12/26/ Fear of the unknown prevents one from embracing the future.

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1 Fear of the unknown prevents one from embracing the future. 12/26/ /26/ The American Psychiatric Association first published a predecessor to the DSM in It was a statistical classification of institutionalized mental patients. It s purpose was to improve communication about the type of patients cared for in hospitals. It was used as a component of the full U.S. census. Since World War II, the DSM has had four major editions 12/26/ /26/

2 DSM-I DSM-II DSM-III DSM-III-R DSM-IV DSM-IV-TR DSM The initial movement for developing a classification of mental disorders in the United States was the need to collect statistical information. The first official attempt was the 1840 census which used a single category, "idiocy/insanity". 12/26/ /26/ In 1917, a Committee on Statistics from what is now known as the American Psychiatric Association (APA), together with the National Commission on Mental Hygiene, developed a new guide for mental hospitals called the "Statistical Manual for the Use of Institutions for the Insane", which included 22 diagnoses. It establishes a nomenclature* for clinicians and scientists. It provides descriptive information quickly. * a system of names; systematic naming in any art or science 12/26/ /26/

3 It is predictive in that it offers information on course, prognosis, and treatment. It aids in information retrieval due to its organization. It enables clinicians to receive payment for services. It serves as a step toward a theoretical understanding of psychiatric disorders. 12/26/ /26/ The purpose of DSM-I was to create a common nomenclature* based on a consensus of the contemporary knowledge about psychiatric disorders. These categories contained 106 diagnoses. The APA sent questionnaires to 10% of its membership and asked for comments on the proposed categories. * a system of names; systematic naming in any art or science Only one diagnosis: Adjustment Reaction of Childhood/Adolescence, could be applied to children. 12/26/ /26/

4 The final version, which assigned categories based on lists of symptoms, was approved by a vote of the membership and published in 1952 (Blashfield, 1998). The DSM-I included 3 categories of psychopathology: organic brain syndromes functional disorders mental deficiency The purpose was to further facilitate communication among professionals. It had 11 major diagnostic categories. 12/26/ /26/ Increased attention was given to the problems of children and adolescence with the categorical addition of Behavior Disorders of Childhood-Adolescence. This category included: Hyperkinetic Reaction Withdrawing Reaction Overanxious Reaction Runaway Reaction Unsocialized Aggressive Reaction Group Delinquent Reaction (Scotti and Morris, 2000). There were a total of 185 diagnoses in the DSM II. 12/26/ /26/

5 The DSM-I and DSM-II were widely criticized for a variety of reasons. Most importantly, the reliability and validity of the first two editions were challenged (Blashfield, 1998; Kirk and Kutchins, 1994). The diagnostic descriptions were not detailed, leaving room for error. Additionally, the descriptions had been written by a small number of academics rather than empirical studies. Many psychiatrists criticized the implicit medical model, stating that it was inappropriate because the cause of most disorders was unknown. 12/26/ /26/ A study by Rosenhan s caused Robert Spitzer and others to question the reliability of the DSM-II and in 1974, Spitzer and Fleiss wrote: A Re-Analysis of the Reliability of Psychiatric Diagnosis. There are no diagnostic categories for which reliability is uniformly high. Reliability appears to be satisfactory for three categories: mental deficiency, organic brain syndrome (but not its subtypes), and alcoholism. The level of reliability is no better than fair for psychosis and schizophrenia and is poor for the remaining categories. Spitzer and others began work on the Research Diagnostic Criteria (RDC), or research-based criteria with associated structured interviews to increase reliability. Because of the impact of his work on the RDC, Spitzer became the named the head of the DSM-III Task Force (Kirk and Kutchins, 1994). Spitzer and Fleiss, /26/ /26/

6 The other major work for the creation of DSM-III was Diagnostic Criteria for Use in Psychiatric Research (Feighner et al., 1972; in Blashfield, 1998). Focusing on the problem of uniform definitions, Feighner et al. offered explicit criteria for 15 categories. They also presented a considerable amount of evidence for validity. Because it seemed that Feighner et al. had found the answer to the DSM s problems, those criteria were accepted immediately. 12/26/ /26/ The DSM-III was revolutionary in many ways. Although based on the medical model, it professed to be atheoretical** It included a multi-axial system for assessment of the client as an individual as well as a family and community member. ** lacking theoretical basis: without a theoretical basis 12/26/

