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Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun.
The American Psychiatric Association (APA) published the DSM-5 in 2013. This latest revision takes a lifespan perspective recognizing the importance of age and development on the onset, manifestation, and treatment of mental disorders. Other changes in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) include eliminating the multi-axial system; removing the Global Assessment of Functioning (GAF score); reorganizing the classification of the disorders; and changing how disorders that result from a general medical condition are conceptualized. Many of these general changes from Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) to DSM-5 are summarized in the report Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. This report will supplement that information by providing details specifically about changes to disorders of childhood and their implications for generating estimates of child serious emotional disturbance (SED).
One of the key changes from DSM-IV to DSM-5 is the elimination of the multi-axial system. DSM-IV approached psychiatric assessment and organization of biopsychosocial information using a multi-axial formulation (American Psychiatric Association, 2013b). There were five different axes. Axis I consisted of mental health and substance use disorders (SUDs); Axis II was reserved for personality disorders and mental retardation; Axis III was used for coding general medical conditions; Axis IV was to note psychosocial and environmental problems (e.g., housing, employment); and Axis V was an assessment of overall functioning known as the GAF. The GAF scale was dropped from the DSM-5 because of its conceptual lack of clarity (i.e., including symptoms, suicide risk, and disabilities in the descriptors) and questionable psychometric properties (American Psychiatric Association, 2013b).
Although the impact of removing the overall multi-axial structure in DSM-5 is unknown, there is concern among clinicians that eliminating the structured approach for gathering and organizing clinical assessment data will hinder clinical practice (Frances, 2010). However, the direct impact on the prevalence rates of childhood mental disorders is likely to be negligible as it will not affect the characteristics of diagnoses.
DSM-IV and DSM-5 categorize disorders into “classes” with the intent of grouping similar disorders (particularly those that are suspected to share etiological mechanisms or have similar symptoms) to help clinician and researchers use of the manual. From DSM-IV to DSM-5, there has been a reclassification of many disorders that reflects a better understanding of the classifications of disorders from emerging research or clinical knowledge. Table 3 lists the disorder classes included in DSM-IV and DSM-5. In DSM-5, six classes were added and four were removed. As a result of these changes in the overall classification system, numerous individual disorders were reclassified from one class to another (e.g., from “mood disorders” to “bipolar and related disorders” or “depressive disorders”). The reclassification of disorder classes will not have a direct effect on any SED estimation; however, it does warrant consideration when documenting disorders that may have changed classes.
Disorder Classes Presented by the DSM-IV and DSM-5, as Ordered in DSM-IV.
Of particular note for childhood mental disorders, the DSM-5 eliminated a class of “disorders usually first diagnosed in infancy, childhood, or adolescence.” Those disorders are now placed within other classes. See Table 4 for a summary the new DSM-5 disorder classes for those disorders formally classified as “disorders usually first diagnosed in infancy, childhood, or adolescence.”
Disorder Classification in the DSM-IV and DSM-5 for Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence.
All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.
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