Academic journal article International Journal of Clinical and Health Psychology

From DSM-IV-TR to DSM-5: Analysis of Some Changes

Academic journal article International Journal of Clinical and Health Psychology

From DSM-IV-TR to DSM-5: Analysis of Some Changes

Article excerpt

To judge by the success of its sales (Blashfield, Keeley, Flanagan, & Miles, 2014), the publication of a new edition of the DSM has immediately become an event. This study is intended to analyze some aspects that the fifth edition of the DSM (American Psychiatric Association APA, 2013b) contributes. It is materially impossible to consider all its sections, at the same time that it requires aneducational effort for its explanation: disappearance of hypochondria or of concepts such as somatization, substance dependence, appearance of spectra, new disorders, etc. Therefore, a selection has been made of what might be the most out- standing from a clinical, psychopathological viewpoint.

The Manual's presentation states its intention of improv- ing the validity of previous editions and of being based on research. However, the sources to which it alludes are from neuroscience and genetics. Although the text considers psy- chological (and social) factors, it is not this type of research that structures the DSM-5. In fact, future contributions from the Research Domain Criteria (RD°C),the principles of which are directed at understanding mental disorders as cerebral disorders, dysfunctions of brain circuitry evaluable by the instruments of cognitive neuroscience, and of developing the biological basis for symptoms,are proposed for inclusion (Insel, 2013; Insel et al., 2010).

Needless to say, the DSM is not a psychopathology text, although, as it is a Manual that has to guide diagnosis (still clinical), treatment and research, it is quite relevant to underline the obvious: that the biologicist perspec- tive (Adam, 2013) conditions the subject of study. As a matter of fact, we could starttalking about a NeuroDSM, given the proliferation of the prefix: Neurodevelopmental disorders, Neurocognitive disorders, or Functional neu- rological symptom disorder. This seems to minimize or discard any contribution of psychological research from the start.

In view of the evidence accumulated (Blashfield et al., 2014), in addition to decreasing the unspecified categories, among the DSM-5 goals were development of clusters and dimensions of disorders. Dimensionality appears in some disorder spectra, in some disorders (scales for diagnos- tic criteria of intellectual disability, autism spectrum and schizophrenia), partially in others (domains are defined in neurocognitive disorders, but the structure is categor- ical), and in determining severity (not in all diagnoses). It is curious in this sense that inspite of following con- tributions from neuroscience and genetics, and although the data matchmuch wider sets of disorders depending on their susceptibility and pathogenesis (Craddock & Owen, 2010; Cross-Disorder Group of the Psychiatric Genomics Consortium, 2013), in reality the resulting clusters are much more limited (e.g., schizophrenia spectrum, but separated from bipolar disorders and autism spectrum). And even within the schizophrenia spectrum, there would be no rea- son (by genetic criteria) for distinguishing schizophreniform disorder from schizophrenia, and by the way, harmonizing the DSM-5 with the ICD-10.

It is not a matter of forcing a choice between categor- ical and dimensional. As Wakefield and First (2013) point out, numerous dimensional variables end up generating a point of inflection (points of rarity) based on which cate- gories are established. Perhaps the most difficult thing to accept is that mental disorders (or that all of them) are nat- ural classes by definition. But it is deficient in that decisions are made in favor of some dimensions and not others which are also backed by research (e.g., related to personality), or that do not develop one of the crucial dimensions, the one establishing the level of distress (Sandín, 2013).

One of the questions that remain under discussion about the diagnostic classifications and their lack of validity has to do with the definition of mental disorder itself. …

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