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Updated DSM-5 Text Revision Officially Released
On March 18, 2022, the revised Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) was released by the American Psychiatric Association (APA). The revision includes updates and clarifying modifications to the criteria sets for more than 70 disorders and updates to the descriptive text. It also examines the impact of 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 text revision reflects the most recent updates in the literature with the added lens of ethnocultural and racial constructs in diagnosis as well as sex and gender constructions,” said APA President Vivian Pender, MD.
In addition to the updates we previously presented and reiterate below, approximately 75% of the disorder texts 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.”
Noteworthy changes to criteria that reflect the ethnocultural and social literature include the following modifications:
- Neurocognitive and substance use disorders (SUDs) underwent coding updates—(ie, data referencing higher rates of alcohol use in Native American communities was removed)
- Supporting literature to each DSM diagnosis was reviewed to ensure the studies "had adequate sample sizes and account for social determinants of health and mental health—including racial bias and discrimination"
- Neurocognitive and substance use disorders (SUDs) underwent coding updates—(ie, data referencing higher rates of alcohol use in Native American communities was removed)
Noteworthy changes to nomenclature that reflect the ethnocultural and social literature include the following modifications:
- "Racial" is now "racialized" and "ethnoracial"
- "Minorities" is no longer an acknowledged term because it evokes a "lesser-than" status
- “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”
The following specifier definitions have been updated to reflect the ethnocultural and social literature:
- Acute/persistent specifier for adjustment disorder, narcolepsy specifiers, and the post-transition specifier for gender dysphoria
APA tasked 29 experts in cultural psychology, psychiatry, and anthropology to review the DSM-5 for “cultural influences on disorder characteristics, incorporating relevant information in the sections on culture-related diagnostic issues.” In addition, 14 mental health practitioners “from diverse ethnic and racialized backgrounds” who are experts in disparity-reduction practices reviewed the manual to avoid “perpetuating stereotypes or including discriminatory clinical information,” APA said in a press release.
Since the last edition, the DSM-5 has been updated through an online process. The online portal allows researchers to submit update proposals that undergo a multistage review process. The DSM-5-TR includes the approved updates and technical fixes. The online process will remain open for the DMS-5-TR for clinicians to submit proposed updates.
Updates to revised diagnostic criteria for several disorders include 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 grief disorder” appears 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.
Other 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 bipolar or depressive disorders
Other noteworthy change to nomenclature includes 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
Other noteworthy 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
“Two hundred expert researchers and practitioners put in countless hours to ensure that the DSM-5-TR is an indispensable contribution to our understanding of mental illness,” said APA CEO and Medical Director Saul Levin, MD, MPA. “We are grateful to all who contributed to its production and look forward to seeing it used by researchers, clinicians, and students worldwide.”
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