DSM-5 Changes – Anxiety, Obsessive-Compulsive and Trauma- and Stressor-Related Disorders
One of the big changes in these disorders in the DSM-5 is the moving of obsessive-compulsive and related disorders into their own chapter and the new chapter titled Trauma- and Stressor-Related Disorders, which includes posttraumatic stress disorder (PTSD). Within the anxiety disorder category, there are changes to:
- Specific phobia – different types are now referred to as "specifiers"
- Social anxiety disorder (social phobia)
- Panic disorder
- Panic attack
- Separation anxiety disorder – now in the anxiety disorders chapter
- Selective mutism – moved into the anxiety disorder chapter
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Anxiety Disorders Changes in the DSM-5
In the DSM-5, agoraphobia, specific phobia, and social anxiety disorder no longer require people over the age of 18 recognize that their anxiety is excessive or unreasonable as anxiety is often overestimated by these individuals. Additionally, all age groups now require a longer than six-month duration to avoid the diagnosis of transient fears.
The terminology around panic attacks has changed. "Situationally bound/cued," "situationally predisposed," and "unexpected/uncued" are replaced with simply unexpected and expected panic attacks in the DSM-5. "Panic attack" may now be used as a specifier in any DSM-5 disorder.
The following are additional changes in the DSM-5 to anxiety disorders:
- Panic disorder and agoraphobia are unlinked in the DSM-5 and each is a separate diagnosis with separate criteria.
- For social anxiety disorder, the "generalized" specifier has been replaced by the "performance-only" specifier in the DSM-5.
- Separation anxiety disorder no longer requires an onset before 18 years of age.
Obsessive-Compulsive and Related Disorders Changes in the DSM-5
Obsessive-Compulsive and Related Disorders is a new chapter to the DSM-5 and new disorders include:
- Hoarding disorder - persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them
- Excoriation (skin-picking) disorder
- Substance-/medication-induced obsessive-compulsive and related disorders
- Obsessive-compulsive and related disorders due to another medical condition
In the DSM-5, the specifier, "with poor insight," used in obsessive-compulsive disorder (OCD), body dysmorphic disorder, and hoarding disorder, has been refined to include good, fair or poor insight or "absent insight/delusional" beliefs. This allows things like body dysmorphic disorder with delusional beliefs to be categorized as an anxiety disorder and not a psychotic disorder. There is an additional "tic-related" specifier for OCD.
For body dysmorphic disorder, a new criterion describing repetitive behaviors or mental acts in response to preoccupations with perceived defects or flaws in physical appearance has been added to the DSM-5.
Trauma- and Stressor-Related Disorders Changes in the DSM-5
In acute stress disorder, a criterion specifying the subjective reaction to the traumatic event has been removed in the DSM-5 as it was felt it was too restrictive considering the various reactions people can have to trauma. Rather, an individual may meet the diagnostic criteria of acute stress disorder in the DSM-5 if they exhibit any 9 of the 14 symptoms in the categories:
- Negative mood
The DSM-5 has also removed the subjective reaction criterion in posttraumatic stress disorder (PTSD). Additionally, there are now four (rather than three) symptom clusters including:
- Persistent negative alterations in cognitions and mood – retains most of the DSM-IV numbing symptoms
- Alterations in arousal and reactivity – retains most of the DSM-IV arousal symptoms as well as irritable or aggressive behavior and reckless or self-destructive behavior
The DSM-5 lowers the diagnostic threshold for children and adolescents and separate criteria have been added for children age six or under.
In the case of reactive attachment disorder, the DSM-IV had two subtypes. In the DSM-5, these are now separate and distinct diagnoses: reactive attachment disorder and disinhibited social engagement disorder.
Tracy, N. (2013, May 17). DSM-5 Changes – Anxiety, Obsessive-Compulsive and Trauma- and Stressor-Related Disorders, HealthyPlace. Retrieved on 2019, August 17 from https://www.healthyplace.com/other-info/mental-illness-overview/dsm-5-changes-anxiety-obsessive-compulsive-and-trauma-and-stressor-related-disorders