DSM-5: What You Need to Know
Darrel A. Regier, M.D., M.P.H.
Vice-Chair, DSM-5 Task Force

Former Research Director (2000-2014),
American Psychiatric Association
Senior Scientist, Center for the Study of Traumatic Stress
Uniformed Services University, Department of Psychiatry
2015 APA Annual Meeting Master Course
Monday, May 18, 2015
Grand Ballroom East , Sheraton Centre
Toronto, Ontario

Disclosures
Dr. Regier has the following financial
disclosures: Senior Scientific Consultant, APA
 Honoraria, National and International

DSM-5 CME Presentations

Course Presentations
Introduction and Conceptual Organization of DSM-5 – DarrelRegier, M.D., M.P.H.
Neurodevelopmental Disorders, focusing on Autism Spectrum
Disorder and Intellectual Disability – Susan Swedo, M.D.
Schizophrenia and Psychotic Spectrum Disorders – Rajiv
Tandon, M.D.
Obsessive-Compulsive and Related Disorders – Katharine
Phillips, M.D.
Bipolar and Depressive Disorders – Raymond DePaulo, M.D.
Trauma- and Stressor-Related Disorders – Robert Ursano, M.D.
Substance Use and Other Addictive Disorders – Wilson
Compton, M.D.
Other Conditions that may be a Focus of Clinical Attention –William E. Narrow, M.D., M.P.H.

DSM-5 Structure♦ Section I: DSM-5 Basics♦ Section II: Essential Elements: Diagnostic

Criteria and Codes♦ Section III: Emerging Measures andModels♦ Appendix♦ IndexSection I:Content

Introduction
Revision process, multiaxial systemUse of the manual
Definition of a mental disorder, elements ofa diagnosis, assessment and monitoring
tools



Cautionary Statements for Forensic Use ofDSM-5

Section II:Chapter Structure
A. Neurodevelopmental Disorders
B. Schizophrenia Spectrum and Other Psychotic
DisordersC. Bipolar and Related Disorders
D. Depressive Disorders
E. Anxiety Disorders
F. Obsessive-Compulsive and Related Disorders
G. Trauma- and Stressor-Related Disorders
H. Dissociative Disorders

Section II:
Chapter Structure
J. Somatic Symptom and Related Disorders
K. Feeding and Eating Disorders
L. Elimination Disorders
M. Sleep-Wake Disorders
N. Sexual Dysfunctions
P. Gender Dysphoria

Section II:
Chapter Structure
Q. Disruptive, Impulse-Control, and Conduct
DisordersR. Substance-Related and Addictive Disorders
S. Neurocognitive Disorders
T. Personality Disorders
U. Paraphilic Disorders
V. Other Disorders

Section III: Purpose♦ Section III serves as a designated location,

separate from diagnostic criteria, text, andclinical codes, for items that appear to haveinitial support in terms of clinical use but
require further research before being
officially recommended as part of the main
body of the manual• This separation clearly conveys to readers that thecontent may be clinically useful and warrants review,
but is not a part of an official diagnosis of a mental
disorder and cannot be used as such

Section III: Content♦ Section III: Emerging Measures andModels• Assessment Measures• Cultural Formulation• Alternative DSM-5 Model for Personality

Disorders• Conditions for Further Study

Section III: Content♦ Section III, Conditions for Further Study• Attenuated Psychosis Syndrome• Depressive Episodes With Short DurationHypomania• Persistent Complex Bereavement Disorder• Caffeine Use Disorder• Internet Gaming Disorder• Neurobehavioral Disorder Due to Prenatal AlcoholExposure• Suicidal Behavior Disorder• Non-suicidal Self-Injury

Appendix: Content♦ Separate from Section III will be an Appendix,

which will include• Highlights of Changes From DSM-IV to DSM-5• Glossary of Technical Terms• Glossary of Cultural Concepts of Distress• Alphabetical Listing of DSM-5 Diagnoses andCodes (ICD-9-CM and ICD-10-CM)• Numerical Listing of DSM-5 Diagnoses and Codes(ICD-9-CM)• Numerical Listing of DSM-5 Diagnoses and Codes(ICD-10-CM)• DSM-5 Advisors and Other Contributors

How many disorders are in Section II?

Changes in Specific DSM Disorder Numbers;
Combination of New, Eliminated, and CombinedDisorders(net difference = -15)

Specific Mental Disorders

DSM-IV

DSM-5

172

157

New and Eliminated Disorders in DSM-5
New Disorders(net difference = +13)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

Social (Pragmatic) Communication Disorder
Disruptive Mood Dysregulation Disorder
Premenstrual Dysphoric Disorder (DSM‐IV appendix)
Hoarding Disorder
Excoriation (Skin‐Picking) Disorder
Disinhibited Social Engagement Disorder (split from Reactive Attachment Disorder)
Binge Eating Disorder (DSM‐IV appendix)
Central Sleep Apnea (split from Breathing‐Related Sleep Disorder)
Sleep-Related Hypoventilation (split from Breathing‐Related Sleep Disorder)
Rapid Eye Movement Sleep Behavior Disorder (Parasomnia NOS)
Restless Legs Syndrome (Dyssomnia NOS)
Caffeine Withdrawal (DSM‐IV Appendix)
Cannabis Withdrawal
Major Neurocognitive Disorder with Lewy Body Disease (Dementia Due to OtherMedical Conditions)
15. Mild Neurocognitive Disorder (DSM‐IV Appendix)

Eliminated Disorders
1.
2.

