1. DSM-5: From Pathological Gambling to Gambling Disorder
Heather A. Chapman, Ph.D, NCGCII, BACC
Louis Stokes Cleveland VA Medical Center
Case Western Reserve University School of Medicine

2. DSM-5 Mainly incremental changes from DSM-IV No more Roman numerals
Considering online updates in the future (e.g. DSM-5.1) making it a “living document”

3. DSM-5 DSM-5 is now in effect as of 12/31/13.
DSM-5 is fully compatible with ICD-9 system now in use by insurance companies and includes ICD-10 codes (to be implemented 10/1/14).

4. Problems with DSM-IV Addressed by DSM-5
High rates of co-morbidity
High use of NOS category
Concerns about reliability and validity

5. Guiding Principles for Changes to DSM
Research evidence should support any addition or substantive modification.
Changes should be based on empirical research rather than clinical consensus.
Behavioral science
Neuroscience
Continuity with the current manual should be maintained when possible.
Routine clinical practices must be able to implement any changes.

6. DSM-5 Structure Section I: Basics/Introduction
Section II: Diagnostic Criteria and Codes
Section III: Emerging Measures and Models
Appendix

7. Section I: Basics Introduction Use of the Manual
Cautionary Statement for Forensic Use

8. Section I: Basics: Introduction
DSM-5 better reliability than DSM-IV.
Research to validate diagnoses continues.
The boundaries between many disorder categories are fluid over the life course.
DSM-5 accommodates dimensional approaches to mental disorders.

9. NOS/CNEC conditions not elsewhere classified
Problem: widespread use of Not Otherwise Specified (NOS) diagnoses.
DSM-5 removes the NOS diagnosis. It adds
Other Specified Disorder (criteria vary by disorder)
Unspecified Disorder (for use when there is insufficient information to be more specific)
NOS  CNEC (conditions not elsewhere classified):
Only for 6 months.
Only for specific reasons:
Diagnosis unclear (e.g., psychotic disorder CNEC)
Clinician not trained to make the dx.
Clinician cannot get info (e.g., client uncooperative; records not available).
You do not have enough info.
Clinicians needs or is required to take more time of direct observation (e.g., 12 months).

10. 22 Chapters: Neurodevelopmental Disorders
Schizophrenia Spectrum & Other Psychotic Disorders
Bipolar & Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive & Related
Trauma- & Stressor-Related
Dissociative Disorders
Somatic Symptom Disorders
Feeding & Eating Disorders
Elimination Disorders
Sleep/Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse-Control & Conduct Disorders
Substance Related & Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Other Mental Disorders
Medication-induced Movement…Med Effects
Other Conditions (v codes)

11. Two Clusters of Disorders
Internalizing group
Disorders with prominent anxiety, depressive, and somatic symptoms
Externalizing group
Disorders with prominent impulsive, disruptive conduct, and substance use symptoms
Disorders within these clusters are adjacent in the DSM-5.

12. Organization of Disorders
Disorders are organized on developmental and lifespan considerations.
DSM-5 begins with diagnoses that manifest early in life, then adolescence and young adulthood, then adulthood and later life.

13. Cultural Issues
Culture is considered as it shapes the experience and expression of the symptoms, signs, and behaviors that are criteria for diagnosis.
Section III contains a Cultural Formulation.
The Appendix contains a Glossary of Cultural Concepts of Distress.
DSM-IV had a list of culture-bound syndromes.

14. Cultural Issues, cont.
DSM-5 replaces the construct of the culture-bound syndrome in DSM-IV with 3 concepts:
Cultural syndrome: a cluster of invariant symptoms in a specific cultural group
Cultural idiom of distress: a way of talking about suffering among people in a cultural group
Cultural explanation or perceived cause for symptoms, illness, or distress

15. DSM-5 is Non-Axial DSM-IV axes I, II, and III have been combined.
Continue to list relevant medical conditions.
The GAF in DSM-IV has been eliminated. Instead, use the World Health Organization Disability Assessment Schedule (WHODAS).
The WHODAS-2.0 is on page 747 of the DSM-5 and is also available online.

16. Chart Entry Example of a Diagnosis
Major depressive disorder, recurrent, severe; gambling disorder; COPD
Anxiety; Insomnia
Recent divorce; financial insecurity
Function seriously impaired

17. Section I: Basics: Use of the Manual
Clinical Case Formulation
Making diagnoses requires clinical judgment, not just checking off the symptoms in the criteria.
The client’s cultural and social context must be considered.
The DSM-5 does not include all possible mental disorders.

