The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was implemented in 2013 after several adjustments were made to DSM-4. Both organizational and fundamental conceptual alterations were made in the manual. Whilst the organizational changes were expected, the conceptual changes were new. Three fundamental conceptual changes were introduced in DSM-5. First, the manual was harmonized with the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Secondly, new spectrum disorders and dimensional ratings were introduced. Lastly, the manual was organized in a uniquely different way from the rest. This paper discusses the three conceptual changes and outlines the strengths and limitations of each.
Harmonization with the ICD
The DSM is a classification for disorders and is used in North America. The ICD serves the same purpose for the world and is dictated by the World Health Organization (WHO). This change brings with it conformity to the international standards which has numerous benefits to psychologists and other mental health practitioners. For instance, a psychologist approved in North America will have similar qualifications and hence opportunities as the one approved in other parts of the world. However, the amalgamation of the two comes with its own limitations. For example, the DSM criteria and the ICD ones have a lot of discrepancies. While ICD depends on prototype descriptions whose background information is minimal and less detailed, the DSM criteria is specific and thoroughly detailed. Secondly, the name of the disorders in DSM-5 are not similar to those in ICD-10 (Harris, 2013) . This also applies to the description of the disorders. Such a factor will make it difficult for psychologists from North America to synchronize their operations with those from other parts of the world.
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Spectrum and Dimensional Ratings Introduction
DSM putts mental disorders into categories that are discrete. Based on this criteria, a mental disorder specialist has to make a yes or no decision as to whether a patient has a particular disorder (American Psychiatric Association Division of Research, 2013) . This comes with a lot of comorbidities. Secondly, when clinicians are not sure, they use the not otherwise specified category which occurs over 30% of the time. Innovations in the DSM-5 have introduced dimensionality which has helped to improve the categorical approach. With this, there is a spectrum that allows clinicians to consider mental disorders between the limits of significant impairment and optimal functioning. The limitation of this is that dimensions have never been appealing intuitively. The appropriate cut point of these limitations cannot be determined as it all relies on the judgment of the psychologist. Different practitioners have different intuitions and hence may breed different results for the same patient.
The New Manual Organization
The previous DSMs used research and tradition to decide the chapters to be included in the document and the disorders to be placed in the chapters (Regier, Kuhl, & Kupfer, 2013) . However, in DSM-5, research was done on how disorders cluster together and this is how the new manual was organized. This has made some disorders to be transferred to other chapters. This will be of huge benefit to clinicians as locating disorders will become easier since related conditions have been grouped together. Furthermore, the comparison of disorders process will be much simpler and, hence, decisions will be made in a more timely and accurate manner. On the flipside, some details have been lost. For example the chapter on disorders affecting children and adolescents has been dismantled and can be found nowhere. Consequently, practitioners who heavily relied on this chapter will be forced to look for other ways to conform their practice to the new standards.
Link to DSM-5: https://psychiatryonline.org/pb-assets/dsm/update/DSM5Update_October2018.pdf
References
American Psychiatric Association Division of Research. (2013). Highlights of Changes from DSM-IV to DSM-5: Somatic Symptom and Related Disorders. FOCUS , 11 (4), 525-527.
Harris, J. C. (2013). New terminology for mental retardation in DSM-5 and ICD-11. Current opinion in psychiatry , 26 (3), 260-262.
Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM‐5: Classification and criteria changes. World Psychiatry , 12 (2), 92-98.