7 Unlike its predecessors, the DSM-III was based on scientific evidence. Its reliability was improved with the addition of explicit diagnostic criteria and structured interviews. 12/26/ The DSM-III stimulated additional research to ensure the adequacy of criteria. The social and political debates over terminology and diagnoses, such as the use of the word neurosis and the removal of homosexuality as a diagnosis, were frequent. The DSM-III was so popular that its revenues lead to the formation of the American Psychiatric Press. 12/26/ Despite its innovations, the DSM-III also presented challenges to professionals. It contained 482 pages, a tremendous increase over the DSM-II s 92 pages. It was not user-friendly in its bulk or in its categories. The DSM-III also contained 265 diagnoses to the DSM-II s 185 diagnoses. A new problem of international communication was becoming apparent. ( 12/26/ /26/

8 The DSM-III-R was intended to be a short update to the 3rd edition manual; however, the differences between III and III-R were great. The DSM-III-R saw categories renamed, reorganized, and significant changes in criteria. Six new categories were deleted while others, such as Trichotillomania, were added. Additional assurances of reliability were presented in the form of field trials and more diagnostic interviews. Controversial diagnoses such as: Premenstrual Syndrome, Masochistic Personality Disorder, Paraphilic Rapism were considered and discarded due to their social implications (Blashfield, 1998). Altogether the DSM-III-R contained 297 diagnoses. 12/26/ /26/ Although widely accepted, the DSM-III and the DSM-III-R were also widely criticized. First, the scientific evidence was questioned because many of the field trials were conducted by experts in the field. Therefore, true objectivism could not be assured. It was believed that the multi-axial system prevented efficiency in diagnosis. Additionally, the DSM offered a different amount of support and direction for each axis. 12/26/ /26/

9 There were: 300 pages of descriptions for Axis I 39 pages of descriptions for Axis II and, 2 pages were given to Axes IV and V (Blashfield, 1998) The rating scale format of IV and V was also foreign to many professionals. The Axis themselves were problematic for many practitioners because no one seemed to know how those particular areas were chosen. Psychoanalysts began to argue for an Axis on defense mechanisms, and nurses wanted an Axis for level of care. 12/26/ /26/ The DSM-IV was published in 1994 to reflect research conducted since the 1987 DSM-III-R. This edition of the DSM was a major undertaking. The DSM-IV saw the restructuring of several categories, such as the inclusion of Overanxious Disorder of Childhood within GAD (generalized anxiety disorder). Scotti and Morris, 2000 The multi-axial system was maintained. The DSM-IV offered detailed information about each disorder including: essential and associated features presence, course, familial pattern differential diagnosis and included age, gender, and culture. 12/26/ /26/

10 Source books, decision trees, glossaries, and alphabetical and numerical listings provided ways to increase the manual s utility. The DSM-IV included 365 diagnoses, and at 886 pages, it was more than 7 times longer than DSM-II (Blashfield, 1998). Like its predecessors, the DSM-IV was criticized. It was accused of leaning toward biological explanations although it purported to be atheoretical**. Co-morbidity, symptom overlap, and heterogeneity of presentation were seen as threats to reliability. ** lacking theoretical basis: without a theoretical basis 12/26/ /26/ It did not solve the problem of PMS and the other controversial disorders; it simply listed them among disorders requiring further study. Additionally, the axes problem remained unsolved, with 3 candidates (defense mechanisms, interpersonal functioning, and occupational functioning) still in the running (Blashfield, 1998). The DSM-IV-TR (2000) was released to correct any factual errors and make changes to reflect recent research. It did not attempt to address any of the problems of DSM-IV. 12/26/ /26/

11 Rather, the changes were limited to text, with particular emphasis placed on client-centered speech. Phrases such as a schizophrenic were removed and replaced with an individual with Schizophrenia in an effort to classify disorders, not people. (DSM-IV-TR, 2000). DSM I diagnosis DSM II diagnosis DSM III diagnosis DSM IIIR diagnosis DSM IV diagnosis DSM IV-TR 2000 Text Changes DSM diagnosis 12/26/ /26/ The APA began an evaluation of the strengths and weaknesses of the DSM Original Participants: World Health Organization (WHO) World Psychiatric Association National Institute of Mental Health (NIHM) 12/26/ /26/

