DSM-S criteria for PTSD differ significantly from the DSM-IV criteria. The stressor cri- terion (Criterion A) is more explicit with regard to events that qualify as ”traumatic” ex- periences. Also, DSM-IV Criterion A2 (subjective reaction) has been eliminated. Whereas there were three major symptom clusters in DSM-IV—reexperiencing, avoidance/numb- ing, and arousal—there are now four symptom clusters in DSM-5, because the avoidance/ numbing cluster is divided into two distinct clusters: avoidance and persistent negative al- terations in cognitions and mood. This latter category, which retains most of the DSM-IV numbing symptoms, also includes new or reconceptualized symptoms, such as persistent negative emotional states. The final cluster—alterations in arousal and reactivity—retains most of the DSM-IV arousal symptoms. It also includes irritable behavior or angry out- bursts and reckless or self—destructive behavior. PTSD is now developmentally sensitive in that diagnostic thresholds have been lowered for children and adolescents. Furthermore, separate criteria have been added for children age 6 years or younger with this disorder.
The DSM-IV childhood diagnosis reactive attachment disorder had two subtypes: emotionally withdrawn/ inhibited and indiscriminately social/disinhibited. In DSM-S, these subtypes are defined as distinct disorders: reactive attachment disorder and disin- hibited social engagement disorder.
Major changes in dissociative disorders in DSM-S include the following: 1) derealization is included in the name and symptom structure of what previously was called depersonali- zation disorder (depersonalization/derealization disorder); 2) dissociative fugue is now a specifier of dissociative amnesia rather than a separate diagnosis, and 3) the criteria for dissociative identity disorder have been changed to indicate that symptoms of disruption of identity may be reported as well as observed, and that gaps in the recall of events may occur for everyday and not just traumatic events. Also, experiences of pathological pos- session in some cultures are included in the description of identity disruption.
In DSM-5, somatoform disorders are now referred to as somatic symptom and related dis- orders. The DSM-S classification reduces the number of these disorders and subcategories to avoid problematic overlap. Diagnoses of somatization disorder, hypochondriasis, pain dis- order, and undifferentiated somatoform disorder have been removed. Individuals previ-
Highlights of Changes From DSM-IV to DSM—5 813 ously diagnosed with somatization disorder will usually have symptoms that meet DSM-5 criteria for somatic symptom disorder, but only if they have the maladaptive thoughts, feel- ings, and behaviors that define the disorder, in addition to their somatic symptoms. Because the distinction between somatization disorder and undifferentiated somatoform disorder was arbitrary, they are merged in DSM—S under somatic symptom disorder. Individuals pre- viously diagnosed with hypochondriasis who have high health anxiety but no somatic symp- toms would receive a DSM-S diagnosis of illness anxiety disorder (unless their health anxiety was better explained by a primary anxiety disorder, such as generalized anxiety dis- order). Some individuals with chronic pain would be appropriately diagnosed as having so- matic symptom disorder, with predominant pain. For others, psychological factors affecting other medical conditions or an adjustment disorder would be more appropriate.
Psychological factors affecting other medical conditions is a new mental disorder in
DSM-5, having formerly been listed in the DSM-IV chapter ”Other Conditions That May