I examine each proposal's face validity and conceptual coherence as well as empirical support where relevant, with special attention to potential implications for false-positive diagnoses. To evaluate these concerns, I critically examine five proposed DSM-5 expansions in the scope of depressive and grief disorders: (1) a new mixed anxiety/depression category (2) a new premenstrual dysphoric disorder category (3) elimination of the major depression bereavement exclusion (4) elimination of the adjustment disorder bereavement exclusion, thus allowing the diagnosis of subsyndromal depressive symptoms during bereavement as adjustment disorders and (5) a new category of adjustment disorder related to bereavement for diagnosing pathological non-depressive grief. Such confusion of normal distress and mental disorder undermines the interpretability of clinical trials and etiological research, causes inefficient allocation of resources, and incurs risks of unnecessary treatment. Some nosologists have expressed concern that the proposed changes could yield many 'false-positive diagnoses' in which normal distress is mislabeled as a mental disorder. Proposed changes for DSM-5 include the creation of several new categories of depressive disorder.
Major depressive disorder dsm 5 manual#
The symptoms are not better accounted for by bereavement (i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation).The Diagnostic and Statistical Manual of Mental Disorders (DSM) is currently undergoing a revision that will lead to a fifth edition in 2013.
MDE is not better explained by schizophrenia spectrum or other psychotic disorders. There has never been a manic episode or hypomanic episode. The symptoms do not meet criteria for a mixed episode 3
The symptoms are not due to the direct physiological effects of a substance (e.g., drug abuse, a prescribed medication’s side effects) or a medical condition (e.g., hypothyroidism).
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Five or more of the following A Criteria (at least one includes A1 or A2)Ī1 Depressed mood-indicated by subjective report or observation by others (in children and adolescents, can be irritable mood).Ī2 Loss of interest or pleasure in almost all activities-indicated by subjective report or observation by others.Ī3 Significant (more than 5 percent in a month) unintentional weight loss/gain or decrease/increase in appetite (in children, failure to make expected weight gains).Ī4 Sleep disturbance (insomnia or hypersomnia).Ī5 Psychomotor changes (agitation or retardation) severe enough to be observable by others.Ī6 Tiredness, fatigue, or low energy, or decreased efficiency with which routine tasks are completed.Ī7 A sense of worthlessness or excessive, inappropriate, or delusional guilt (not merely self-reproach or guilt about being sick).Ī8 Impaired ability to think, concentrate, or make decisions-indicated by subjective report or observation by others.Ī9 Recurrent thoughts of death (not just fear of dying), suicidal ideation, or suicide attempts.
0 kommentar(er)
