The Conceptual Evolution of DSM-5

by Regier, Darrel A., M.D.

• ISBN13: 9781585623884
• ISBN10: 1585623881
• Edition: 1st
• Format: Paperback
• Copyright: 2010-11-01
• Publisher: AMERICAN PSYCHIATRIC PUBLISHING INC

Summary

There is a need to refine our current psychiatric nosology to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience while at the same time enhance clinical utility. Furthermore, dimensional aspects of psychiatric disorders require greater recognition so as to improve our understanding of boundaries between disorders and underscore the heterogeneous nature of psychopathology. The Conceptual Evolution of DSM-5provides a framework for the evolution of the forthcoming diagnostic system in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which will help advance clinical practice and facilitate ongoing development of diagnostic criteria. This manual: • Highlights recent progress in our understanding of cross-cutting factors relevant to psychiatric diagnosis and symptom presentation• Includes detailed discussions on the role of factors such as age, gender, culture, and disability in the expression of mental disorders• Provides a review of genetic evidence supporting a cross-cutting approach to nosology• Offers suggestions for integrating cross-cutting factors with DSM-5.The Conceptual Evolution of DSM-5was written to impart a theoretical context for understanding potential revisions to DSM-5. The authors reevaluate the structure of the current manual and discuss cross-cutting approaches to facilitate clinical practice and refine research approaches that will guide clinical trials, genetics, imaging, and treatment guidelines. The authors provide the following insights: • Detailed descriptions of age-, gender-, and culture-specific aspects relevant to psychiatric diagnosis and the need for sensitivity to these factors when making diagnoses• Discussions on the dimensional aspects of mental disorders, including overlapping symptoms relevant to many or most diagnoses• Consideration of alternative classifications of disorders that recognize disorders sharing validating features• Presentation of neuroscientific and epidemiologic evidence to expand understanding of disorders beyond that of the categorical organization presented in DSM-IV• A review of clinical implications, including how clinicians may shift their conceptualization of previously reified diagnostic criteria and their consequences.As presented to the 99th Annual Meeting of the American Psychopathological Association, The Conceptual Evolution of DSM-5explores the rapidly changing research base for the understanding of neurodevelopmental, neurocognitive, addictive, and other psychiatric disorders. The contributions in this volume confirm that DSM-5 is intended to be a living document that can accommodate revisions to specific diagnostic areas based on new evidence that is replicable and subject to review. This efficient updating process will help researchers and clinicians keep abreast of the latest protocols for the research, diagnosis, and treatment of mental illness.

Author Biography

Darrel A. Regier, M.D., M.P.H., is Executive Director of the American Psychiatric Institute for Research and Education and Di-¼rector of the Division of Research at the American Psychiatric Association in Arlington, Virginia, and Vice-Chair of the DSM-5 Task Force.

William E. Narrow, M.D., M.P.H., is Associate Director of the Division of Research at the American Psychiatric Association and the American Psychiatric Institute for Research and Education in Arlington, Virginia, and Research Director of the DSM-5 Task Force.

Emily A. Kuhl, Ph.D., is a science writer in the Division of Research at the American Psychiatric Association in Arlington, Virginia.

David J. Kupfer, M.D., is Thomas Detre Professor in the Department of Psychiatry at the University of Pittsburgh and Western Psychiatric Institute & Clinic in Pittsburgh, Pennsylvania, and Chair of the DSM-5 Task Force.

Table of Contents

Contributors	p. xi
Introduction	p. xxi
Diagnostic Spectra: Assessing the Validity of Disorder Groupings
Diagnosis of Mental Disorders in Light of Modern Genetics	p. 3
Integration of Dimensional Spectra for Depression and Anxiety Into Categorical Diagnoses for General Medical Practice	p. 19
One Way Forward for Psychiatric Nomenclature: The Example of the Spectrum Project Approach	p. 37
Meta Effects of Classifying Mental Disorders	p. 59
Integrating Dimensional Concepts Into a Categorical System
A Proposal for Incorporating Clinically Relevant Dimensions Into DSM-5	p. 81
Empirically Derived Personality Disorder Prototypes: Bridging Dimensions and Categories in DSM-5	p. 97
Options and Dilemmas of Dimensional Measures for DSM-5: Which Types of Measures Fare Best in Predicting Course and Outcome?	p. 119
Assessing Functional Impairment for Clinical Significance and Disability
Clinical Significance and Disorder Thresholds in DSM-5: The Role of Disability and Distress	p. 147
Assessing Activity Limitations and Disability Among Adults	p. 163
Measuring Disability Across Physical, Mental, and Cognitive Disorders	p. 189
Identifying Important Culture- and Gender-Related Expressions of Disorders
Assessing Mental Disorders and Service Use Across Countries: The Who World Mental Health Survey Initiative	p. 231
The Intersection of Race, Ethnicity, Immigration, and Cultural Influences on the Nature and Distribution of Mental Disorders: An Examination of Major Depression	p. 267
Gender and Gender-Related Issues in DSM-5	p. 287
Incorporating Developmental Variations of Disorder Expression Across the Lifespan
Increasing the Developmental Focus in DSM-5: Broad Issues and Specific Potential Applications in Anxiety	p. 305
Diagnostic Issues Relating to Lifespan From Adulthood Into Later Life	p. 323
Index	p. 343
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