The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has received its first published revision since it was published in 2013. This update is referred to as the DSM-5 Text Revision (DSM-5-TR).
DSM-5-TR mainly focuses on updates to the descriptions of each disorder listed in the manual, including some changes to diagnostic codes. Other revisions include adding diagnostic entities and modifying terminology in diagnostic criteria and definitions.
Many of these changes are minor, intended to remove errors and clear up any confusion in the text. However, some of the revisions may significantly change how behavioral health clinicians practice.
The DSM-5-TR includes two significant additions. One of them is a new diagnosis, and another is the reinstatement of a previously removed diagnosis.
Adding Prolonged Grief Disorder
The revised version of DSM-5 now includes the diagnosis of “prolonged grief disorder” in Section 2 of the chapter on trauma and stressor-related disorders. The original version of DSM-5 had a category of “persistent complex bereavement disorder” for further study. The category was later approved for inclusion in the main text.
Characterizations of prolonged grief disorder include:
- Intense yearning for a deceased loved one, and/or persistent preoccupation with thoughts of the deceased, for at least 12 months after the loved one’s death
- Grief-related symptoms that hinder a person’s ability to function normally, such as feeling numb, intense emotional pain, and avoiding reminders of the death
- For children and adolescents, fixation on the circumstances of the death
Reinstating Unspecified Mood Disorder
Unspecified mood disorder is a residual category for mood symptoms that do not fit neatly into other disorders within the classes of bipolar or depressive disorders. According to the American Psychiatric Association (APA), this category applies to “presentations that do not meet criteria for any specific mood disorder and in which it is difficult to choose between an unspecified depressive disorder and an unspecified bipolar disorder.”
The original version of DSM-5 had removed unspecified mood disorder, because it had removed the entire mood disorders diagnostic class. Instead, bipolar disorders and depressive disorders were moved to top-level diagnostic classes. Once the mood disorders grouping was removed, unspecified mood disorder fell within both the depressive disorders and the bipolar disorders chapters. This also makes DSM-5-TR more compatible with ICD-10-CM and ICD-11.
Unspecified mood disorder may be present when there are depression symptoms that cause clinically significant distress or hinder functioning, but do not meet the full criteria for any other depressive disorders. The clinician may make a diagnosis of unspecified mood disorder if he or she chooses not to specify why the symptoms do not meet the full criteria. The diagnosis also may apply if there is not enough information for a more specific diagnosis, such as when a patient presents in the emergency room.
Want more information on the DSM-5-TR changes? The APA has provided a list of fact sheets for all the most significant revisions.
Staying up-to-date on clinical, regulatory, and other types of changes is crucial for behavioral health providers. BestNotes EHR solutions for behavioral health providers include automatic updates for federal and state documentation requirements, as well as CARF and Joint Commission standards, so you can put more attention where it’s needed. Reach out to us today to schedule your free demo!