18. Definition of a Mental Disorder
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
There is usually significant distress or disability in social or occupational activities.
A mental disorder is a disturbance
That reflects a dysfunction
In psychological or biological or developmental processes

19. Definition of a Mental Disorder
The diagnosis of a mental disorder should have clinical utility; it should help clinicians to determine prognosis and treatment plan.
The diagnosis of a mental disorder is not equivalent to a need for treatment.
There is no need to make a diagnosis unless it interferes with the patient’s functioning.
Some patients may not want treatment for their mental disorder.
Eg. A patient who has hallucinations may choose to live with them.

20. Definition of a Mental Disorder
Diagnoses are made on the basis of
The clinical interview
DSM-5 text descriptions
DSM-5 criteria
Clinician judgment

21. Steps in Making a Diagnosis
Administer cross-cutting assessments
Administer WHODAS 2.0
Conduct clinical interview
Determine whether a diagnostic threshold is met
Consider subtypes and/or specifiers
Consider contextual information, disorder text, distress, clinician judgment
Apply codes and develop a treatment plan

22. Section I: Basics: Cautionary Statement for Forensic Use of DSM-5
The diagnosis of a mental disorder does not imply that the person meets legal criteria for the presence of a mental disorder or a specific legal standard for competence, criminal responsibility, disability, etc.
Having a diagnosis does not imply that the person is (or was) unable to control his or her behavior at a particular time.

23. Section II: Diagnostic Criteria and Codes
Highlights of Specific Disorder Revisions

24. Neurodevelopmental Disorders
Autism Spectrum Disorder (ASD) replaces DSM-IV’s Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorder, etc.
Rationale: Clinicians had applied the criteria for these disorders inconsistently and incorrectly. There was not enough data to justify continuing to separate these disorders.

25. Intellectual Disability
The term “Intellectual Disability” replaces “Mental Retardation.”
DSM-5 places greater emphasis on adaptive functioning deficits rather than IQ scores alone.
Begin the diagnostic process by looking at adaptive functioning. Then add in the information provided by IQ scores.

26. Attention-Deficit/Hyperactivity Disorder
Age of onset was raised from 7 years to 12 years.
The symptom threshold for adults was reduced to five symptoms.
Specific Learning Disorder
Now presented as a single disorder, with specifiers for deficits in reading, writing, and mathematics.

27. Schizophrenia Spectrum and Other Psychotic Disorders
Elimination of special treatment of bizarre delusions and special hallucinations in Criterion A.
At least one of two required symptoms to meet Criterion A must be delusions, hallucinations, or disorganized speech.
Specific subtypes were deleted due to poor reliability and validity.
Schizoaffective Disorder
Now based on the lifetime (rather than the episodic) duration of the illness.
Catatonia
Now exists as a specifier for many mental disorders.
There was poor reliability in distinguishing bizarre from non-bizarre delusions.
DSM-IV said only one Criterion A symptom is required if delusions are bizarre or if hallucinations consist of a voice keeping a running commentary on the person’s behavior or two or more voices conversing with each other.
Subtypes: Paranoid, Disorganized, Catatonic

28. Bipolar and Related Disorders
Mania and Hypomania
Criterion A now includes increased energy/activity as a required symptom.
“Mixed episode” is replaced with a “with mixed features” specifier.
“With anxious distress” was added as a specifier for bipolar and depressive disorders.
Increased energy is a major symptom of mania.
This loosens the criteria some for clients with sub-threshold mixed states.

29. Depressive Disorders
The bereavement exclusion was eliminated from major depressive episode (MDE).
In some people, a major loss can lead to a MDE.
Disruptive Mood Dysregulation Disorder (DMDD) was added.
For children with extreme behavioral dyscontrol but persistent rather than episodic irritability.
This should decrease the number of children diagnosed with bipolar disorder.
Dysthymic Disorder was renamed Persistent Depressive Disorder.
This change allows such people to receive treatment for depression. In DSM-IV they could not be diagnosed.
In DSM-IV bereavement is a V-code and required more than an two-month time frame before MDE could be diagnosed. This time period was arbitrary.

30. Anxiety Disorders
DSM-5 has four chapters to cover the anxiety disorders covered by two chapters in DSM-IV.
Anxiety Disorders
Obsessive-Compulsive & Related Disorders
Trauma- & Stressor-Related Disorders
Dissociative Disorders
Panic attacks was added as a specifier for any mental disorder.
Panic attacks can occur in many mental disorders.
It’s probably a good idea to separate PTSD, for example, from the other anxiety disorders.

