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Section IV: Important Changes from the DSM-IV-TR to the DSM-5

For clinicians who have been comfortable and familiar with using the DSM-IV-TR, the DSM-5 requires a major shift in thinking and a more detailed knowledge base. There are a number of key changes that will significantly reshape how diagnoses are made and recorded. The next several sections will provide a detailed overview of these changes.

First, this course will go over the large-scale structural changes that have been made in the transition from the DSM-IV-TR to the DSM-5.  Because there have been several significant changes to the way that a diagnosis is recorded in clinical paperwork, it is important for mental health clinicians to have a thorough understanding in these areas. 

This will be followed by a section on diagnostic terms and categories that are no longer being used. More than just the definitions of diagnoses have been changed as part of the evolution of the DSM; the terminology of various categories of problems have been re-conceptualized. Clinicians must remain current with this shift in clinical vocabulary.

Once these changes are clarified, discussion will focus on the changes to individual diagnoses that have occurred within this update to the DSM.  We will first look at diagnoses that were part of the DSM-IV-TR but have been removed or replaced within the DSM-5. Clinicians who worked with the DSM-IV-TR since its inception are likely to have memorized a number of diagnoses that are frequently seen in their practice. If the diagnosis has been deleted within the DSM-5, the clinician can no longer apply it as part of their diagnostic processes. This course will help direct the clinician towards the proper replacement for those deletions.

In each section where deleted diagnoses are noted, there are notes to serve as an overview to the changes. Explanatory text that explains the rationale for the changesand what this means for the diagnostic process are also provided.. Where the deletions correspond to the development of new categories or diagnoses, there will be some clarification about the new categories and diagnoses. This information will be drawn from materials put out to address the changes in the DSM by the American Psychiatric Association, the group responsible for the DSM-5.

Once all of the deleted diagnoses are covered, the course will move to the handful of new diagnostic categories that have been added within the DSM-5. Several of these are diagnoses previously appeared in the DSM-IV-TR as conditions or disorders warranting further study. Some of the diagnoses warranting further study made the cut to become part of the DSM-5 and some did not.

Next, two other major sections of the course will address some of the changes and refinements made to diagnoses that are retained from the DSM-IV-TR. The first of these sections will cover diagnoses with more substantial changes to the diagnostic criteria and/or specifiers, while the second will cover more subtle or minor changes.

These changes may involve the addition of better specifiers for some diagnoses, allowing the diagnosis to provide more clarification about the severity of the disorder or the core features of the disorder. They may also address whether the disorder has different manifestations to accompany the core symptoms, such as behavioral disturbances versus no behavioral disturbances, or with good prognostic features versus without good prognostic features. 

Some of these sections are further divided into two parts. The first part of these sections will begin by examining the disorders that are 1) diagnosed and 2) encountered by mental health clinicians in actual practice. This is to say that the disorders covered earlier in these sections are those for which you will likely be the primary person to make the diagnosis, beginning with diagnoses that are most likely to be seen in your practice.

Once this is completed, within these selected sections there will be some examination of those diagnoses that you may encounter in your practice but will, in all likelihood,   initially be diagnosed by another professional. These are diagnoses for which the diagnostic process requires licensure, skills and training that lie outside your area of competence. This would consist of diagnoses made as the result of psychological testing (by a licensed psychologist) or by a medical or psychiatric examination conducted by a physician or other appropriate medical personnel.

For all disorders not initially diagnosed by the mental health clinician, no matter how obscure, it is still important for the mental health clinician to have some familiarity with both the diagnoses and the processes through which the diagnoses were generated. Those diagnoses may be the focus of treatment and may constitute the rationale for whether the treatment is covered under the client’s insurance.

It is the goal of this course to have each mental health clinician fully aware of these important changes to the DSM so that diagnoses can be made with accuracy and ease.