12 From the Original Participants were joined by: The National Institute on Alcoholism and Alcohol Abuse (NIAAA) National Institute on Drug Abuse (NIDA) There were 13 international conferences with 400 participants from 39 countries. In 2006 the approval of the chairs for the 13 diagnostic work groups and additional task force members were named. In 2007 the 28 members of the task forces were approved. In 2008 there were appointments of 130 work groups. 12/26/ /26/ The task force and work groups recounted the history of the DSM-IV s classification of mental disorders, evaluated its strengths and limitations and strategic directions for the revision. An intensive six year process involved conducting literature reviews, publishing research reports in scientific journals, developing draft diagnostic criteria, posting preliminary drafts on the DSM-5 website for comment, presenting preliminary findings at professional meetings, performing field trials, and revising criteria and text. 12/26/ /26/

13 Four principles guided the draft revisions: The DSM-5 was intended to be used by clinicians, and revisions must be feasible for routine clinical practice. Recommendations for revisions should be guided by research evidence. Where possible, continuity should be maintained with the previous editions of the DSM. No a priori** constraints should be placed on the degree of change between the DSM-IV and the DSM-5. **a way of gaining knowledge without appealing to any particular experience(s) 12/26/ /26/ A mental disorder is a syndrome characterized by clinically significant disturbance in an individual s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities, an expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. SECTION 1 DSM BASICS Introduction Use of the Manual Cautionary Statement for Forensic Use of DSM-5 Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above. 12/26/ /26/

14 Organization of chapters is designed to demonstrate how the disorders are related to one another. Throughout the entire manual the disorders are framed in age, gender, developmental characteristics. The Multi-axial system has been eliminated. Removing artificial distractions between medical and mental disorders. SECTION II DIAGNOSTIC CRITERIA AND CODES Neurodevelopmental Disorders Schizophrenia Spectrum and Other Psychotic Disorders Bipolar and Related Disorders Depressive Disorders Anxiety Disorders Obsessive-Compulsive and Related Disorders 12/26/ /26/ SECTION II DIAGNOSTIC CRITERIA AND CODES Trauma and Stressor-Related Disorders Dissociative Disorders Feeding and Eating Disorders Elimination Disorder Sleep-Wake Disorders Sexual Dysfunctions Gender Dysphoria Disruptive, Impulse-Control, and Conduct Disorders Substance-Related and Addictive Disorders SECTION II DIAGNOSTIC CRITERIA AND CODES Neurocognitive Disorders Personality Disorders Paraphilic Disorders Other Mental Disorders Medication-Induced Movement Disorders and Other Adverse Effects of Medication Other Conditions That May Be A Focus of Clinical Attention 12/26/ /26/

15 SECTION III Emerging Measures and Models Assessment Measures Cultural Formulation Alternative DSM-5 Model for Personality Disorders Conditions for Further Study Alphabetical Listing of DSM 5 Diagnoses and Codes (ICD* 9 CM and ICD* 10-CM) can be found on page 839. ICD 10 codes go into effect October 1, *International Classification of Diseases 12/26/ /26/ SUBSTANCE-RELATED AND ADDICTIVE DISORDERS (483/227) ALCOHOL CAFFEINE CANNABIS HALLUCINOGENS (WITH SEPARATE CATEGORIES FOR PHENCYCLIDINE*) {OR SIMILARLY ACTING ARYLCYCLOHEXYLAMINES**} INHALANTS * PCP ** CLASS OF PHARMACEUTICAL, DESIGNER, AND EXPERIMENTAL DRUGS 12/26/ /26/

16 OPIOIDS SEDATIVES, HYPNOTICS, AND ANXIOLYTICS* STIMULANTS TOBACCO OTHER (OR UNKNOWN) SUBSTANCES SUBSTANCE-RELATED DISORDERS ARE DIVIDED INTO TWO GROUPS: SUBSTANCE USE DISORDERS and SUBSTANCE INDUCED DISORDERS * replaced with the term anti-anxiety medication 12/26/ /26/ SUBSTANCE INDUCED DISORDERS: 1. INTOXICATION 2. WITHDRAWAL 3. OTHER SUBSTANCE/MEDICATION INDUCED MENTAL DISORDERS: PSYCHOTIC DISORDERS BIPOLAR DISORDERS DEPRESSIVE DISORDERS ANXIETY DISORDERS OBSESSIVE - COMPULSIVE DISORDERS SLEEP DISORDERS SEXUAL DYSFUNCTIONS DELIRIUM NEUROCOGNITIVE DISORDERS DSM IV-TR vs. DSM 5 CRITERIA 12/26/ /26/

