The criteria for oppositional defiant disorder are now grouped into three types: an- gry/irritable mood, argumentative/defiant behavior, and vindictiveness. Additionally, the exclusionary criterion for conduct disorder has been removed. The criteria for conduct the disorder but also present with limited prosocial emotions. The primary change in in- termittent explosive disorder is in the type of aggressive outbursts that should be consid- ered: DSM-IV required physical aggression, whereas in DSM-5 verbal aggression and nondestructive/noninjurious physical aggression also meet criteria. DSM-S also provides more specific criteria defining frequency needed to meet the criteria and specifies that the aggressive outbursts are impulsive and / or anger based in nature, and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences. Furthermore, a minimum age of 6 years (or equivalent developmental level) is now required.
An important departure from past diagnostic manuals is that the chapter on substance—related disorders has been expanded to include gambling disorder. Another key change is that
DSM-S does not separate the diagnoses of substance abuse and dependence as in DSM-IV. Rather criteria are provided for substance use disorder, accompanied by criteria for intoxication, withdrawal, substance-induced disorders, and unspecified substance-related disorders, where relevant. Within substance use disorders, the DSM-IV recurrent substance-related legal problems criterion has been deleted from DSM-S, and a new criterion—craving, or a strong de- sire or urge to use a substance—has been added. In addition, the threshold for substance use disorder diagnosis in DSM—S is set at two or more criteria, in contrast to a threshold of one or more criteria for a diagnosis of DSM—IV substance abuse and three or more for DSM-IV depen- dence. Cannabis withdrawal and caffeine withdrawal are new disorders (the latter was in
DSM-IV Appendix B, ”Criteria Sets and Axes Provided for Further Study").
Severity of the DSM-S substance use disorders is based on the number of criteria en- dorsed. The DSM-IV specifier for a physiological subtype is eliminated in DSM-S, as is the
DSM-IV diagnosis of polysubstance dependence. Early remission from a DSM-S substance use disorder is defined as at least 3 but less than 12 months without meeting substance use disorder criteria (except craving), and sustained remission is defined as at least 12 months without meeting criteria (except craving). Additional new DSM-S specifiers include ”in a controlled environment” and ”on maintenance therapy” as the situation warrants.
816 Highlights of Changes From DSM-IV to DSM-5
The DSM-IV diagnoses of dementia and amnestic disorder are subsumed under the newly named entity maj or neurocognitive disorder (NCD). The term dementia is not precluded from use in the etiological subtypes where that term is standard. Furthermore, DSM-S now recog- nizes a less severe level of cognitive impairment, mild NCD, which is a new disorder that per- mits the diagnosis of less disabling syndromes that may nonetheless be the focus of concern and treatment. Diagnostic criteria are provided for both of these disorders, followed by diag- nostic criteria for different etiological subtypes. In DSM-IV, individual diagnoses were desig- nated for dementia of the Alzheimer’s type, vascular dementia, and substance-induced dementia, whereas the other neurodegenerative disorders were classified as dementia due to another medical condition, with HIV, head trauma, Parkinson’s disease, Huntington’s disease,
Pick’s disease, Creutzfeldt-Jakob disease, and other medical conditions specified. In DSM-S, major or mild NCD due to Alzheimer's disease and major or mild vascular NCD have been re— tained, while new separate criteria are now presented for major or mild frontotemporal NCD,