DSM-5: New DisordersGary G. Gintner, Ph.D., LPC -S, Bezdek, M. T., Master’s Candidate, Smith, S. E., Master’s Candidate, & Mecholsky, S., Master’s Candidate
Louisiana State University, Baton Rouge, LA
• Why add new disorders and specifiers?
• Poor coverage
Introduction
• DSM-5 Work Group reviews the extant data on the topic
• A rationale for the addition is provided based upon the data
• DSM-5 field trial data is reviewed
• Two outside committees review the evidence
• APA’s Board of Trustees vote (November, 2012)
Steps in Adding a New Disorder
Winners Losers
Nonsuicidal Self-Injury
Binge-Eating Disorder
Neurocognitive Disorders
• Essential Features: Persistent difficulty discarding or parting with possessions, regardless of value
• Perceived need to save items and distress about discarding
• Clutter takes up active living area
• Clinically significant
• Not due to a medical problem or other mental disorder
• Specifiers
• Maladaptive cognitive processes
• Frequent stressful events
• Chronic stress
• Perpetuating factors
• Behavioral avoidance
• Behavior therapy (exposure and response prevention)
• SSRI’s
• Psychoeducation
• Identifying barriers and reinforcing successive approximations
• Relapse prevention
Treating Hoarding Disorder (Tolin, 2011; Muroff et al., 2013; )
• Essential feature: Recurrent episodes of binge eating in which there is a sense of lack of control • At least three ways eating is
disturbed • Not part of Anorexia or
Bulimia and no compensatory behaviors
• Severity rating based upon the number of binges per week
Binge-Eating Disorder (BED)
• Perpetuating factors
• Metabolic syndrome
• Psychoeducation: Dieting, healthy eating and exercise
• Self-monitoring binges/urges
• Relapse prevention
• Essential feature: Severe temper outbursts with underlying persistent angry or irritable mood
• Outburst frequency: 3x or more a week
• Duration: At least 12 months
• Severity: Present in two settings and severe in at least one
• Onset: Before 10 but do not diagnose before age 6
• Rule-outs: Bipolar, ASD, ODD, CD and Intermittent Explosive Disorder
Disruptive Mood Dysregulation Disorder
• Family Stress
What are the treatment implications?
• No empirically supported treatments
• Avoid bipolar medications
• Consider CBT treatments used for depression in children (Waxmonsky et al., 2012):
• Coping skills for thoughts, feelings and behavior
• Parent training
• Parent support group
• Essential feature: Depression that persists for two years or longer (one year or longer in children and adolescents)
• May include major depressive episodes
• Course specifiers:
• With intermittent major depressive episodes, with current episode
• With intermittent major depressive episodes, without current episode
Persistent Depressive Disorder
• Predisposing factors for PDD
• Personality traits (Negative affectivity, introversion)
• Depressogenic thinking
• Precipitating factors
• Loss event
• Perpetuating
• Acute Phase Treatments
• Combination of psychotherapy plus meds are superior to either alone
• Indications for psychotherapy:
• Onset due to a stressful life event or interpersonal problems
• Empirically supported psychotherapies for chronic depression
• CBT
• IPT
• Why note subtypes and specifiers?
• New specifiers for Bipolar Disorders and Depressive Disorder:
• With Anxious Distress
• With Mixed Features
• With Peripartum Onset
• Sources for practice guidelines:
• Keep up with the changes
Final Comments
Alexson, D., Findling, R. L., Fristad, M. A., Kowatch, R. A., Youngstrom, E. A., Horwitz, S. M., Arnold, L. E., Frazier, T. W., Ryan, N., Demeter, C., Gill, M. K., Hauser-Harrington, J. C., Depew, J., Kennedy, S. M., Gron, B. A., Rowles, B. M., & Birmaher, B. (2012). Examining the proposed disruptive mood dysregulation disorder diagnosis in children in the longitudinal assessment of manic symptoms study. Journal of Clinical Psychiatry, 73(10), 1342-1350. doi: 10.4088/JCP012m07674.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: American Psychiatric Association.
American Psychiatric Association. (2010). Practice guidelines for the treatment of major depressive disorder, third edition. [Supplement]. American Journal of Psychiatry. 167(10). doi:10.1176/appi.books.9780890423387.654001
Colins, O. F., & Vermeiren, R. R. J. (2013). The usefulness of DSM-IV and DSM-5 conduct disorder subtyping in detained adolescents. The Journal of Nervous and Mental Disease, 201(9), 736-743. doi:10.1097/NMD.0b013e3182a20e94
Copeland, W. E., Angold, A., Costello, E., & Egger, H. (2013). Prevalence, comorbidity, and correlates of DSM -5 proposed disruptive mood dysregulation disorder. American Journal of Psychiatry, 170(2), 173-179.
Copeland, W. E., Shanahan, L., Egger, H., Angold, A., & Costello, E. J. (2014). Adult diagnostic and functional outcomes of DSM -5 disruptive mood dysregulation disorder. American Journal of Psychiatry, 171(6), 668-674.
Choate, L. H., & Gintner, G. G. (2011). Prenatal depression: Best practices for diagnosis and treatment. Journal of Counseling and Development,84, 373-382.
Davis, C., and J.C. Carter. (2009). Compulsive overeating as an addiction disorder: A review of theory and evidence. Appetite, 53, 1-8.
Deveney, C. M, Connolly, M. E., Haring, C. T., Bones, B. L., Reynolds, M. S., Kim, P., Pine, D. S., & Leibenluft, E. (2013). Neural mechanisms of frustration in chronically irritable children. American Journal of Psychiatry, 170(10), 1186-1194.
Gintner, G. G. (In press). DSM-5 conceptual changes: Innovations, limitations and clinical implications. The Professional Counselor.
Grilo, C. M., Masheb, R. M., & Crosby, R. D. (2012). Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder. Journal of Counseling and Clinical Psychology, 80(5), 897-906. doi: 10.1037/a0027001
Guerdjikova, A. I., McElroy, S. L., Winstanley, E. L., Nelson, E. B., Mori, N., McCoy, J., Keck, P. E., & Hudson, J. I. (2012). Duloxetine in the treatment of binge eating disorder with depressive disorders: A placebo -controlled trial. International Journal of Eating Disorders, 45(2), 281-289. doi: 10.1002/eat.20946
References
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