17 A PROBLEMATIC PATTERN OF USE LEADING TO CLINICALLY SIGNIFICANT IMPAIRMENT OR DISTRESS, AS MANIFESTED BY AT LEAST TWO OF THE FOLLOWING WITHIN A 12 MONTH PERIOD. 1. SUBSTANCE IS OFTEN TAKEN IN LARGER AMOUNTS OR OVER A LONGER PERIOD THAN WAS INTENDED (DEP) 2. THERE IS A PERSISTENT DESIRE OR UNSUCCESSFUL EFFORTS TO CUT DOWN OR CONTROL USE (DEP) 3. GREAT DEAL OF TIME IS SPENT IN ACTIVITIES NECESSARY TO OBTAIN THE SUBSTANCE, USE THE SUBSTANCE OF RECOVER FROM ITS EFFECTS (DEP) 4. CRAVING, OR A STRONG DESIRE OR URGE TO USE THE SUBSTANCE (NEW) 5. RECURRENT USE RESULTING IN A FAILURE TO FULFILL MAJOR ROLE OBLIGATIONS AT WORK, SCHOOL, OR HOME (ABUSE) 12/26/ /26/ CONTINUED USE DESPITE HAVING PERSISTENT OR RECURRENT SOCIAL OR INTERPERSONAL PROBLEMS CAUSED OR EXACERBATED BY THE EFFECTS OF THE SUBSTANCE (ABUSE) 7. IMPORTANT SOCIAL, OCCUPATIONAL, OR RECREATIONAL ACTIVITIES ARE GIVEN UP OR REDUCED BECAUSE OF USE (DEP) 8. RECURRENT USE IN SITUATIONS IN WHICH IT IS PHYSICALLY HAZARDOUS (ABUSE) 9. SUBSTANCE USE IS CONTINUED DESPITE KNOWLEDGE OF HAVING A PERSISTENT OR RECURRENT PHYSICAL OR PSYCHOLOGICAL PROBLEM THAT IS LIKELY TO HAVE BEEN CAUSE OR EXACERBATED BY THE SUBSTANCE (DEP) 10. TOLERANCE, AS DEFINED BY EITHER OF THE FOLLOWING: (DEP) A NEED FOR MARKEDLY INCREASED AMOUNT OF THE SUBSTANCE TO ACHIEVE INTOXICATION OR DESIRED EFFECT. A MARKEDLY DIMINISHED EFFECT WITH CONTINUED USE OF THE SAME AMOUNT OF THE SUBSTANCE 11. WITHDRAWAL, AS MANIFESTED BY EITHER OF THE FOLLOWING: (DEP) THE CHARACTERISTIC WITHDRAWAL SYNDROME FOR THE SUBSTANCE THE SUBSTANCE IS TAKEN TO RELIEVE OR AVOID WITHDRAWAL SYMPTOMS 12/26/ /26/

18 DIAGNOSIS IS BASED ON A PATHOLOGICAL PATTERN OF BEHAVIORS RELATED TO THE USE OF A SUBSTANCE. RECURRENT SUBSTANCE-RELATED LEGAL PROBLEMS (ABUSE) (e.g., arrests for substance related disorderly conduct) CRITERIA 1-4 IS ASSOCIATED WITH: IMPAIRED CONTROL CRITERIA 5-7 IS ASSOCIATED WITH: SOCIAL IMPAIRMENT CRITERIA 8-9 IS ASSOCIATED WITH: RISKY USE CRITERIA IS ASSOCIATED WITH: PHARMACOLOGICAL ISSUES 12/26/ /26/ Specify if: In early remission: After full criteria for use disorder were previously met, none of the criteria for the use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, Craving, or a strong desire or urge to use (alcohol), may be met). In sustained remission: After full criteria for use disorder were previously met, none of the criteria for alcohol use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, Craving, or a strong desire or urge to use (alcohol), may be met). Specify if: In a controlled environment: This additional specifier is used if the individual is in an environment where access to the substance is restricted. 12/26/ /26/

19 Specify if: On maintenance therapy: This additional specifier is used if the individual is taking a prescribed agonist medication. The following Remission specifiers have been eliminated: Early Full Remission Early Partial Remission Sustained Full Remission Sustained Partial Remission 12/26/ /26/ Polysubstance Dependence is no longer a diagnosis in the DSM 5. With or Without Physiological Dependence is no longer a specifier. The DSM 5 has moved to a non-axial documentation of diagnosis (formerly Axis I, II, and III) with separate notations for important psychosocial and contextual factors (formerly Axis IV) and disability (Axis V). 12/26/ /26/

