In DSM-5, some gender-specific sexual dysfunctions have been added, and, for females, sexual desire and arousal disorders have been combined into one disorder: female sexual interestlarousal disorder. All of the sexual dysfunctions (except substance/medication-in- duced sexual dysfunction) now require a minimum duration of approximately 6 months and more precise severity criteria. Genito-pelvic pain/penetration disorder has been added to
DSM-S and represents a merging of vaginismus and dyspareunia, which were highly co- morbid and difficult to distinguish. The diagnosis of sexual aversion disorder has been re- moved due to rare use and lack of supporting research.
There are now only two subtypes for sexual dysfunctions: lifelong versus acquired and generalized versus situational. T0 indicate the presence and degree of medical and other nonmedical correlates, the following associated features have been added to the text: partner factors, relationship factors, individual vulnerability factors, cultural or religious factors, and medical factors.
Gender dysphoria is a new diagnostic class in DSM-S and reﬂects a change in conceptual- ization of the disorder’s defining features by emphasizing the phenomenon of ”gender in- congruence” rather than cross-gender identification per se, as was the case in DSM-IV gender identity disorder. Gender dysphoria includes separate sets of criteria: for children and for adults and adolescents. For the adolescents and adults criteria, the previous Criterion A (cross-gender identification) and Criterion B (aversion toward one’s gender) are merged. In the wording of the criteria, ”the other sex” is replaced by ”the other gender" (or ”some alter- native gender").” Gender instead of sex is used systematically because the concept ”sex” is in- adequate when referring to individuals with a disorder of sex development. In the child criteria, ”strong desire to be of the other gender” replaces the previous ”repeatedly stated de- sire to be...the other sex” to capture the situation of some children who, in a coercive envi- ronment, may not verbalize the desire to be of another gender. For children, Criterion A1 (”a strong desire to be of the other gender or an insistence that he or she is the other gender.. .)” is now necessary (but not sufficient), which makes the diagnosis more restrictive and conser- vative. The subtyping on the basis of sexual orientation is removed because the distinction is no longer considered clinically useful. A posttransition specifier has been added to identify
Highlights of Changes From DSM-IV to DSM-S 815 individuals who have undergone at least one medical procedure or treatment to support the new gender assignment (e.g., cross-sex hormone treatment). Although the concept of post- transition is modeled on the concept of full or partial remission, the term remission has impli- cations in terms of symptom reduction that do not apply directly to gender dysphoria.
Disruptive, Impulse-Control, and Conduct Disorders
The chapter “Disruptive, Impulse—Control, and Conduct Disorders” is new to DSM-S and combines disorders that were previously included in the chapter “Disorders Usually First Di- agnosed in Infancy, Childhood, or Adolescence” (i.e., oppositional defiant disorder; conduct disorder; and disruptive behavior disorder not otherwise specified, now categorized as other specified and unspecified disruptive, impulse—control, and conduct disorders) and the chap- ter ”Impulse—Control Disorders Not Elsewhere Classified” (i.ei, intermittent explosive disor- der, pyromania, and kleptomania). These disorders are all characterized by problems in emotional and behavioral self—control. Notably, ADHD is frequently comorbid with the dis- orders in this chapter but is listed with the neurodevelopmental disorders. Because of its close association with conduct disorder, antisocial personality disorder is listed both in this chapter and in the chapter ”Personality Disorders,” where it is described in detail.