The Diagnostic Statistical Manual of Mental Disorders Fifth Edition (DSM-V) is a large piece of text that doctors, social workers, and other healthcare professionals use within the US to help diagnose mental disorders and illnesses. In March of 2022, there was an updated release of the text called the DSM-V, Text Revision (DSM-5-TR). This is the first update since 2013, and there have been many, many changes within the text. Let’s take a look at some highlights.
The DSM-5-TR includes new disorders, such as Prolonged Grief Disorder, which can occur in individuals who have experienced a death of a person close to them over a 12-month period for adults and 6 months for children/adolescents.
According to the American Psychiatric Association (APA), prolonged grief disorder is defined as intense yearning or longing for the deceased (often with intense sorrow and emotional pain), and preoccupation with thoughts or memories of the deceased.
In children and adolescents, this preoccupation may focus on the circumstances of the death.
There is also now an addition of “other specified depressive disorder,” which is used to describe when a major depressive episode occurs simultaneously alongside a psychotic disorder that doesn’t traditionally have a mood episode as part of its diagnostic criteria.
There is also the addition of symptom codes for suicidal behavior and non-suicidal self-injury.
The inclusion of codes for suicidal behavior and non-suicidal self-injury in DSM-5-TR highlights the wide range of issues that may be encountered in routine clinical practice and provides a useful systematic listing to clinicians in documenting these issues.
Revisions to Pre-Existing Diagnoses
In respect to Autism Spectrum Disorder, the DSM-5-TR changed part of its criterion from “as manifested by the following” to “as manifested by all of the following” to improve the intent and clarity of the wording.
For gender dysphoria, its language has been updated to be more culturally sensitive and inclusive. For example, “desired gender” has been updated to “experienced gender,” and “cross-sex hormone treatment” was changed to “gender-affirming hormone treatment.”
What used to be called “social phobia” has now completely become the term “Social Anxiety Disorder” due to its adaptation in the field.
The new DSM revised its language in response to concerns from the mental health field regarding race, ethnic differences, racism, and discrimination. These changes include:
- “Racialized” is used instead of “race/racial” to highlight the socially constructed nature of race.
- “Ethnoracial” is used in the text to denote the U.S. Census categories, such as Hispanic, White, or African American, that combine ethnic and racialized identifiers.
- “Minority” and “non-White” are avoided in the text because they describe social groups in relation to a racialized “majority,” a practice that tends to perpetuate social hierarchies.
- “Latinx” is used in place of Latino/Latina to promote gender-inclusive terminology.
- The term Caucasian is not used because it is based on obsolete and erroneous views about the geographic origin of a prototypical pan-European ethnicity.
Additionally, the new DSM-5-TR updated its criteria to be more precise for diagnosing children with Autism Spectrum Disorder, Disruptive Mood Dysregulation Disorder, Posttraumatic Stress Disorder, and Prolonged Grief Disorder.
Why Are the Changes in DSM-5-TR Important?
Unlike other health conditions or injuries—such as a broken bone or high cholesterol—mental health is a linguistic, subjective area of the healthcare industry. The diagnoses and definitions of these different disorders are shaped by our culture and are ever-changing.
As our society and our world become more aware of our limitations, we can begin to expand our ideas and definitions to be more inclusive of all people.
Additionally, how we see a diagnosis today may differ from how we once perceived it. For example, depression was once seen as a “women’s disease”—this inherently created barriers for men and nonbinary people to feel like they could associate or relate to a disorder that might apply to them.
While depression is becoming more normalized for all, its underlying history and ties to sexist language make it difficult for some to deal with their depression today.
While these new updates are a good step forward, they do not answer the challenges of the larger issues around mental health. Our language and terminology are going to continue to change and adapt to meet the needs and adjustments of our world.
How long will we continue to use words like disorders or illness? How long will we be defining people by their mental illness? How will our definitions of grief, depression, and autism change as more people begin to open up and talk about their struggles?
When we look at the language around mental health, we can see there are clear divides—despite the DSM-5-TR’s attempts to refine and adjust its language to be more “culturally sensitive,” humans and their emotions are not stagnant.
We may come to learn that how we talk about our mental health greatly changes depending on context, and that context is different and perceived differently by everyone.
The Rising Issue of Self-Diagnosing
Now more than ever, people are opening up about their mental health struggles. This is an amazing and progressive step forward, given that people have multiple platforms to talk about their mental health—such as Instagram, TikTok, Youtube, and other social media outlets.
This growing discussion is making mental health a topic that’s become more normalized and widely accepted. We’re seeing everything from therapists sharing their tips and insights to famous athletes opening up about the mental pressures of their work.
Corporations are implementing more programs to increase mindfulness and provide flexible working hours to let their employees work in a healthier, more productive way.
However, with so much information getting spread about, it can be easy to slip into a labeling mindset. Now that almost everyone has a device where they can share their personal messages, it can be incredibly harmful when the wrong messages get spread to wide audiences.
For example, terms like narcissism or “acting bipolar” might be used inappropriately, especially when that person is in an emotional state. These kinds of misuses can actually lessen the severity and importance of the diagnosis.
When we turn terminology into adjectives, they lose their importance in the context of a clinical setting. A patient needs to feel empowered in treating their condition. If that’s seen as just an adjective, a person might feel it’s not severe enough to treat.
Finally, while the DSM-5-TR has made some wonderful progressions to be more culturally sensitive, this update is far overdue. Given that our culture and society are continuously growing and changing, it’s important that these diagnoses and the language surrounding these diagnoses get updated regularly.
Why is it that the DSM hadn’t been updated since 2013? Why did people and healthcare workers across the country have to wait nearly a decade for more appropriate language? How long will it be until the next update?
Learn more about the DSM-5-TR.