Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Wednesday, May 8, 2013

The Other Winner

I haven't forgotten my promise to review the winners in my survey. Survey takers, god bless you, voted for chapter rearrangement as the change in DSM-5 that would do the most good. You can link to the full Table of Contents from here (sorry it's indirect).

Looking over the chapters there's really a lot to cover, especially if I'm trying to compare with DSM-4. So I thought I'd start with just the first clinical section in each.

DSM-5 begins with the general heading, Neurodevelopmental Disorders, and this section is broken down into subsections (which are further broken down). They are:

  • Intellectual Disabilities
  • Communication Disorders
  • Autism Spectrum Disorder
  • ADHD
  • Specific Learning Disorder
  • Motor Disorders
  • Other 

The corresponding section of DSM-4 is called, Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence with these sections:

  • Mental Retardation
  • Learning Disorders
  • Motor Skills Disorder
  • Communication Disorders
  • PDD
  • ADHD
  • Feeding and Eating Disorders of Infancy or Early Childhood
  • Tic Disorders
  • Elimination Disorders
  • Other

I'm not sure which I prefer. In DSM-5, Tic Disorders are included under Motor Disorders, rather than having their own section as in DSM-4. Learning Disorders are broken down into specific disorders in DSM-4, while in DSM-5 they're not. And, of course, DSM-4 includes multiple Pervasive Developmental Disorders, where DSM-5 groups all under the heading of Autism Spectrum.

In addition, DSM-5 puts all feeding and eating disorders, regardless of developmental stage, into their own section, entitled, unsurprisingly, "Feeding and Eating Disorders", and this section occurs much later in the book. It's immediately followed by the Elimination Disorders section, which removes the implication of these as childhood disorders.

So it's looking like DSM-5 does more lumping, where DSM-4 did more splitting. But that's not entirely consistent.

And you have to admit, there's a nice logic to following the Eating chapter with the Elimination chapter.

One thing I do like about the chapter organization in DSM-5 is that, unlike DSM-4, Neurodevelopmental disorders, which are basically childhood disorders, are not followed immediately by delirium and dementia, disorders of old age.

I'll cover more in future posts because it's getting past my bedtime.

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