Sexual Aversion Disorder
Polysubstance‐Related DisorderCombined Specific Disorders in DSM-5(net difference = -28)

1.

Language Disorder (Expressive Language Disorder & Mixed Receptive Expressive
Language Disorder)

2.

Autism Spectrum Disorder (Autistic Disorder, Asperger’s Disorder, Childhood
Disintegrative Disorder, & Rett’s disorder)

3.

Specific Learning Disorder (Reading Disorder, Math Disorder, & Disorder of WrittenExpression)

4.

Delusional Disorder (Shared Psychotic Disorder & Delusional Disorder)

5.

Panic Disorder (Panic Disorder Without Agoraphobia & Panic Disorder With Agoraphobia)

6.

Dissociative Amnesia (Dissociative Fugue & Dissociative Amnesia)

7.

Somatic Symptom Disorder (Somatization Disorder, Undifferentiated Somatoform
Disorder, & Pain Disorder)

8.

Insomnia Disorder (Primary Insomnia & Insomnia Related to Another Mental Disorder)

9.

Hypersomnolence Disorder (Primary Hypersomnia & Hypersomnia Related to Another
Mental Disorder)10.

Non-Rapid Eye Movement Sleep Arousal Disorders (Sleepwalking Disorder & Sleep
Terror Disorder)

Combined Disorders in DSM-5 (Continued)(net difference = -28)

11.

Genito‐Pelvic Pain/Penetration Disorder (Vaginismus & Dyspareunia)

12.

Alcohol Use Disorder (Alcohol Abuse and Alcohol Dependence)

13.

Cannabis Use Disorder (Cannabis Abuse and Cannabis Dependence)

14.

Phencyclidine Use Disorder (Phencyclidine Abuse and Phencyclidine Dependence)

15.

Other Hallucinogen Use Disorder (Hallucinogen Abuse and Hallucinogen Dependence)

16.

Inhalant Use Disorder (Inhalant Abuse and Inhalant Dependence)

17.

Opioid Use Disorder (Opioid Abuse and Opioid Dependence)18.

Sedative, Hypnotic, or Anxiolytic Use Disorder (Sedative, Hypnotic, or Anxiolytic Abuse andSedative, Hypnotic, or Anxiolytic Dependence)

19.

Stimulant Use Disorder (Amphetamine Abuse; Amphetamine Dependence; Cocaine Abuse;Cocaine Dependence)

20.

Stimulant Intoxication (Amphetamine Intoxication and Cocaine Intoxication)

21.

Stimulant Withdrawal (Amphetamine Withdrawal and Cocaine Withdrawal)

22.

Substance/Medication-Induced Disorders (aggregate of Mood (+1), Anxiety (+1), andNeurocognitive (-3))

Changes from NOS to
Other Specified/Unspecified(net difference = +24)

NOS (DSM-IV); Other
Specified/Unspecified(DSM-5)

DSM-IV

DSM-5

4165

Other Specified and Unspecified Disorders in DSM-5 replaced
the Not Otherwise Specified (NOS) conditions in DSM-IV tomaintain greater concordance with the official International
Classification of Diseases (ICD) coding system. This statisticalaccounting change does not signify any new specific mentaldisorders.

Other Considerations andOngoing Developments

Pre-Publication Controversies:
Final Accepted Conditions♦

The collapse of DSM-IV’s Autistic Disorder (Autism),
Asperger’s Disorder, Childhood Disintegrative Disorder,and Pervasive Developmental Disorder Not Otherwise
Specified into Autism Spectrum Disorder♦

Addition of Binge Eating Disorder♦

Removal of the bereavement exclusion♦Adoption of a Trauma- and Stressor-Related Disordersection♦Introduction of Somatic Symptom Disorder♦

Merger of abuse and dependence into Substance UseDisorder♦

Addition of Mild Neurocognitive DisordersPre-Publication Controversies:
Final Section III or Rejected Conditions♦ Attenuated Psychosis Syndrome♦ Pedophilic Disorder – rejected♦ Inclusion of Hypersexual Disorder - rejected♦ Dimensional Trait-based Personality Disorders (PID-5)♦ Dimensional Cross-cutting Symptom Measures♦ Dimensional Cross-cutting Severity Measures♦ Dimensional Disability Measures (WHO-DAS)♦ Inclusion of Early-Puberty Victims of PedophilicDisorderRDoC Domains

Cuthbert/Insel and Psychiatry Nosology“The standard approach to psychiatric illness has been todefine a mental disorder on the basis of signs and symptoms
and then seek a pathophysiology relating to those symptoms.
In contrast RDoC asks the following questions: what is thenormal distribution of a certain trait or characteristic; what isthe brain system that primarily implements this function; and,how can we understand at various levels of mechanism, what
accounts for the development of a dysregulation ordysfunction in these systems along normal-to abnormal
dimensions…It may be more difficult for clinical researchers,
since the symptoms that they are accustomed to study
literally do not appear in the RDoC matrix”
Cuthbert BN, The RDoC framework: facilitating transition from ICD/DSM
to dimensional approaches that integrate neuroscience andpsychopathology. World Psychiatry, Feb 2014; 13(1):28-35

Need for Mix of Syndromal (DSM) and
Psychophysiology (RDoC) Research
1.

Autism Spectrum epidemiology andpathophysiology research

2.

Recovery After Initial Schizophrenia Episode(RAISE) research

3.

Genome-Wide Association Study (GWAS)-requiring large phenotype data base4.

All epidemiology, health policy, health services
research--must use clinical diagnoses

5.

All clinical research that is patient based--e.g.
IOM psychotherapy and hypothesis generating