31. Obsessive-Compulsive & Related Disorders
Hoarding Disorder was added.
Excoriation (Skin-Picking) Disorder was added.
Body Dysmorphic Disorder (BDD) was moved from the chapter on somatic disorders to the chapter on OCD & Related disorders.
A “delusional” specifier was added for both OCD and BDD.

32. Trauma- & Stressor-Related Disorders
Posttraumatic Stress Disorder
The stressor criterion (A) is now more explicit.
Criterion A2 (subjective reaction) is eliminated.
The symptom clusters were enlarged from 3 to 4.
Separate criteria were added for children age 6 and younger.
Reactive attachment disorder was separated into RAD and disinhibited social engagement disorder.
More children will meet the criteria for PTSD than before

33. Feeding and Eating Disorders
Binge Eating Disorder (BED) is new.
The diagnosis of Anorexia Nervosa no longer requires amenorrhea as a diagnostic criterion.
There is now good evidence that BED is a valid and clinically useful diagnosis.

34. Sleep-Wake Disorders Primary Insomnia renamed Insomnia Disorder.
Rapid Eye Movement Sleep Behavior Disorder and Restless Legs Syndrome elevated to the main body of the manual.
Subtypes expanded for Circadian Rhythm Sleep Disorders.

35. Disruptive, Impulse-Control, and Conduct Disorders
Added a specifier “with limited prosocial emotions.”
Intermittent Explosive Disorder
Provides more specific criteria to define outbursts.
Trichotillomania was moved from the Impulse-Control Disorder chapter in DSM-IV to the Obsessive-Compulsive and Related Disorders chapter in DSM-5.
The conduct disorder specifier may help identify future psychopaths and provide them with treatment.

36. Neurocognitive Disorders
The word dementia was eliminated; the new term is Major Neurocognitive Disorder.
The word “Dementia” was linked to old age diseases and clinicians tended to be pessimistic about its prognosis.
Mild Neurocognitive Disorder is new.
This condition exists and treatment can help.
Neurocognitive decline is not inevitable.
People think of dementia as occurring in older people, but neurocognitive problems can occur in young or older people, e.g., due to traumatic brain injury.

37. Adjustment Disorders
The chapter “Adjustment Disorders” in DSM-IV was incorporated into the chapter on Trauma- and Stressor- Related Disorders in DSM-5.
Criterion B-1 was rephrased as “marked distress that is out of proportion to the severity or intensity of the stressor.”
Symptoms are in response to an identifiable stressor.

38. Personality Disorders
All 10 PDs in DSM-IV remain intact in DSM-5.
Note that “Axis II” in DSM-IV no longer exists.
Section III of the DSM-5 contains an alternate, trait-based approach to assessing personality. It helps with the diagnosis of people who meet the core criteria for a PD but do not meet the criteria for a specific type of PD.

39. Alternate Model for PDs
PDs are characterized by impairments in personality functioning and pathological personality traits.
General Criteria for Personality Disorder
Specific Personality Disorders
Antisocial, Avoidant, Borderline, Narcissistic, Obsessive- Compulsive, and Schizotypal.

40. Alternate Model for PDs
Proposed Diagnostic Criteria
Impairment in personality functioning.
Identity
Self-direction
Empathy
Intimacy
Pathological personality trait domains.
Negative affectivity; detachment; antagonism; disinhibition; psychoticism.

41. Paraphilic Disorders
Emphasizes paraphilic disorders rather than paraphilias.
Paraphilias that do not involve non-consenting victims are not necessarily indicative of a mental disorder.
To have a paraphilic disorder requires distress, impairment, or abuse of a non-consenting victim.

42. Substance-Related and Addictive Disorders
Substance Use Disorder (SUD)
Substance abuse and substance dependence are combined into a single disorder.
Severity can be rated as mild, moderate, or severe.
Craving was added as a new criterion for SUD.
Legal consequences was removed as a criterion.
The term dependence is often misunderstood and has negative connotations, but it is the normal pattern of withdrawal that can occur from the proper use of medications.