20 NOT OTHERWISE SPECIFIED HAS CHANGED TO: UNSPECIFIED OR OTHER SPECIFIED Alcohol Use Disorder Alcohol Intoxication Alcohol Withdrawal Other Alcohol Induced Disorders Unspecified Alcohol Related Disorders 12/26/ /26/ Specify current severity: (F10.10) Mild: Presence of 2-3 symptoms (F10.20) Moderate: Presence of 4-5 symptoms Specify if: In early remission In sustained remission In a controlled environment (F10.20) Severe: Presence of 6 or more symptoms 12/26/ /26/

21 Caffeine Intoxication Caffeine Withdrawal Other caffeine-induced disorders Unspecified Caffeine Related Disorder Cannabis Use Disorder Cannabis Intoxication Cannabis Withdrawal Other Cannabis-Induced Disorders Unspecified Cannabis-Related Disorder ** Note There is no dependence diagnosis for Caffeine 12/26/ /26/ Specify current severity: Specify if: (F12.10) Mild: Presence of 2-3 symptoms (F10.20) Moderate: Presence of 4-5 symptoms In early remission In sustained remission In a controlled environment (F10.20) Severe: Presence of 6 or more symptoms 12/26/ /26/

22 Phencyclidine Use Disorder (PCP) Other Hallucinogen Disorder Phencyclidine Intoxication Other Hallucinogen Intoxication Hallucinogen Persisting Perception Disorder Other Hallucinogen-Related Disorders Unspecified Phencyclidine-Related Disorder Unspecified Hallucinogen-Related Disorder 12/26/ /26/ Inhalant Use Disorder Inhalant Intoxication Inhalant-Induced Disorders Unspecified Inhalant-Related Disorder **Specify the particular inhalant: When possible, the particular substance should be named (e.g., solvent use disorder ) Specify current severity: (F16.10) Mild: Presence of 2-3 symptoms (F16.20) Moderate: Presence of 4-5 symptoms (F10.20) Severe: Presence of 6 or more symptoms 12/26/ /26/

23 Specify if: In early remission In sustained remission In a controlled environment Specify current severity: (F16.10) Mild: Presence of 2-3 symptoms (F16.20) Moderate: Presence of 4-5 symptoms (F10.20) Severe: Presence of 6 or more symptoms 12/26/ /26/ Opioid Use Disorder Specify if: In early remission In sustained remission In a controlled environment Opioid Intoxication Opioid Withdrawal Other Opioid-Induced Disorders Unspecified Opioid-Related Disorder ** Specify if On Maintenance Therapy if a prescribed agonist medication (methadone/buprenorphine) 12/26/ /26/

24 Specify current severity: SPECIFIC TO THIS DISORDER: 1. CRITERION #10 (TOLERANCE) IS NOT CONSIDERED TO BE MET FOR THOSE TAKING OPIOIDS SOLELY UNDER APPROPRIATE MEDICAL SUPERVISION. 2. CRITERION #11 (WITHDRAWAL) IS NOT CONSIDERED TO BE MET FOR THOSE TAKING OPIOIDS SOLELY UNDER APPROPRIATE MEDICAL SUPERVISION (F11.10) Mild: Presence of 2-3 symptoms (F11.20) Moderate: Presence of 4-5 symptoms (F11.20) Severe: Presence of 6 or more symptoms 12/26/ /26/ Specify if: In early remission In sustained remission On maintenance therapy Sedative, Hypnotic, or Anxiolytic Disorder*** Sedative, Hypnotic, or Anxiolytic Intoxication *** Sedative, Hypnotic, and Anxiolytic s are drugs that work on the central nervous system to treat anxiety and insomnia. The main classes of these drugs are benzodiazepines and barbiturates. 12/26/ /26/

