DSM-5

After several publication delays, the DSM-5 was finally released this past week!  As I mentioned in my 5/5/13 post, it has been 13 years since the DSM was last revised in 2000.  Although the DSM-5 brings many changes, I will focus here on a few that are relevant to my work, as a therapist.  I plan to write more about the new DSM-5 in future posts.

The DSM-5 adds a new category: Obsessive-Compulsive and Related Disorders, which includes: 

• Obsessive-Compulsive Disorder (previously classified as an Anxiety Disorder in the DSM-IV-TR)  
• Trichotillomania, or hair-pulling (previously classified as an Impulse Control Disorder) 
• The DSM-5 adds Hoarding Disorder and Excoriation Disorder (skin-picking) as separate diagnoses.  
• Body Dysmorphic Disorder (previously classified as a Somatoform Disorder).  The diagnosis of Body Dysmorphic Disorder now includes a specifier for Muscle Dysmorphia, in which the individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular.  There is an additional specifier for degree of insight, which runs the continuum from good or fair, where individuals recognize that their BDD beliefs are probably not true, to absent/delusional, where they are completely convinced that their BDD beliefs are accurate.  Poor insight is sometimes referred to as Overvalued Ideation, or OVI.

The DSM-5 also makes some important changes in the diagnosis of eating disorders, including:

• The DSM-5 adds Binge Eating Disorder as a separate diagnosis, when it had previously been classified under the more general diagnosis of Eating Disorder Not Otherwise Specified.  
• There are two changes in the diagnosis of Anorexia Nervosa. The first is the removal of the criteria of amenorrhea (loss of menstrual cycle). Removal of this criterion means that boys and men with Anorexia will finally be able to receive an accurate diagnosis.  Similarly, girls and women who continue to have their period despite other symptoms associated with Anorexia, such as weight loss and food restriction, will now be eligible for a diagnosis of Anorexia.  Second, the criterion that "the patient must be 85% or less than their recommended weight," has been removed in the DSM-5, and is now addressed by requiring "restriction of energy intake...leading to significantly low body weight."  
• The main change in the diagnosis for Bulimia Nervosa is that the number of times a person binges and purges per week is no longer a central criterion for a diagnosis of Bulimia.  In the DSM-5, the binge/purge cycle criterion is now at least once per week for three months.  Previously, if binging and purging occurred less than twice per week for three months, the individual would be diagnosed with Eating Disorder Not Otherwise Specified. 

On an unrelated note, I recently saw an excellent movie called What Maisie Knew, which is about a child caught in the aftermath of her parents' bitter divorce.  Told through young Maisie's eyes, she is shuttled between her selfish mother, Susanna (played by Julianne Moore) and her vain father, Beale (played by Steve Coogan), who value her only as a means for provoking each other.  The movie is based on the Henry James novel of the same name, which was published in 1897, but has been updated to the present. Sadly, the novel remains as relevant today as it was when first published in 1897.