activity or energy. The DSM-IV diagnosis of bipolar I disorder, mixed episodes—requiring that the individual simultaneously meet full criteria for both mania and major depressive ep- isode—is replaced with a new specifier "with mixed features.“ Particular conditions can now be diagnosed under other specified bipolar and related disorder, including categori- zation for individuals with a past history of a major depressive disorder whose symptoms meet all criteria for hypomania except the duration criterion is not met (i.e., the episode lasts only 2 or 3 days instead of the required 4 consecutive days or more). A second condition con- stituting an other specified bipolar and related disorder variant is that too few symptoms of hypomania are present to meet criteria for the full bipolar II syndrome, although the dura- tion, at least 4 consecutive days, is sufficient. Finally, in both this chapter and in the chapter ”Depressive Disorders,” an anxious distress specifier is delineated.
To address concerns about potential overdiagnosis and overtreatment of bipolar disorder in children, a new diagnosis, disruptive mood dysregulation disorder, is included for children up to age 18 years who exhibit persistent irritability and frequent episodes of extreme behav- ioral dyscontrol. Premenstrual dysphoric disorder is now promoted from Appendix B, ”Cri- teria Sets and Axes Provided for Further Study,” in DSM-IV to the main body of DSM-S. What was referred to as dysthyrnia in DSM-IV now falls under the category of persistent depressive disorder, which includes both chronic major depressive disorder and the previous dysthymic disorder. The coexistence within a major depressive episode of at least three manic symp- toms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier
Highlights of Changes From DSM-IV to DSM-5 811 ”with mixed features." In DSM-IV, there was an exclusion criterion for a major depressive ep- isode that was applied to depressive symptoms lasting less than 2 months following the death of a loved one (i.e., the bereavement exclusion). This exclusion is omitted in DSM—S for several reasons, including the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode in a vulnerable individual, generally beginning soon after the loss, and can add an additional risk for suffering, feelings of worthlessness, suicidal ideation, poorer medical health, and worse interpersonal and work functioning. It was critical to remove the implication that bereavement typically lasts only 2 months, when both physi- cians and grief counselors recognize that the duration is more commonly 1—2 years. A detailed footnote has replaced the more simplistic DSM-IV exclusion to aid clinicians in making the critical distinction between the symptoms characteristic of bereavement and those of a major depressive disorder. Finally, a new specifier to indicate the presence of mixed symptoms has been added across both the bipolar and the depressive disorders.
The chapter on anxiety disorders no longer includes obsessive-compulsive disorder (which is in the new chapter ”Obsessive-Compulsive and Related Disorders”) or posttraumatic stress disorder (PTSD) and acute stress disorder (which are in the new chapter ”Trauma- and Stressor-Related Disorders"). Changes in criteria for specific phobia and social anxiety disorder (social phobia) include deletion of the requirement that individuals over age 18 years recognize that their anxiety is excessive or unreasonable. Instead, the anxiety must be out of proportion to the actual danger or threat in the situation, after cultural contextual fac- tors are taken into account. In addition, the 6-month duration is now extended to all ages.