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DSM-5-TR: Rationale, Process, and Overview of Changes
Michael B First1, Diana E Clarke1, Lamyaa Yousif1
1Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum).
Abstract:
The DSM-5 text revision (DSM-5-TR) is the first published revision of the DSM-5 since its publication in 2013. Like the previous text revision (DSM-IV-TR), the main goal of the DSM-5-TR is to comprehensively update the descriptive text accompanying each DSM disorder on the basis of reviews of the literature over the past 10 years. In contrast to the DSM-IV-TR, in which updates were confined almost exclusively to the text, the DSM-5-TR includes many other changes and enhancements of interest to practicing clinicians, such as the addition of diagnostic categories (prolonged grief disorder, stimulant-induced mild neurocognitive disorder, unspecified mood disorder, and a category to indicate the absence of a diagnosis); the provision of ICD-10-CM symptom codes for reporting suicidal and nonsuicidal self-injurious behavior; modifications, mostly for clarity, of the diagnostic criteria for more than 70 disorders; and updates in terminology (e.g., replacing "neuroleptic medications" with "antipsychotic medications or other dopamine receptor blocking agents" throughout the text and replacing "desired gender" with "experienced gender" in the text for gender dysphoria). Finally, the entire text was reviewed by an Ethnoracial Equity and Inclusion Work Group to ensure appropriate attention to risk factors such as the experience of racism and discrimination, as well as the use of nonstigmatizing language.
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