis
-Added anxious distress
-Dysthymia is not PDD
-Gender identity disorder is now gender dysphoria
-Substance abuse/dependence is now substance use disorder
-Asperger’s is folded into ASD
Bereavement Clause
It prevented people from being diagnosed with MDD if their symptoms began within two months of a loved one’s death
DSM-5-TR release date
2022
What changed in the DSM-5-TR? (APA, 2022)
-More attention to culture, racism, and discrimination
-Updates to all prevalence rates, risk, and prognostic factors for each disorder based on new research
-Switched from ICD-9 to ICD-10 codes
-Eliminated male/female checkboxes on clinical sequence measures
-Updated language
-New disorders
Example of the attention to culture, racism, and discrimination
-Updating terminology and language “to challenge the view that races are discrete and natural entities”
-Including more information on cultural influences and the possibility of misdiagnosis in socially oppressed groups
Updated Language in the DSM-5-TR
-Intellectual Disability –> Intellectual Developmental Disorder
-“Natal Sex” –> “Birth-Assigned Gender”
-Suicidal behavior and NSSI were added as ICD-10 codes to be used as additional descriptors
New Disorders in the DSM-5-TR
-Prolonged Grief Disorder (added to trauma and stressor-related disorders section)
-Unspecified Mood Disorder
