The DSM-5, short for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the latest update to the American Psychiatric Association’s (APA) classification and diagnostic tool. It is used for diagnosing psychiatric disorders and also makes treatment recommendations for these disorders. Because there is always new research and findings in the medical field and especially in regards to psychological illnesses and disorders, there are changes in the DSM 5.
The DSM is like an encyclopedia of mental illness concepts and definitions, which change over time. Therefore the changes in the DSM 5 can be seen in this current version – the fifth edition, published on May 18, 2013.
Changes in the DSM 5: Substance Use and Addictive Disorders
The first noticeable difference to the section on substance use and addictive disorders is that it is laid out differently. Whereas previously organized according to the diagnosis, such as use, intoxication, and withdrawal, new changes in the DSM 5 reflect chapter order and numbering that is designated according to the specific substance.
Changes in the DSM 5: Substance-Related and Addictive Disorders
Some major and apparent changes in the DSM 5 are that gambling disorder and tobacco use disorder are now recognized. Also, criteria for marijuana (cannabis) and caffeine withdrawal were added.
A new “addictions and related disorders” category combines substance abuse and substance dependence into single substance use disorders specific to each substance of abuse.
Instead of the term of “recurrent legal problems” as part of the criteria, changes in the DSM 5 now use “craving or a strong desire or urge to use a substance” in the diagnostic criteria. The DSM 5 also uses a spectrum of severe-to-mild; severity from mild to severe is based on the number of criteria endorsed. And the threshold of the number of criteria that must be met was changed.
Other Changes in the DSM 5
- Hallucinogen Disorders have now include Phencyclidine (PCP) Disorders
- Sedative, Hypnotic, or Anxiolytic Disorders now called Sedative/Hypnotic-Related Disorders
- Amphetamine and Cocaine Disorders now called Stimulant Disorders
- Removal of Substance-Induced Dissociative Disorder
- Minor wording changes to most of the criteria
- Added criteria for Hallucinogen Persisting Perception Disorder
- Added criteria for Neurobehavioral Disorder Associated With Prenatal Alcohol
- Added criteria for Caffeine Use Disorder
- Added criteria for Internet Use Disorder
- Added criteria for Drug Specific “Not Elsewhere Classified” diagnoses
Concerns Regarding the Changes in the DSM 5
Because of the re-structuring that is based on the specific substance, there are concerns that first-time substance abusers will be lumped in with hard-core addicts. This is problematic because of their very different treatment needs and prognosis as well as the stigma this may cause.
Changes in the DSM 5 have also created a slippery slope by introducing the concept of Behavioral Addictions (i.e. gambling, internet, sex) that eventually can be used to make everything we enjoy doing a lot into a mental disorder. There is concern that this sort of thing can lead to careless over-diagnosis of internet and sex addiction and result in the development of lucrative treatment programs to exploit these new markets.