DSM-5 updates: How will they affect patients and clinicians?
Key Takeaways
In 2022, the DSM-5 received its first update since 2013.
The DSM-5 TR now includes the diagnostic entities of prolonged grief disorder, unspecified mood disorder, and stimulant-induced mild neurocognitive disorder. Symptom codes for suicidal behavior and non-suicidal self-injury have also been added, as well as terminology pertaining to race, culture, and gender.
Psychiatrists and physicians who work in this area may acknowledge and implement the added DSM-5 TR diagnoses, symptom codes, and terminology in their practice.
Doctors who work in psychiatry may know that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) hasn’t seen any editorial changes since 2013—that is, until mid-spring 2022.
The DSM-5 Text Revision (DSM-5 TR) now includes several additional diagnoses, revisions to existing criteria, and fresh terms referring to cultural, racial, and gender-based topics. Here are updates to note.
Added diagnoses
Of the many updates, one of the most significant is the addition of three diagnostic entities.
According to an article published by World Psychiatry, these include prolonged grief disorder, unspecified mood disorder, and stimulant-induced mild neurocognitive disorder.[]
Those who suffer from prolonged grief disorder experience “intense yearning for and/or persistent preoccupation with thoughts” about a deceased loved one for at least 12 months after their death.
This disorder is also characterized by classic traits of grief, which may include emotional numbness or acute pain, as well as avoidance of the loved one’s loss. These symptoms may have a severe impact on the patient’s ability to function.
Unspecified mood disorder is known as a “residual category.” It encompasses all presentations of mood symptoms that don’t fit neatly within the criteria for any bipolar, depressive, or related disorder.
Stimulant-induced mild neurocognitive disorder is characterized by difficulties relating to learning, memory, executive function, and other neurocognitive impairments associated with stimulant use. This disorder is grouped with other substance abuse-related mild neurocognitive disorders that may be induced by alcohol, inhalants, sedatives, hypnotics, or anxiolytics.
Additional symptom codes
The revised DSM-5 TR also includes new symptom codes to cover existing illnesses.
An article published by Psychiatric News stated that the new symptom codes give physicians a way to recognize current or past suicidal behavior and nonsuicidal self-injury.[]
Patients who may have intent to die and use self-injurious behavior as a means to achieve that, for example, exhibit suicidal behavior. You may infer that the intent is there based on the circumstances, or the patient may explicitly tell you. A patient may also exhibit self-injury that is not in an attempt to commit suicide, however.
The symptom code for nonsuicidal self-injury, on the other hand, applies to patients who do not have intent to die but still engage in self-injurious behaviors such as excessive rubbing, cutting, burning, stabbing, or hitting.
A patient who engages in these behaviors is likely trying to induce pain, bleeding, or bruising, according to Psychiatric News.
Both the suicidal behavior and nonsuicidal self-injury symptom codes can be located in the DSM-5 TR section II chapter, “Other Conditions That May Be a Focus of Clinical Attention.” It offers clinicians a systematic way to record symptoms that don’t qualify as disorders but may necessitate ongoing care.
Addressing race, gender, and culture
Outside of the additional clinical updates to the DSM-5 TR, literature-based terminology changes have also been implemented for cultural, racial, and gender-based topics.
According to an article published by the APA, the DSM-5 TR now includes:[]
Racialized: This term is now used in place of “race” and “racial” to acknowledge that race is a social construct.
Ethnoracial: The DSM-5 TR now uses “ethnoracial” to refer to the US Census categories (Hispanic, White, or African American), as these racialized and ethnic identifiers intersect for some patients.
Latinx: Taking the place of “Latino” and “Latina,” “Latinx” is a gender-inclusive term used to describe all patients of Latin descent.
On top of these updated terms, the DSM-5 TR now avoids the terms “minority” and “non-White,” writing that their use is “a practice that tends to perpetuate social hierarchies.”
The term “Caucasian” has also been discarded, since its inception rests on outdated, inaccurate ideas regarding the origins of a “prototypical pan-European” ethnicity.
What this means for you
The DSM-5 TR has undergone a few major changes in 2022. Of particular significance is the addition of diagnoses like prolonged grief disorder, unspecified mood disorder, and stimulant-induced mild neurocognitive disorder. The DSM-5 TR also includes new symptom codes for suicidal behavior and self-injury. You may acknowledge and implement these additions, as well as the added terminology that aims to appropriately address culture, race, and gender in medical contexts.