"Significant" DSM-5 Text Revisions to be Released March 2022

The revised Diagnostic and Statistical Manual of Mental Disorders, 5^th edition, Text Revision (DSM-5-TR) will include updates and clarifying modifications to the criteria sets for more than 70 disorders as well as updates to the descriptive text. It will also examine the impact of racism and discrimination on the diagnosis and manifestations of mental disorders. 

It has been 9 years since the 2013 edition of the DSM-5-TR. Historically, the DSM has been revised every 5 to 7 years.

“This information, encapsulated in the DSM text, is continually evolving. Consequently, it is crucial for the text to be kept current based on evolving psychiatric literature. DSM-5 text sections on ‘Risk and Prognostic Factors’ and ‘Diagnostic Markers’ contain information more susceptible to becoming outdated on the basis of scientific advances,” said Michael B First, MD, co-chair of the revision subcommittee and DSM-5-TR editor, in an interview with Psychiatric Times.

The updates include revised diagnostic criteria for several disorders, including the following diagnoses:

• Attenuated psychosis syndrome
• Autism spectrum disorder
• Avoidant-restrictive food intake disorder
• Bipolar I and bipolar II disorder
• Cyclothymic disorder
• Delirium
• Major depressive disorder
• Manic episode
• Persistent depressive disorder
• Post-traumatic stress disorder (PTSD) in children
• Substance/medication-induced mental disorders

After years of research and clinical experience, “prolonged greif disorder” will appear in the DSM-5-TR. The condition encompasses patients who experienced the death of a person close to them over 12 months ago—6 months for children—and cannot move past the grief leading to symptoms negatively impacting daily functioning. One in 10 adults is at risk of developing the disorder after losing a loved one.

Noteworthy changes to criteria include the following modifications:

• New symptom codes for a history of suicidal behavior and nonsuicidal self-injury, aiding in systemic recording
• The restoration of "Unspecified Mood Disorder” for mixed-mood presentations that do not meet the criteria for a bipolar or depressive disorders
• Neurocognitive and substance use disorders underwent coding updates

Noteworthy changes to nomenclature include the following:

• "Neuroleptic" is no longer an acknowledged term as it spotlights side effects—unless used in "neuroleptic malignant syndrome"—and will be replaced with "antipsychotic medication" and other terms depending on the situation
• "Desired gender" is now "experienced gender"
• "Cross-sex medical procedure" is now "gender-affirming medical procedure" 
• "Natal male"/"Native female" is now "individual assigned male/female at birth"

Updates have been made to the following specifier definitions:

• Manic episode
• Mood congruent/mood incongruent specifier for bipolar disorder
• Mixed features specifier for major depressive disorder
• Acute/persistent specifier for adjustment disorder, narcolepsy specifiers, and the post-transition specifier for gender dysphoria

Additionally, approximately 75% of the disorder texts will have significant revisions, with the most extensive changes being within "Prevalence," "Risk and Prognosis Factors," "Culture-Related Diagnostic Features," "Sex and Gender Diagnostic Features," "Association With Suicidal Thoughts or Behavior, and "Comorbidity."

“The updated manual reflects evolving research and clinical experience and will be of enormous benefit to practitioners, researchers, academic institutions, and health systems,” said American Psychiatric Association (APA) CEO and Medical Director, Saul Levin, MD, MPA, FRCP-E, FRCPsyc.

Reference

Moran M. Updated DSM-5 text revisions to be released in March. Psychiatric News. Accessed January 18, 2022.