25 Sedative, Hypnotic, or Anxiolytic Withdrawal Other Sedative, Hypnotic, or Anxiolytic Disorders Unspecified Sedative, Hypnotic, or Anxiolytic Disorder SPECIFIC TO THIS DISORDER: 1. CRITERION #10 (TOLERANCE) IS NOT CONSIDERED TO BE MET FOR THOSE TAKING SEDATIVE-HYPNOTIC OR ANXIOLYTIC SOLELY UNDER APPROPRIATE MEDICAL SUPERVISION. 2. CRITERION #11 (WITHDRAWAL) IS NOT CONSIDERED TO BE MET FOR THOSE TAKING SEDATIVE-HYPNOTIC OR ANXIOLYTIC SOLELY UNDER APPROPRIATE MEDICAL SUPERVISION. 12/26/ /26/ Specify current severity: (F13.10) Mild: Presence of 2-3 symptoms (F13.20) Moderate: Presence of 4-5 symptoms Specify if: In early remission In sustained remission In a controlled environment (F13.20) Severe: Presence of 6 or more symptoms 12/26/ /26/

26 Stimulant Use Disorder Amphetamine-type substance Cocaine Other or unspecified stimulant Stimulant Intoxication Specify the intoxicant -- Amphetamine or Cocaine Stimulant Withdrawal Specify the substance -- Amphetamine or Other Stimulant Cocaine Other Stimulant-Induced Disorders Unspecified Stimulant-Related Disorder Amphetamine or Other Stimulant Cocaine 12/26/ /26/ SPECIFIC TO THIS DISORDER: 1. CRITERION #10 (TOLERANCE) IS NOT CONSIDERED TO BE MET FOR THOSE TAKING STIMULANT MEDICATION SOLELY UNDER APPROPRIATE MEDICAL SUPERVISION. (MEDICATIONS FOR ATTENTION- DEFICIT OR HYPERACTIVITY DISORDER OR NARCOLEPSY) 2. CRITERION #11 (WITHDRAWAL) IS NOT CONSIDERED TO BE MET FOR THOSE TAKING STIMULANT MEDICATION SOLELY UNDER APPROPRIATE MEDICAL SUPERVISION. (MEDICATIONS FOR ATTENTION- DEFICIT OR HYPERACTIVITY DISORDER OR NARCOLEPSY) Mild: Presence of 2-3 symptoms (F15.10) Amphetamine-type substance (F14.10) Cocaine (F1510) Other or unspecified stimulant 12/26/ /26/

27 Moderate: Presence of 4-5 symptoms Severe: Presence of 6 or symptoms (F15.10) Amphetamine-type substance (F14.10) Cocaine (F1510) Other or unspecified stimulant (F15.20) Amphetamine-type substance (F14.20) Cocaine (F1510) Other or unspecified stimulant 12/26/ /26/ Specify if: In early remission In sustained remission In a controlled environment Tobacco Use Disorders Tobacco Withdrawal Other Tobacco-Induced Disorders Unspecified Tobacco-Related Disorder 12/26/ /26/

28 Specify current severity: 305.1(Z72.0) Mild: Presence of 2-3 symptoms 305.1(F17.200) Moderate: Presence of 4-5 symptoms Specify if: In early remission In sustained remission On maintenance therapy** In a controlled environment 305.1(F17.200) Severe: Presence of 6 or more symptoms 12/26/ /26/ **Specify if: On Maintenance Therapy if the individual is taking a long-term maintenance medication and no criteria for tobacco use disorder have been met for that class of medication (except tolerance to, or withdrawal from the nicotine replacement medication). Other (or unknown) Substance Use Disorders Other (or unknown) Substance Intoxication Other (or unknown) Substance Withdrawal 12/26/ /26/

29 Other (or unknown) Substance-Induced Disorders Unspecified Other (or unknown) Substance-Related Disorder A PROBLEMATIC PATTERN OF USE OF AN INTOXICATING SUBSTANCE NOT ABLE TO BE CLASSIFIED WITHIN THE ALCOHOL, CAFFEINE, CANNABIS, HALLUCINOGEN (PHENCYCLIDINE AND OTHERS), INHALANT, OPIOID, SEDATIVE, HYPNOTIC, OR ANXIOLYTIC, STIMULANT, OR TOBACCO CATEGORIES AND LEADING TO CLINICALLY SIGNIFICANT IMPAIRMENT OR DISTRESS, AS MANIFESTED BY AT LEAST TWO OF THE SUBSTANCE USE CRITERIA. 12/26/ /26/ Gambling Disorder Gambling disorder is associated with poor general health. In addition, some specific medical diagnoses, such as tachycardia and angina, are more common among individuals with gambling disorder than the general population, even when other substance use disorders, including tobacco use disorder, are controlled for. Individuals with gambling disorder have high rates of comorbidity with other mental disorders, such as substance use disorders, depressive disorders, anxiety disorders, and personality disorders. In some individuals, other mental disorders may precede gambling disorder and be either absent or present during the manifestation of gambling disorder. Gambling disorder may also occur prior to the onset of other mental disorders, especially anxiety disorders and substance use disorders. 12/26/ /26/

