Although DSM-S remains a categorical classification of separate disorders, we recog— nize that mental disorders do not always fit completely within the boundaries of a single disorder. Some symptom domains, such as depression and anxiety, involve multiple di- of disorders. In recognition of this reality, the disorders included in DSM-S were reordered into a revised organizational structure meant to stimulate new clinical perspectives. This new structure corresponds with the organizational arrangement of disorders planned for
ICD-11 scheduled for release in 2015. Other enhancements have been introduced to pro- mote ease of use across all settings: 0 Representation of developmental issues related to diagnosis. The change in chapter organization better reﬂects a lifespan approach, with disorders more frequently diag- nosed in childhood (e.g., neurodevelopmental disorders) at the beginning of the man- ual and disorders more applicable to older adulthood (e.g., neurocognitive disorders) at the end of the manual. Also, within the text, subheadings on development and course provide descriptions of how disorder presentations may change across the lifespan.
Age-related factors specific to diagnosis (e.g., symptom presentation and prevalence differences in certain age groups) are also included in the text. For added emphasis, these age-related factors have been added to the criteria themselves where applicable (e.g., in the criteria sets for insomnia disorder and posttraumatic stress disorder, spe- cific criteria describe how symptoms might be expressed in children). Likewise, gender and cultural issues have been integrated into the disorders where applicable.
0 Integration of scientific findings from the latest research in genetics and neuroimag- ing. The revised chapter structure was informed by recent research in neuroscience and by emerging genetic linkages between diagnostic groups. Genetic and physiological risk factors, prognostic indicators, and some putative diagnostic markers are high- lighted in the text. This new structure should improve clinicians’ ability to identify di- agnoses in a disorder spectrum based on common neurocircuitry, genetic vulnerability, and environmental exposures.
0 Consolidation of autistic disorder, Asperger’s disorder, and pervasive developmen- tal disorder into autism spectrum disorder. Symptoms of these disorders represent a single continuum of mild to severe impairments in the two domains of social commu- ders. This change is designed to improve the sensitivity and specificity of the criteria for the diagnosis of autism spectrum disorder and to identify more focused treatment tar- gets for the specific impairments identified.
' Streamlined classification of bipolar and depressive disorders. Bipolar and depres— sive disorders are the most commonly diagnosed conditions in psychiatry. It was there- fore important to streamline the presentation of these disorders to enhance both clinical and educational use. Rather than separating the definition of manic, hypomanic, and major depressive episodes from the definition of bipolar I disorder, bipolar II disorder, and major depressive disorder as in the previous edition, we included all of the com- ponent criteria within the respective criteria for each disorder. This approach will facil- itate bedside diagnosis and treatment of these important disorders. Likewise, the provide far greater clinical guidance than was previously provided in the simple be- reavement exclusion criterion. The new specifiers of anxious distress and mixed fea- tures are now fully described in the narrative on specifier variations that accompanies the criteria for these disorders.
' Restructuring of substance use disorders for consistency and clarity. The categories an overarching new category of substance use disorders—with the specific substance used defining the specific disorders. "Dependence” has been easily confused with the term ”addiction” when, in fact, the tolerance and withdrawal that previously defined dependence are actually very normal responses to prescribed medications that affect the central nervous system and do not necessarily indicate the presence of an addiction.
By revising and clarifying these criteria in DSM-S, we hope to alleviate some of the widespread misunderstanding about these issues.