____________________________________________________________ A Clinician’s Guide to the DSM-5-TR
edition, text revision of the DSM, known as the DSM-5-TR, is the culmination of many decades of research and count- less arguments for how such a diagnostic manual should be structured. To understand the advances of DSM-5-TR, it is also essential to know the history of the DSM and how it has changed over the years. Understanding this is also relevant to understanding current controversies with the DSM-5-TR. Cli- nicians must possess this knowledge to function within their specific scope of practice and ethical guidelines and provide best practices to clients [4; 5; 6]. Before the development of a comprehensive diagnostic sys- tem, there was little agreement on categories of psychological disorders or what disorders were psychological versus medi- cal. The first large-scale attempt at generating mental health diagnoses was published in the 1840s, and it was primarily an attempt to obtain statistical data through the census and consisted of a single diagnosis of idiocy/insanity. Following this, in 1917, to better standardize the classification of mental disorders across mental hospitals, the American Psychiatric Association (APA) developed a standard nomenclature for some psychological disorders that would be included in the American Medical Association’s Standard Classified Nomenclature of Disease . Although this was an essential step in the direction of identifying standardized psychological diagnoses, it was limited in that it did little to distinguish between psychological and medical disorders, and it was primarily focused on the most severe disorders that were seen in inpatient units. Following World War II, to better classify and distinguish the presentations of psychological disorders in service veterans, the U.S. Army, Veterans Administration, and World Health Organization (WHO) worked to incorporate a section for mental disorders into the sixth edition of the International Classification of Disease (ICD), which was published in 1949. In 1952, the APA published a manual solely focused on mental health diagnoses called the Diagnostic and Statistical Manual: Mental Disorders [7]. This volume is now referred to as DSM-I and was an essential development in the progress of diagnostic structure because it was heavily focused on clinical utility and provided additional descriptions of disorders beyond what was available in the ICD-6. Importantly, DSM-I was also more extensive than previous attempts at classifying psychiatric con- ditions and listed 106 mental disorders ranging from neurosis to personality disturbance. Although DSM-I was a significant advancement, it was still limited in many ways, particularly by the lack of a consistent and agreed-upon definition for mental illness. As an example, homosexuality was listed in DSM-I as a sociopathic personal- ity diagnosis, which reflected more on the social traditions at the time of DSM-I than on the actual psychological aspects of homosexuality. By the 1960s, many viewed the concept of mental illness as a myth or as a way for society to exert control over those who might deviate from societal norms [8; 9]. In 1968, in conjunction with the development of the ICD-7, the
COURSE OVERVIEW With the development of the Diagnostic and Statistical Manual of Mental Disorders , fifth edition, text revision (DSM-5-TR), professionals who work with people who have mental health diagnoses will be responsible for learning and understanding the changes that have taken place in the new diagnostic manual [1]. The transition from using the previous edition of DSM-5 to the new DSM-5-TR presents a challenge for any clinician [1; 2]. Given the extent of the changes that have occurred for DSM-5, reading through DSM-5-TR and piecing together these changes should be quick but done thoroughly. This course provides clinicians with the most up-to-date infor- mation on DSM-5-TR, relative to the previous edition, DSM-5, including diagnostic criteria needed to assess the presence of various disorders. This course will not only present newly clas- sified disorders and identify those that have been removed or reclassified but will also illuminate any changes to diagnostic criteria for disorders in the previous manual and continue to be defined as disorders in DSM-5-TR. The course will cover the development process used by the DSM-5-TR task force in deciding the diagnostic system’s new structure and removing the multiaxial system. Alternative diagnostic systems proposed in place of DSM-5-TR will also be described. This course is designed for social workers, psychologists, marriage and family therapists, mental health counselors, occupational therapists, nurses, advanced practice registered nurses, and other ancillary behavioral health staff. Summary tables are provided to assist with understanding the significant changes that have taken place. Without a strong understand- ing of these changes, clinicians may be more prone to making psychiatric diagnoses based on out-of-date criteria, or they may make a diagnosis that no longer formally exists (e.g., Asperger syndrome). This knowledge will benefit treatment in various settings, whether addressing psychiatric symptoms directly or understanding the impact of the symptoms on other aspects of the person’s functioning. This course concludes with a discussion of the controversies and criticisms that arose with the publication of DSM-5-TR and the alternative diagnostic systems that have recently been proposed instead of DSM-5-TR. HISTORY OF THE DSM The DSM aims to provide a common language for clinicians, a tool for researchers, a bridge between research and clinical work, and a textbook of information for students and educa- tors. The DSM also provides a coding system for statistics, insurance, and administrative processes [3]. However, despite being commonly referred to by the media as the “bible” of psychiatry, the DSM is a constantly changing manual that has undergone extensive revision over time. Publication of the fifth
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