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Good Grief It's the DSM-5 Quiz

March 07, 2014

    Last May when  the American Psychiatric Association (APA)  published its latest version of the  diagnostic and statistical  manual,  the  DSM-5, I was dreading having to learn the new system.   While many of you  are already using it,  we  are holding off  until  October 1, 2014  when  the new   edition of the International Classification of Disease  is adopted  as the nation’s standard medical coding system. The proliferation of ICD codes is  staggering, indeed.  A recent webinar I attended  generated a lot of anxiety over the DSM-5.  Strangely enough  it was more fiscal  then clinical, as the phrase "diagnosis creep"  was over shadowed  by "revenue cycle interruption". 

This new manual   is a far cry from the slim amber-covered booklet  that I was given when I first  started working in the field of mental health  in the early 1970’s. The Diagnostic and Statistical Manual of Mental Disorders-II  (DSM-II)  I used then was just  the  second  revision of this best-selling manual and it  was  published in 1968. It contained a list of all the common psychiatric diagnoses along with  a very short  paragraph describing each one. These descriptions were very general and loaded with the current  Freudian terminology and theoretical references. My favorite diagnosis back then was something called “Inadequate Personality”. I was told that this diagnosis, which is now long-gone, was used to describe people who no matter how hard they try, just can’t seem to succeed. These were folks like Charlie Brown, in  the Charles Schultz comic strip Peanuts  who seem  to have  “endless determination and hope, but who  are ultimately dominated by his insecurities and a  permanent case of bad luck".

 While the DSM-5 changes have riled up a lot of protest it seems more like DSM-IV-TR  than different. The promise of a real neuroscience based system, or even a workable dimension systems for personality disorders, still seems as far away as  Freud's Project  for a Scientific Psychology or a detailed description of the inner workings of Skinner's black ever where. I have completed  some  on-line training and attended a workshop and have spent a lot of  time  pouring through  the new volume,  along with some critical books and articles.

First of all,  I miss Allen J. Frances and Thomas Widiger.  I'm glad to see the  GAF bite  the dust and I'm  not sure I ever saw a Rett's or Childhood distintegerative diagnosis actually ever used.  Most alarming, however,  is that  the Autistism  Spectrum Disorder (ASD)  criteria seems to be living up to the early expressed  concerns  that it would  reduce  the number of diagnosed cases by up to 30%.  I'm especially anxious to see how all the specifiers are going to be programmed into our EMR.

I am  concerned about the increasing pathologizing of everyday life and the intrusion of big pharama,  which seems to be ever  increasing. Paradoxically this is occurring  at the same time as  folks  are earnestly arguing things like  ADS should be considered  neurodiversity, rather than pathology.

Pardon the cliché but it is what it is.   Try your hand at my brief quiz below. The answers are in the book or in one of France's cogent criticism. E-mail me if you get stumped (tstawar@lifespr.com).

   DSM-5 Quiz for Beginners

 1. What five disorders combined to form Autism Spectrum Disorder?

 2. What two Personality Disorders  are  also listed in two  diagnostic chapters. 

3. What diagnosis will Asperger’s patients most like get in DSM-5?

4. What are learning disorders now called in DSM-5?

 5. Why was the bereavement exclusion dropped?

 6. Persistent Depressive Disorder is the new name for what?

 7. Mental Retardation is now called what in DSM-5?

 8. Hoarding Disorder  and Excoriation  are included in  what new chapter?

 9. How does Social (pragmatic) Communication Disorder differ from Autism Spectrum disorder?

10.  What personality disorder from DSM-IV-TR was eliminated?

11. What are some difference between bereavement and depression symptoms?

12. Disruptive Mood Dysregulation Disorder was supposed to prevent the  over diagnosis  of what in children?

13.  How much is the new diagnosis of ASD expected to lower the rates of Autism and related disorders?

14. What is the one behavioral (non-substance) addiction officially listed (hint: it’s  not kleptomania)?

15. What is the WHODAS-2  and what is it intended to replace?

 16. What class of disorders are given an alternative dimensional diagnosis scheme in Section  III of DSM-5?

17. What disorder involving the internet is included in “condition for further study”?

18. What new disorder has been said to turn ordinary gluttony into a mental disorder?

 19. A picky eater might end up getting get what new DSM-5 diagnosis?

 20. Why is it DSM-5 and not DSM-V?

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