Panic attacks can now be listed as a specifier that is applicable to all DSM-5 disorders. Panic disorder and agoraphobia are unlinked in DSM-S. Thus, the former DSM-IV diagnoses of panic disorder with agoraphobia, panic disorder without agoraphobia, and agoraphobia without history of panic disorder are now replaced by two diagnoses, panic disorder and ag- oraphobia, each with separate criteria. The ”generalized" specifier for social anxiety disor- der has been deleted and replaced with a ”performance only” specifier. Separation anxiety disorder and selective mutism are now classified as anxiety disorders. The wording of the criteria is modified to more adequately represent the expression of separation anxiety symp- toms in adulthood. Also, in contrast to DSM-IV, the diagnostic criteria no longer specify that onset must be before age 18 years, and a duration statement—"typically lasting for 6 months or more”—has been added for adults to minimize overdiagnosis of transient fears.
The chapter ”Obsessive-Compulsive and Related Disorders" is new in DSM-S. New disor- ders include hoarding disorder, excoriation (skin-picking) disorder, substance/medica- tion-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition. The DSM-IV diagnosis of trichotillo- mania is now termed trichotillomania (hair-pulling disorder) and has been moved from a
DSM—IV classification of impulse—control disorders not elsewhere classified to obsessive- compulsive and related disorders in DSM-5. The DSM-IV ”with poor insight” specifier for obsessive-compulsive disorder has been refined to allow a distinction between individuals with good or fair insight, poor insight, and "absent insight/delusional” obsessive-compul- sive disorder beliefs (i.e., complete conviction that obsessive-compulsive disorder beliefs are true). Analogous "insight” specifiers have been included for body dysmorphic disorder and hoarding disorder. A "tic-related" specifier for obsessive-compulsive disorder has also been added, because presence of a comorbid tic disorder may have important clinical im- plications. A ”muscle dysmorphia” specifier for body dysmorphic disorder is added to re- flect a growing literature on the diagnostic validity and clinical utility of making this 812 Highlights of Changes From DSM-IV to DSM-5 distinction in individuals with body dysmorphic disorder. The delusional variant of body dysmorphic disorder (which identifies individuals who are completely convinced that their perceived defects or ﬂaws are truly abnormal appearing) is no longer coded as both delu- sional disorder, somatic type, and body dysmorphic disorder; in DSM-S, this presentation is designated only as body dysmorphic disorder with the absent insight/ delusional specifier.
Individuals can also be diagnosed with other specified obsessive-compulsive and related disorder, which can include conditions such as body-focused repetitive behavior disorder and obsessional jealousy, or unspecified obsessive-compulsive and related disorder.
For a diagnosis of acute stress disorder, qualifying traumatic events are now explicit as to whether they were experienced directly, witnessed, or experienced indirectly. Also, the
DSM-IV Criterion A2 regarding the subjective reaction to the traumatic event (e.g., expe- riencing ”fear, helplessness, or horror”) has been eliminated. Adjustment disorders are reconceptualized as a heterogeneous array of stress-response syndromes that occur after exposure to a distressing (traumatic or nontraumatic) event, rather than as a residual cat- not meet criteria for a more discrete disorder (as in DSM-IV).