43. Substance-Related & Addictive Disorders
No “abuse” or “dependence”; now “use.”
Chapter reorganized by substance.
10 classes of drugs:
Alcohol; Caffeine; Cannabis; Hallucinogens; Inhalants; Opioids; Sedatives, hypnotics & anxiolytics; Stimulants; Tobacco; Other.
Two groups of disorders:
(a) Substance use disorders,
(b) Substance-induced disorders.
p. 481

44. Substance-Related & Addictive Disorders
Substance use disorder: continued use of substance despite significant substance-related problems. 4 sets of criteria:
Impaired control (4 criteria).
Social impairment (3 criteria).
Risky use (2 criteria).
Pharmacological criteria (2 criteria: tolerance & withdrawal).

45. Substance-Related and Addictive Disorders
Cannabis withdrawal is a new disorder.
Caffeine withdrawal is a new disorder.

46. Substance-Related & Addictive Disorders
Severity levels:
Mild (2-3 symptoms)
Moderate (4-5 symptoms)
Severe (> 6 symptoms)
Remission:
Early vs Sustained;
Maintenance therapy
Controlled environment
Example: Moderate Valium use disorder; Mild alcohol use disorder; Secobarbital withdrawal.

47. Substance-Related & Addictive Disorders
New language:
“All drugs that are taken in excess have in common direct activation of the brain reward system…. Individuals with lower levels of self-control, which may reflect impairments of brain inhibitory mechanisms, may be particularly predisposed to develop substance use disorders, suggesting that the roots of substance use disorders for some persons can be seen in behaviors long before the onset of actual substance use itself.” (p. 481)

48. Substance-Related & Addictive Disorders
“This chapter also includes gambling disorder, reflecting evidence that gambling behaviors activate reward systems similar to those activated by drugs of abuse, and produce some behavioral symptoms that appear comparable to those produced by the substance use disorders.”
(p. 481)

49. Non-Substance-Related and Addictive Disorders
“Pathological Gambling” in DSM-IV was renamed “Gambling Disorder” and moved from the Impulse Control Disorders chapter to the chapter in DSM-5 called Substance-Related and Addictive Disorders.
Internet Gaming Disorder is included in Chapter 3 as a “condition for further study.”
No other behavioral addictions are mentioned even hypersexuality
Sex Addiction is not in the DSM-5, even as a condition for further study.

50. Pathological Gambling: DSM-IV
"chasing"
lies to conceal the extent of involvement with gambling
has committed illegal acts, to finance gambling
has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
relies on others to provide money to relieve a desperate financial situation caused by gambling
is preoccupied with gambling
needs to gamble with increasing amounts of money for desired excitement
repeated unsuccessful efforts to control, cut back, or stop
restless or irritable when attempting to cut down or stop gambling
gambles as a way of escaping from problems or of relieving a dysphoric mood
ODADAS Advanced Training

51. Gambling Disorder: DSM-5
"chasing"
lies to conceal the extent of involvement with gambling
has committed illegal acts, to finance gambling
has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
relies on others to provide money to relieve a desperate financial situation caused by gambling
is preoccupied with gambling
needs to gamble with increasing amounts of money for desired excitement
repeated unsuccessful efforts to control, cut back, or stop
restless or irritable when attempting to cut down or stop gambling
gambles as a way of escaping from problems or of relieving a dysphoric mood
ODADAS Advanced Training

52. DSM-5 Gambling Disorder
Specifiers
Specify if
Episodic: meeting criteria at more than one point, symptoms subsiding between periods of gambling disorder for at least several months
Persistent: Experiencing continuous symptoms, to meet diagnostic criteria for multiple years
In early remission: after full criteria met, none of the criteria have been met for at least 2 months but for less than 12 months
In sustained remission: after criteria met, none of the criteria have been met during a period of 12 or more months
Specify current severity level
Mild: 4-5 criteria
Moderate: 6-7 criteria
Severe: 8-9 criteria
ODADAS Advanced Training

53. Why the difference… SUD Gambling Mild: 2-3 criteria
Moderate: 4-5 criteria
Severe: > 6 criteria
Mild: 4-5 criteria
Moderate: 6-7 criteria
Severe: >8 criteria

54. Windsor Items literature review and focus groups and testing
Have you frequently gambled with larger amounts of money than you intended to or for longer periods of time than you intended to?
Did you make excuses or think of reasons to justify your gambling, such as “I will win money, or I need to calm down”?
Did your gambling cause you to feel depressed, for example, sad, anxious, withdrawn, tearful?
Did your gambling cause you to disregard the worth or value of money?
Has your gambling caused you to have negative feelings about your self-worth or your outlook on life?
Has your gambling caused you to lose interest in things that used to be important to you, such as relationships, work, hobbies, family activities, friends, etc.?
Did you feel that you were in control when you gambled?
Have you gambled to fill a void or emptiness in your life?
Did you continue to gamble despite having lost your life savings or house due to gambling? (DSM-III-R)
Have you been secretive about your gambling and tried to hide the evidence of your gambling?
Did you believe it was possible to win more than you lose?
ODADAS Advanced Training

