DSM-5 – Diagnostic and Statistical Manual

DSM-5 open reference book

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is used extensively by professionals to diagnose mental health conditions. It serves as a critical guide for clinicians, researchers, and insurance providers. It reflects the most up-to-date knowledge on mental disorders.

Data Points

  • Published by: American Psychiatric Association (APA)
  • Edition: Fifth
  • Purpose: Classify and diagnose mental disorders
  • Coverage: Addresses a broad spectrum of mental health conditions
  • Organization: Categorized into 20 chapters
  • Updates: Replaces the DSM-IV-TR

Addiction Assessment Criteria

These are the 11 criteria used to determine whether a person has a substance Use Disorder and, if so, at what level.

  • Taking the substance in larger amounts or for longer than you’re meant to
  • Wanting to cut down or stop using the substance but not managing to
  • Spending a lot of time getting, using, or recovering from use of the substance
  • Cravings and urges to use the substance
  • Not managing to do what you should at work, home, or school because of substance use
  • Continuing to use, even when it causes problems in relationships
  • Giving up important social, occupational, or recreational activities because of substance use
  • Using substances again and again, even when it puts you in danger
  • Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
  • Needing more of the substance to get the effect you want (tolerance)
  • Development of withdrawal symptoms, which can be relieved by taking more of the substance

Here are the levels of SUD based on the results of the assessment;

  • Mild: Two or three symptoms indicate a mild substance use disorder.
  • Moderate: Four or five symptoms indicate a moderate substance use disorder.
  • Severe: Six or more symptoms indicate a severe substance use disorder.

Drug classifications in the DSM-5:

  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives
  • Hypnotics, or anxiolytics
  • Stimulants 
  • Tobacco

Historical Context

  • The first DSM was published in 1952, and there have been multiple revisions since.
  • Each revision reflects advances in knowledge, research, and clinical practice.

Structure and Organization

  • The DSM-5 is organized into three sections and an appendix.
    • Section I: Basics and use
    • Section II: Diagnostic criteria and codes
    • Section III: Emerging measures and models
  • Contains 20 chapters, categorized by related disorders.

Significant Changes from DSM-IV-TR

  • Introduction of the dimensional approach: Some disorders can now be rated along a spectrum of severity.
  • Reclassification of Disorders: For instance, the separate categories of substance abuse and dependence in DSM-IV-TR are combined into ‘substance use disorders’ in DSM-5.
  • New Disorders Added: Conditions like Disruptive Mood Dysregulation Disorder and Premenstrual Dysphoric Disorder were added.

Critiques and Controversies

  • Some professionals felt that certain changes may lead to over-diagnosis.
  • Concerns about the validity of certain disorders or classifications.
  • DSM-5’s shift toward a more dimensional approach was both praised and criticized.

Impact on Treatment and Research

  • Standardizes diagnoses, leading to consistent research findings and treatment strategies.
  • Helps in determining treatment plans, predicting outcomes, and guiding the selection of interventions.
  • Influences insurance coverage and reimbursements for mental health services.

Future Directions

  • APA has initiated a living document approach, meaning future updates to diagnostic criteria might occur more frequently but in smaller increments.
  • Ongoing research and clinical feedback will influence future editions and updates.