30 DIAGNOSTIC CRITERIA A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12 month period: 1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement. 2. Is restless or irritable when attempting to cut down or stop gambling. 3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling. 4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of was to get money with which to gamble. 5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). 6. After losing money gambling, often returns another day to get even ( chasing one s losses). 7. Lies to conceal the extent of involvement with gambling. 8. Has jeopardized or lost a significant relationship, job or educational or career opportunity because of gambling. 9. Relies on others to provide money to relieve desperate financial situation caused by gambling. 12/26/ /26/ B. The gambling behavior is not better explained by a manic episode (F63.0) Specify current severity: Mild: 4-5 criteria met Moderate: 6-7 criteria met Severe: 8-9 criteria met 12/26/ /26/

31 Specify if: Episodic: Meeting diagnostic criteria at more than on time point, with symptoms subsiding between periods of gambling disorder for at least several months. Persistent: Experiencing continuous symptoms, to meet diagnostic criteria for multiple years. Specify if: In early remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met for at least 3 months but for less than 12 months. In sustained remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been during a period of 12 months or longer. 12/26/ /26/ Letting go of the familiar can open the door to new experiences, knowledge, and in some cases power. Glossary of Technical Terms 817 Glossary of Cultural Concepts of Distress 833 Alphabetical Listing of DSM-5 Diagnoses and Codes (ICD-9-CM and ICD-10-CM) 839 ICD-9-CM codes are to be used for coding purposes in the US through 9/30/14. ICD-10-CM codes are to be used starting 10/1/14 12/26/ /26/

32 Numerical listing of DSM-5 Diagnosis and Codes (ICD-9-CM) 863/ix Index 917/277 Achenbach, T.M. (1995). Developmental issues in assessment, taxonomy, and diagnosis of child and adolescent psychopathology. In Cicchetti, D. & Cohen, D.J. (Eds.), Developmental Psychopathology, Vol. 2: Risk, disorder, and adaptation, (pp.57-80). New York: Wiley and Sons. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed, Text Revision.). Washington: Author. Blashfield, R.K. (1998). Diagnostic models and systems. In A.S. Bellack, M. Herson, & Reynolds, C.R. (Eds.), Clinical Psychology: Assessment, Vol. 4, ( pp ). New York: Elsevier Science. Brendel, D. H. (2001). Multifactorial causation of mental disorders: A proposal to improve the DSM. Harvard Review of Psychiatry, 9, /26/ /26/ Colorado Department of Public Health and Environment. (2001, March). New International Classification of Diseases (ICD-10): The history and impact. Brief Health Statistics, 41. Retrieved April 4, 2004, from Emil Kraepelin. (n.d.) Retrieved April 4, 2004, from Frances, A.J., & Egger, H.L. (1999). Whither psychiatric diagnosis. Australian and New Zealand Journal of Psychiatry, 33, Frances, A.J., Mack, A.H., Ross, R., & First, M.B. (2000). The DSM-IV classification and psychopharmacology. Neuropsychology: The fifth generation of progress. Retreived April 3, 2004, from Fulford, K.W.M., Vile, J.M., & Beer, D. (n.d.) The ethical, legal, and social problems arising from changes in psychiatric classification as a result of the new technologies in brain research. Retrieved April 21, 2004, from Kirk, S.A., & Kutchins, H. (1994). The myth of the reliability of DSM [Electronic version]. Journal of Mind and Behavior, 15, Scotti, J.R., & Morris, T.L. (2000). Diagnosis and classification. In Hersen, M., & Ammerman, R.T. (Eds.), Advanced Abnormal Child Psychology, (pp.15-32). Mahwah, NJ: Erlbaum. The Kraepelinian system of classification is invalid and should be abandoned. (n.d.) Retrieved April 3, 2004 from Thomas, R.K. Lecture notes, January 22, Galen's theory of personality types. The overemphasis on biomedical diagnosis in psychiatry. (n.d.) Retrieved April 4, 2004, from Untitled PowerPoint presentation. (n.d.) Retrieved April 4, 2004, from 12/26/ /26/