55. Windsor Items literature review and focus groups and testing
How often have you spent a lot of time thinking about past gambling experiences, planning your next gambling activity, or thinking of ways to get money to gamble?  
How often have you needed to gamble with larger amounts of money or with larger bets in order to obtain the same feeling of excitement?  
How often have you tried to control, cut back, or stop gambling several times and were unsuccessful?  For example, setting a money or time limit for yourself and then going over it.  
How often have you felt restless or irritable when you tried to cut down or stop gambling?  
How often did you feel that your gambling was a way of avoiding or escaping from personal problems or a way of relieving uncomfortable emotions, such as feelings of nervousness, helplessness, guilt, anxiety or sadness?  
After you lost money gambling how often did you return another day to get even or try to win back your losses?  
How often have you lied to family members, therapists, or others to hide your gambling from them?  
How often have you committed any illegal acts such as forgery, fraud, theft, or embezzlement to get money to gamble or to pay gambling debts?  
How often have you risked or lost a relationship with someone important to you, or a job, or career opportunity because of gambling?
How often have you relied on others to pay your gambling debts or to pay your bills when you had financial problems caused by your gambling?  
Not in the past 12 months once a few times many times
ODADAS Advanced Training

56. DSM-5 Changes Rationale
The Criterion of “Illegal Acts”
It does not appear to be a decisive symptom for most people with gambling problems (American Psychiatric Association, 2010)
Individuals who commit illegal acts as a result of their gambling already reach the threshold of five or more symptoms and, therefore, this symptom does not improve the precision of the diagnostic code for identifying most individuals with pathological gambling/gambling disorder.
ODADAS Advanced Training

57. Other Conditions That May Be A Focus of Clinical Attention
The list of “V-Code” and other conditions was expanded to 134 separate conditions.
Examples
Relational Problems
Abuse and Neglect
Educational and Occupational Problems
Phase of Life Problem
Malingering

58. V codes
Code Condition
V Personal history (past history) of physical abuse in childhood
V Personal history (past history) of sexual abuse in childhood
V Personal history (past history) of spouse or partner violence, Physical
V Personal history (past history) of spouse or partner violence, Sexual
V Personal history (past history) of neglect in childhood
V Personal history (past history) of psychological abuse in childhood
V Personal history (past history) of spouse or partner psychological abuse
V Personal history (past history) of spouse or partner neglect
V Other personal history of psychological trauma
V Personal history of self-harm

59. V codes Code Condition V15.81 Nonadherence to medical treatment
V Other personal risk factors
V Wandering associated with a mental disorder
V60.0 Homelessness
V60.1 Inadequate housing
V60.2 Extreme poverty
V60.2 Insufficient social insurance or welfare support
V60.2 Lack of adequate food or safe drinking water
V60.2 Low income
V60.3 Problem related to living alone

60. V codes
Code Condition
V60.6 Problem related to living in a residential institution
V Discord with neighbor, lodger, or landlord
V60.9 Unspecified housing or economic problem
V Disruption of family by separation or divorce
V Relationship distress with spouse or intimate partner
V Encounter for mental health services for victim of spouse or partner psychological abuse
V Encounter for mental health services for victim of spouse or partner neglect
V Encounter for mental health services for victim of spouse or partner violence, Physical
V Encounter for mental health services for victim of spouse or partner violence, Sexual
V Encounter for mental health services for perpetrator of spouse or partner psychological abuse
V Encounter for mental health services for perpetrator of spouse or partner neglect

61. V codes
Code Condition
V Encounter for mental health services for perpetrator of spouse or partner violence, Physical
V Encounter for mental health services for perpetrator of spouse or partner violence, Sexual
V Parent-child relational problem
V Encounter for mental health services for victim of child neglect by parent
V Encounter for mental health services for victim of nonparental child neglect
V Encounter for mental health services for victim of child abuse by parent
V Encounter for mental health services for victim of nonparental child abuse
V Encounter for mental health services for victim of child psychological abuse by parent
V Encounter for mental health services for victim of nonparental child psychological abuse
V Encounter for mental health services for victim of child sexual abuse by parent
V Encounter for mental health services for victim of nonparental child sexual abuse

