DSM-5 진단체계의 이해 대구사이버대학교 미술치료학과 / 심리성장센터 - 디엠 Clinical Psychologist, Ph.D. 이흥표 1

If sanity and insanity exist, how shall we know them? 2

An experiment into the validity of psychiatric diagnosis conducted by David Rosenhan in !e study consisted of two parts. –1. using healthy associates or pseudopatients, who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. –2. asking staff at a psychiatric hospital to detect non-existent "fake" patients. Results –In the first case, hospital staff failed to detect a single pseudopatient. –In the second the staff falsely identified large numbers of genuine patients as impostors. 3

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Diagnostic and Statistical Manuals DSM-I (1952): Classified Mental Disorders as Reactions to Stressors DSM-II (1968): Influenced by Psychodynamic Theory DSM-III (1980): Development of Classification System DSM-IV (1994): Characterized as the “Biologic” or “Syndromal” Approach to Diagnosis DSM-IV-TR (2000): Evidence-based text revision of DSM-IV 6

Diagnostic and Statistical Manual of Mental Disorders To provide clear descriptions of diagnostic categories in order to enable clinicians and investigator to diagnose, communicate about, study, and treat people with various mental disorder 7

International Classification of Disease (ICD-10) Comprehensive classification system of medical conditions and mental disorders Official medical and psychiatric nosology used throughout most of the world 8

16 MAJOR DIAGNOSTIC CLASSES Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence Delirium, Dementia, and Amnestic and Other Cognitive Disorders Mental Disorders Due to a General Medical Condition Substance-Related Disorders Schizophrenia and Other Psychotic Disorders Mood Disorders Anxiety Disorders Somatoform Disorders 9

16 MAJOR DIAGNOSTIC CLASS Factitious Disorders Dissociative Disorders Sexual and Gender Identity Disorders Eating Disorders Sleep Disorders Impulse-Control Disorders Not Elsewhere Classified Adjustment Disorders Personality Disorders Additionally, there is a section on other conditions that may be a focus of clinical attention 10

MULTIAXIAL DIAGNOSTIC SYSTEM - AXIS I : Clinical Disorders, Other Conditions that my be a focus of attention - AXIS II : Personality Disorders, Mental Retardation - AXIS III : General Medical Conditions - AXIS IV : Psychosocial/Environmental Problems - AXIS V : Global Assessment of Functioning/Children’s Global Assessment of Functioning (GAF) 11

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) Adult GAF Children’s Global Assessment Scale(CGAS) – For ages 4-16 GAF and CGAS both assign a specific numerical rating of the person’s overall functioning Scales are in 10 point increments with a general description of the level of functioning within the range 12

Global Assessment of Functioning Scale : Superior functioning, no symptoms 90-81: Absent or minimal symptoms, good functioning in all area 80-71: Transient and expectable reactions to psycho social stressors 70-61: Some mild symptoms, some difficulty in social, occupational, or school functioning 60-51: Moderate symptoms, moderate difficulty in social, occupational, or school functioning 50-41: Serious symptoms, serious impairment in social, occupational, or school functioning 13

Global Assessment of Functioning Scale 40-31: Some impairment in reality testing or communication or major impairment in several areas- work, school, family relations, judgment, thinking or mood 30-21: Behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment 20-11: Some danger of hurting self or others, or gross impairment in communication 10-1: Persistent danger of severely hurting self or others, or serious suicidal act with 0: Inadequate information 14

SUBTYPES AND SPECIFIERS Subtypes define mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis Specifiers are not intended to be mutually exclusive or jointly exhaustive Both subtypes and specifiers increase specificity in diagnosis 15

SEVERITY AND COURSE SPECIFIERS If criteria are currently met, one of the following severity specifiers may be noted: Mild / Moderate / Severe If criteria are no longer met, one of the following specifiers may be noted: In Partial Remission / In Full Remission / Prior History / Recurrence NOS = Not Otherwise Specified. Provisional Diagnosis 16

Multiaxial Diagnostic Schema: Case Axis I: Delusional Disorder Axis II: Paranoid Personality: Moderate Axis III: Hypertension Axis IV: Psychosocial Stressor: Extreme (death of children) Axis V: GAF: Major Impairment in Work (40) 17

Multiaxial Diagnostic Schema: Case Axis I: – Major Depressive Disorder, Single Episode, Severe Without Psychotic Features – Alcohol Abuse Axis II: Dependent Personality Disorder, Frequent use of denial Axis III: None Axis IV: Threat of job loss Axis V: GAP = 35 (current) 18

From DSM-IV to DSM-5(2013) 19

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1. Neurodevelopmental Disorders 2. Schizophrenia Spectrum and Other Psychotic Disorders 3. Bipolar and Related Disorders 4. Depressive Disorders 5. Anxiety Disorders 6. Obsessive-Compulsive and Related Disorders 7. Trauma and Stressor-Related Disorders 8. Dissociative Disorders 9. Somatic Symptom Disorders 10. Feeding and Eating Disorders 11. Elimination Disorders 12. Sleep-Wake Disorders 13. Sexual Dysfunctions 14. Gender Dysphoria 15. Disruptive, Impulse Control, and Conduct Disorders 16. Substance Use and Addictive Disorders 17. Neurocognitive Disorders 18. Personality Disorders 19. Paraphilias 20. Other Disorders 21

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Removal of Multiaxial System –DSM-- ‐ 5 has moved to a non-- ‐ axial documentation of diagnosis, combining The former Axes I, II, and III, with separate notations for psychosocial And contextual factors (formerly Axis IV) and disability (formerly Axis V). The phrase “general medical condition” is replaced in DSM-- ‐ 5 With “another medical condition” where relevant across all disorders. 27

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Personality Disorders 46

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