1. Sheila L. Videbeck, PhD, RN
Changes in DSM-5: An Overview
Sheila L. Videbeck, PhD, RN

2. Overview
The focus of this overview is major changes between DSM-IV-TR (2000) and DSM-5 (2013).
Both organizational and conceptual changes in diagnoses are included.
Further, inclusive and detailed changes and explanations for changes are available at

3. Major DSM-5 Changes
Elimination of the only age-based section: Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence. Diagnoses from this section have been distributed to other sections based on disorder categories.
Creation of new sections: Neurodevelopmental Disorders; Obsessive-Compulsive and Related Disorders; Trauma- and Stressor-Related Disorders.

4. Major DSM-5 Changes (continued)
Sections renamed to better reflect disorders in the section
Change in the name of diagnoses (with minimal change in individual diagnosis)
Change in conceptual approach to a set of diagnoses, specifically Autism Spectrum Disorder
Changes in definition, criteria for diagnoses, and/or specifiers of the disorder

5. Major DSM-5 Changes (continued)
The term “General medical condition” has been replaced throughout DSM-5 with “Another medical condition”
Diagnoses are no longer placed on the multi-axial system of Axes I-V
The Global Assessment of Functioning Scale (GAF) has been eliminated

6. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
This category has been eliminated
Disorders formerly in the section have been distributed in other sections
Neurodevelopmental Disorders is a new section that contains many of the diagnoses from this old section

7. Intellectual Disability
Mental Retardation diagnosis has been replaced with Intellectual Disability
Both cognitive capacity (IQ) and adaptive functioning are assessed with severity based on adaptive functioning rather than IQ

8. Communication Disorders is a category in Neurodevelopmental Disorders that includes:
Language Disorder (combines Expressive and Mixed Receptive-Expressive Disorder)
Speech Sound Disorder (replaces Phonological Disorder)
Childhood Onset Fluency Disorder (formerly Stuttering)
Social Pragmatic Disorder (New)

9. Autism Spectrum Disorder
A conceptual change defines Autism Spectrum Disorder as a single condition with different levels of symptom severity – 2 symptom categories are: social communication & interaction; and repetitive, behavior, interests, & activities
Encompasses previous diagnoses of Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder NOS

10. Additional Neurodevelopmental Disorder Diagnoses
Attention Deficit/Hyperactivity Disorder
Specific Learning Disorder (includes former reading, math, written expression, and NOS diagnoses)
Motor Disorders (includes Developmental Coordination Disorder, Stereotypic Movement Disorder, Tourette’s Disorder, and other vocal and motor tics, & unspecified disorders)

11. Schizophrenia Spectrum and other Psychotic Disorders
Elimination of paranoid, undifferentiated, disorganized, and residual subtypes
Delusional Disorder – can now include bizarre delusion(s)
Schizoaffective Disorder – major mood episode must be present for a majority of the total duration of disorder

12. Bipolar and Related Disorders
Criteria for mania and hypomania now include changes in activity and energy as well as mood changes
Changes in diagnosis of Bipolar Disorder in children on slide #13

13. Depressive Disorders
Disruptive Mood Dysregulation Disorder – for children under age 18 who have persistent irritability and frequent extreme out of control behavior (to address concerns about potential overdiagnosis of Bipolar Disorder)
Persistent Depressive Disorder (replaces Dysthymic Disorder)
Bereavement no longer excluded from depression diagnosis

14. Anxiety Disorders
PTSD moved to new section called Trauma and Stressor Related Disorders
OCD moved to new section called Obsessive-Compulsive and Related Disorders
Social Anxiety Disorder (replaces Social Phobia)
Panic Disorder with Agoraphobia – now 2 diagnoses, no longer one diagnosis
Separation Anxiety Disorder – moved from the old First Diagnosed in Infancy…section

15. Obsessive-Compulsive and Related Disorders
Obsessive-Compulsive Disorder – moved from Anxiety Disorder section
New Diagnosis: Hoarding Disorder
Body Dysmorphic Disorder – moved from old Somatoform Disorder section
Trichotillomania
Skin-picking Disorder
Substance-induced OCD and OCD due to another medical condition

16. Trauma and Stressor-Related Disorders
Reactive Attachment Disorder – moved from the old First Diagnosed in Infancy…section
Disinhibited Social Engagement Disorder
PTSD – moved from Anxiety Disorders section
Acute Stress Disorder – moved from Anxiety Disorder Section
Adjustment Disorders – old section of Adjustment Disorders eliminated

17. Dissociative Disorders
Depersonalization/Derealization Disorder – concepts of depersonalization and derealization combined to replace former Depersonalization Disorder
Dissociative Fugue – now a specifier under Dissociative Amnesia instead of a stand-alone diagnosis

18. Somatic Symptom and Related Disorders
Formerly called Somatoform Disorders
Somatic Symptom Disorder (replaces Somatization Disorder)
Illness Anxiety Disorder (replaces Hypochondirasis)
Conversion Disorder – also called Functional Neurological Symptom Disorder
Factitious Disorder: Imposed on self or Imposed on other colloquially known as Munchausen’s Syndrome and Munchausen’s by proxy)

19. Feeding and Eating Disorders
Adult diagnoses of Anorexia Nervosa and Bulimia Nervosa are essentially unchanged
New Diagnosis: Binge Eating Disorder
New Diagnosis: Avoidant/Restrictive Food Intake Disorder
Pica and Rumination Disorder - moved from former First Diagnosed in Infancy…section

20. Disruptive, Impulse-Control, and Conduct Disorders
Conduct Disorder and Oppositional Defiant Disorder – moved from former First Diagnosed in Infancy…section
Intermittent Explosive Disorder, Kleptomania, & Pyromania – moved from former Impulse-Control Disorder section

21. Substance-Related and Addictive Disorders
Gambling – moved from former Impulse-Control Disorder section
No longer a separation of substance abuse and dependence
Categories reduced by combining amphetamine and cocaine into stimulants; phencyclidine included in hallucinogens; and nicotine expanded to tobacco

22. Neurocognitive Disorders
Formerly Delirium, Dementia, and Amnestic and other Cognitive Disorders section
Delirium remains in section
Amnestic Disorder and Dementia are now in a new category called Mild or Major Neurocognitive Disorder specified according to etiology (vascular, HIV Infection, Traumatic Brain Injury, Alzheimer’s Parkinson’s Huntington’s, Prion, other medical condition, multiple etiologies), location (Frontotemporal), or characteristics (with Lewy Bodies)

23. Personality Disorders
Personality Disorder diagnoses remain unchanged in Section II
Another alternative approach is proposed in Section III to be used for further study; it contains changes proposed in drafts of DSM-5 which were not ultimately accepted
The alternate section has 6 rather than 10 diagnoses with criteria focusing on personality traits and personality functioning

24. Additional Changes
For changes in criteria, definitions, or specifiers that are routinely used by clinicians making diagnoses, see the website