62. V codes
Code Condition
V Encounter for mental health services for perpetrator of parental child neglect
V Encounter for mental health services for perpetrator of parental child abuse
V Encounter for mental health services for perpetrator of parental child psychological abuse
V Encounter for mental health services for perpetrator of parental child sexual abuse
V Child affected by parental relationship distress
V61.5 Problems related to multiparity
V61.7 Problems related to unwanted pregnancy
V61.8 High expressed emotion level within family
V61.8 Sibling relational problem
V61.8 Upbringing away from parents
V Problem related to current military deployment status

63. V codes
Code Condition
V Exposure to disaster, war, or other hostilities
V Personal history of military deployment
V Other problem related to employment
V62.3 Academic or educational problem
V62.4 Acculturation difficulty
V62.4 Social exclusion or rejection
V62.4 Target of (perceived) adverse discrimination or persecution
V62.5 Conviction in civil or criminal proceedings without imprisonment
V62.5 Imprisonment or other incarceration
V62.5 Problems related to other legal circumstances
V62.5 Problems related to release from prison
V Uncomplicated bereavement

64. V codes
Code Condition
V Encounter for mental health services for perpetrator of nonspousal adult abuse
V Encounter for mental health services for perpetrator of nonparental child neglect
V Encounter for mental health services for perpetrator of nonparental child abuse
V Encounter for mental health services for perpetrator of nonparental child psychological abuse
V Encounter for mental health services for perpetrator of nonparental child sexual abuse
V Borderline intellectual functioning
V Discord with social service provider, including probation officer, case manager, or social services worker
V Other problem related to psychosocial circumstances
V Phase of life problem
V Religious or spiritual problem
V Victim of crime

65. V codes Code Condition V62.89 Victim of terrorism or torture
V62.9 Unspecified problem related to social environment
V62.9 Unspecified problem related to unspecified psychosocial circumstances
V63.8 Unavailability or inaccessibility of other helping agencies
V63.9 Unavailability or inaccessibility of health care facilities
V65.2 Malingering
V Other counseling or consultation
V Encounter for mental health services for victim of nonspousal adult abuse
V Sex counseling
V69.9 Problem related to lifestyle
V Adult antisocial behavior
V Child or adolescent antisocial behavior

66. Section III: Emerging Measures and Models
Optional Assessment Measures
Level 1 Cross-Cutting Symptom Measure
To measure depression, anger, mania, anxiety, etc.
To screen for important symptoms; self-administered by patient; brief (1-3 questions per symptom domain).
Level 2 Cross-Cutting Symptom Measure
To be done when a Level 1 item is endorsed at the level of “mild” or greater.

67. Emerging Measures, cont.
Diagnosis-Specific Severity Measures
To document the severity of a specific disorder.
Some are clinician-rated, some are patient-rated.

68. Emerging Measures, cont.
WHO Disability Assessment Schedule 2.0
Replaces the GAF Scale in DSM-IV
Is recommended but not required.
Has 36 self-administered questions.
Cultural Formulation
Outline for Cultural Formulation
Cultural Formulation Interview
The GAF (Globa Assessment of Functioning) was fairly useless and had poor reliability and validity.

69. Conditions for Further Study
Attenuated Psychosis Syndrome
Persistent Complex Bereavement Disorder
Caffeine Use Disorder
Internet Gaming Disorder
Suicidal Behavior Disorder
Non-suicidal Self-Injury

70. Suicidal Behavior Disorder
A suicide attempt within the past 24 months.
The act is not non-suicidal self-injury.
Suicidal ideation does not qualify.

71. Nonsuicidal Self-Injury
In the last year the person has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body with the expectation that the injury will lead to only minor or moderate physical harm (i.e. there is no suicidal intent).
Five additional criteria.

72. For More Information http://www.dsm5.org

73. References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
Jones, K. D. (2013, March). Understanding the DSM-5 and the ICD. Workshop sponsored by the American Psychological Association.
Nock, M. K. (2013, October). Teaching about psychopathology: Implications of DSM-5. Workshop sponsored by Harvard University and Macmillan Higher Education.
Thienhaus, O. J. (2013, October). DSM-5: What You Need To Know To Transition From DSM-IV. Workshop sponsored by the American Psychiatric Association and the Arizona Psychiatric Society. Flagstaff, AZ.