Be a Focus of Clinical Attention.” This disorder and factitious disorder are placed among the somatic symptom and related disorders because somatic symptoms are predominant in both disorders, and both are most often encountered in medical settings. The variants of psychological factors affecting other medical conditions are removed in favor of the stern diagnosis. Criteria for conversion disorder (functional neurological symptom disorder) have been modified to emphasize the essential importance of the neurological examina- tion, and in recognition that relevant psychological factors may not be demonstrable at the time of diagnosis. Other specified somatic symptom disorder, other specified illness anx- iety disorder, and pseudocyesis are now the only exemplars of the other specified somatic symptom and related disorder classification.
Because of the elimination of the DSM-IV-TR chapter ”Disorders Usually First Diagnosed
During Infancy, Childhood, or Adolescence,” this chapter describes several disorders found in the DSM-IV section ”Feeding and Eating Disorders of Infancy or Early Childhood,” such as pica and rumination disorder. The DSM-IV category feeding disorder of infancy or early childhood has been renamed avoidant/restrictive food intake disorder, and the criteria are significantly expanded. The core diagnostic criteria for anorexia nervosa are conceptually un- changed from DSM-IV with one exception: the requirement for amenorrhea is eliminated. As in DSM—IV, individuals with this disorder are required by Criterion A to be at a significantly low body weight for their developmental stage. The wording of the criterion is changed for clarification, and guidance regarding how to judge whether an individual is at or below a sig- nificantly low weight is provided in the text. In DSM-S, Criterion B is expanded to include not only overtly expressed fear of weight gain but also persistent behavior that interferes with weight gain. The only change in the DSM-IV criteria for bulimia nervosa is a reduction in the required minimum average frequency of binge eating and inappropriate compensatory be- havior frequency from twice to once weekly. The extensive research that followed the prom- ulgation of preliminary criteria for binge-eating disorder in Appendix B of DSM-IV documented the clinical utility and validity of binge—eating disorder. The only significant dif- ference from the preliminary criteria is that the minimum average frequency of binge eating re- quired for diagnosis is once weekly over the last 3 months, identical to the frequency criterion for bulimia nervosa (rather than at least 2 days a week for 6 months in DSM-IV).
There have been no significant changes in this diagnostic class from DSM-IV to DSM-S.
The disorders in this chapter were previously classified under disorders usually first di- agnosed in infancy, childhood, or adolescence in DSM-IV and exist now as an independent classification in DSM-S.
814 Highlights of Changes From DSM-IV to DSM-5
In DSM-5, the DSM-IV diagnoses named sleep disorder related to another mental disorder and sleep disorder related to another medical condition have been removed, and instead greater specification of coexisting conditions is provided for each sleep-wake disorder. The diagnosis of primary insomnia has been renamed insomnia disorder to avoid the differen- tiation between primary and secondary insomnia. DSM-S also distinguishes narcolepsy— now known to be associated with hypocretin deficiency—from other forms of hypersomno- lence (hypersomnolence disorder). Finally, throughout the DSM-S classification of sleep- wake disorders, pediatric and developmental criteria and text are integrated where existing science and considerations of clinical utility support such integration. Breathing-related sleep disorders are divided into three relatively distinct disorders: obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation. The subtypes of circadian rhythm sleep disorders are expanded to include advanced sleep phase type and irregular sleep-wake type, whereas the jet lag type has been removed. The use of the former “not oth- ment sleep behavior disorder and restless legs syndrome to independent disorders.