DSM-IV vs. DSM-5

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Dec 6, 2023

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1 DSM-IV vs. DSM-5 The DSM, the Diagnostic and Statistical Manual of Mental Disorders, is a classification system for mental disorders written by the American Psychiatric Association (Comer & Comer 2022). This classification system is used in North America and can be changed as things progress, are found, or are studied. The latest issue of the DSM is the DSM-5-TR, published in 2022 and replaced the previous DSM-5 written in 2013 (Comer & Comer 2022). The DSM-5 contains over five hundred mental disorders and describes how to diagnose and features of the mental disorder (Comer & Comer 2022). The DSM-5-TR added a new mental disorder, updated background information, alternate names, conditions that are required when diagnosing, and new terminology, along with how racism and other things affected mental disorders (Comer & Comer 2022). Before the DSM-5 there was the DSM-IV, these two will be the focus of this paper. The DSM-IV was written in 1994 and was later changed into the DSM-5 in 2013. PTSD (Post-traumatic stress disorder) is a mental disorder. It also goes in hand with acute stress disorder. This is when a person witnesses (or is part of) a terrifying event. Normally the feelings that come with extreme stress (such as arousal, fear, anxiety, and depression) subside after the event. However, when it does not this can lead to acute stress disorder or PTSD. The DSM is used to help diagnose this in both children and adults. When looking into the DSM-IV criteria in PTSD adult patients were as follows; The person had been exposed to a traumatic event (death, threatened death, serious injury, or threat to harm self or others), their response involved fear, intrusive recollections of an event (thoughts, dreams, acting/feeling as if the event

2 was recurring, psychological distress at exposure to cues, and physical reaction to cues), avoidance of anything associated with the event, increased arousal (such as difficulty sleeping, outbursts, difficulty concentrating, and exaggerated startle response), symptoms have lasted longer than a month, causes distress or the inability to function normally (“FOCUS” 2013). While for children the only additions were that children may express disorganized/agitated behavior and they may do “repetitive play” where aspects of the event appear. When looking at the DSM-5 criteria for PTSD in adults is as follows; the person had to be exposed to a traumatic event (threatened death, death, injury, or sexual violence), had to have intrusions in everyday life (from flashbacks, dreams, memories, psychological stress due to cues, or physiological reactions to cues from the event), avoiding things that reminded them of the event, negative mood and cognition in accordance of the event (inability to remember the event, negative beliefs, negative emotional state, dimmed interest in things, detached, and unable to provide positive emotions), noticed reactivity to the event, everything above has lasted over a month, the event causes extreme distress (in social, work, or prevents normal functioning), the event caused unnecessary stress, and none of the above was due to medications or another medical condition(“U.S. Dept.” 2009). While in children the criteria were; exposure to a traumatic event, intrusion into everyday life from the event, avoidance of things that could remind them of the event, negative mood/cognition, the difference in reactivity/arousal, has lasted more than a month, causes significant stress, and impairs relationships between other people (such as parents, siblings, friends, peers, and teachers) (American Psychiatric Association Division of Research 2013). Going from the DSM-IV to the DSM-5 a few notable changes were made. For one, children six and under got their continued section in the DSM-5 compared to two notes in the

3 DSM-IV. It also brought more attention to PTSD with dissociative symptoms. The DSM-5 also included more information on what can be a traumatic event, it also includes sexual violence (“Highlights of” 2013). The DSM-5 also paid more attention to behavioral aspects, and the role of re-occurrence, and they also put more on what it means to have increased arousal (American Psychiatric Association 2013). It also changed the original three symptom clusters into four symptom clusters, by dividing one cluster into two. Overall it added a section for children and became more aware that children may not have as many symptoms as adults, while also adding more depth to already existing symptoms criteria. I believe the proposed revisions were needed. When thinking about the world, one thing we know is that it changes and we change with it. Having a DSM from 1994 was overall not going to be as effective as we learned more about mental disorders and how they affect people. Adding a criteria page for children six and under was also very helpful. It gave more in-depth and let people know that those who don’t have fully developed brains and psychological understanding will experience PTSD differently. One of the things pointed out was that children do “repetitive play”, meaning they show hints of the event through their play (“FOCUS” 2013). A great example of this is a child who survived a car crash playing with cars and making them crash over and over again. Or a little girl who was sexually assaulted showing that through having male dolls “play” with female dolls. These revisions give us insight into how as time goes by we will learn more about ourselves and we need to be ready to change things with that. Such as how we diagnose and the criteria for diagnosing, as shown through the revisions for PTSD.

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4 References: American Psychiatric Association. Posttraumatic Stress Disorder. (2013). Retrieved January 28, 2023, from https://www.psychiatry.org/File %20Library/Psychiatrists/Practice/DSM/APA_DSM-5-PTSD.pdf Comer, R. J., & Comer, J. S. (2022). Fundamentals of Abnormal Psychology (10th ed.). Worth Publishers. FOCUS: the journal of lifelong learning in psychiatry. (2013). Highlights of changes from DSM-IV to DSM-5: Posttraumatic stress disorder , 11 (3), 358–361. https://doi.org/https://focus.psychiatryonline.org/doi/pdf/10.1176/appi.focus.11.3.358 Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Association. (2013). Retrieved January 28, 2023, from https://www.psychiatry.org/File %20Library/Psychiatrists/Practice/DSM/APA_DSM_Changes_from_DSM-IV-TR_- to_DSM-5.pdf U.S. Dept. of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. (2009). Substance abuse treatment: Addressing the specific needs of women .

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